Your First Postpartum Checkup: What to Expect and What to Ask

The basics

After delivering a baby, life can be a blur. There’s a reason the postpartum period is referred to as “the fourth trimester.” It involves a lot of recovery, and it’s an exhausting time. It can be difficult to find time to care for yourself, but it’s important.  

This is where your postpartum checkup comes into play. Because your body is changing and recovering, it’s best to ensure you’re healing properly. This is especially true if you had problems before or during pregnancy, like high blood pressure or diabetes. It’s also important to check in with your provider on your physical and mental health, address your concerns, and discuss family planning.

In this guide we’ll discuss why postpartum care is needed and what to expect from your visit(s).

Is a postpartum checkup really necessary?

Yes. The risk of pregnancy-related complications doesn’t go away after birth, so it’s important to continue medical care. As we’ll discuss below, there are many medical issues that need to be addressed postpartum in order to keep you healthy. Of course, if you have any questions or concerns before your postpartum visit, don’t hesitate to reach out to your provider. 

Everyone who has delivered a baby should take part in the comprehensive postpartum visit. No matter how you delivered your baby (vaginal or C-section) or how healthy you feel, the postpartum visit is important for everyone.  

If you experienced a miscarriage, stillbirth, or neonatal death, you should still have a follow-up visit with your obstetrician (OB). It’s important to get emotional support and make sure your body is recovering. You may also need more testing to help determine if there are any risks to future pregnancies. 

How many weeks after giving birth should I have my first postpartum doctor’s appointment?

The American College of Obstetricians and Gynecologists recommends postpartum medical care. This should include a blood pressure check 3 to 10 days after delivery and a comprehensive postpartum visit by 12 weeks. 

For most women who deliver vaginally, the postpartum visit is done at around 4 to 6 weeks later. If you had a cesarean delivery (C-section), you will likely be asked to follow up sooner to check on your incision. The postpartum visit should not be later than 12 weeks postpartum. 

In some cases, additional clinic visits are needed sooner or more regularly. This is true for those who had complications during delivery or are dealing with chronic health conditions. 

It can be difficult to find time to care for yourself after delivery, but it’s important. Your health is just as important as your baby’s, so be sure to make it a priority. It’s not a secret that 6 weeks might be too long to wait for a follow-up appointment. Don’t wait until your first checkup to contact your provider if you have questions, concerns, or problems at home. 

Emergencies that shouldn’t wait for the postpartum checkup

If you have any questions or concerns before your scheduled follow-up visit, please ask. The postpartum period is challenging, and you may feel like you don’t have time for yourself. That’s normal. But it’s really important to pay attention to your body and notify your provider if you have any troubling symptoms. 

In certain situations, your symptoms need attention right away:

• Persistent headaches or vision changes: These could be symptoms of a blood pressure problem. This can occur even if your blood pressure was normal during pregnancy. You should contact your medical provider and get your blood pressure checked as soon as possible. You may need treatment to lower your blood pressure in order to prevent damage to your kidneys, liver, and brain. 

• Breast pain with swelling, warmth, lumps, or bloody nipple discharge: These could mean you have mastitis, or an infection of your breast milk ducts. You might also have a fever or body aches. Mastitis needs to be treated with antibiotic medication, so don’t hesitate to call your care team. 

• Excessive bleeding: If you have heavy vaginal bleeding that fills a pad within an hour, you should seek medical attention. You may be experiencing a dangerous amount of blood loss. Heavy bleeding and other symptoms, such as dizziness, blurry vision, and racing heartbeat, could mean you are losing too much blood. 

• Fever: If your temperature is consistently over 100.4°F, it could mean you have an infection. 

• Pain, redness, or warmth in one of your legs: These are signs of a blood clot, which could be life-threatening if left untreated. The risk of blood clots goes up during and after pregnancy. 

• Needing to pee more often and/or painful urination: You should alert your care team if you have symptoms of a urinary tract infection (UTI). You may need treatment with antibiotics. Other symptoms can include pain above your pubic bone and cloudy urine.  

• Feelings that get in the way of caring for yourself or your child(ren): These can include sadness, hopelessness, crying a lot, and not being able to think clearly. This could mean you’re experiencing postpartum depression. This can be a real problem after childbirth, even if you’ve never had mental health problems before. 

What happens at a postpartum checkup?

If this is your first time, you might be wondering about the postpartum visit. What’s going to happen at this checkup? Will there be a pelvic exam? And what are you going to do with the baby while you’re there? Here’s what to expect. 

Your postpartum checkup should be pretty comprehensive. It will include: 

• A physical examination

• Review of pregnancy-related problems (such as gestational diabetes)

• Questions about your emotional well-being

• Discussion of infant care and feeding

• Making a birth control plan that works for you

• Review of preventative health screenings, with vaccinations and cancer screenings done as needed

This isn’t an all-inclusive list, so feel free to ask any questions during this visit. There’s a lot to process during the postpartum period. It might help to jot down notes or questions at home before your visit, just in case.

Is there a pelvic exam at a postpartum checkup?

Yes. The pelvic exam is done to make sure your vagina, cervix, and uterus are healing. Your provider might also perform a pap smear to check the cervix for cancer or precancer. 

Are family planning and birth control covered?

Figuring out the next steps for birth control might not be on the forefront of your mind right now. You might not have any interest in sexual activity for a while, or you may be interested in having more children soon. There’s no “right” place to be, but expect your provider to discuss family planning at your postpartum visit. 

While birth control might not seem like the most pressing issue at the moment, it’s important to plan ahead. Ovulation (egg release from the ovaries) can resume as early as 25 days after giving birth. But experts recommend waiting at least 6 months after delivering a baby before getting pregnant again. The waiting period reduces the risk of preterm (early) delivery and rupture of the uterus. This is especially important if you delivered by C-section. Experts consider an interval of at least 18 months to be optimal for the health of you and your next baby. 

There are a few different options for postpartum birth control, which we’ll discuss here. But because everyone is different, it helps to talk through the options with your provider. 

Lactational amenorrhea

You may have heard that breastfeeding can keep you from getting pregnant again — but how does that work? Lactational amenorrhea is when your menstrual periods stop while breastfeeding. Breastfeeding causes hormonal changes that can prevent ovulation. 

In order to prevent pregnancy using the lactational amenorrhea method, all three of these conditions need to be met:

1) You’re breastfeeding exclusively (no supplementing) and on demand during the day and night.

2) The baby is less than 6 months of age.

3) Your period hasn’t restarted yet.

The lactational amenorrhea method of birth control may be difficult to sustain. It’s a viable form of birth control, but it may be impractical for many women. It’s also important to know that ovulation happens before your period starts. So it’s possible to become pregnant without knowing it.

Long-acting reversible contraception 

Long-acting reversible contraception (LARC) methods include implantable uterine devices (IUDs) and implants. They are low maintenance: There’s no daily pill to remember, and they don’t require any intervention for years. LARCs are over 99% effective. They can be placed at the time of delivery, at the postpartum visit, or anytime later. 

• IUD: This is a small device that’s inserted into the uterus to prevent pregnancy. There are different IUDs available, which work by releasing hormones or a small amount of copper. The hormonal implants are effective for 3 to 5 years (depending on the exact brand), and the copper IUD works for up to 10 years.

• Implant: An implant for contraception is a small rod, the size of a matchstick, that’s implanted into the upper arm. This device works by releasing hormones into the body, and it works for up to 3 years. 

Birth control injections

The Depo-Provera shot is another hormonal birth control option. It involves a hormone injection once every 3 months, and it can be started right after delivery. These injections are similarly effective as LARCs when they’re given on time. 

Other hormonal birth control (pills, patch, ring)

The birth control pills, patch (a small patch on the skin), and ring (a small, flexible ring that you place near the cervix) prevent pregnancy using either a combination of estrogen and progesterone hormones, or using only progesterone hormones (the “mini pill”). The failure rate of these forms of birth control is much higher than that of the LARCs or birth control injection. 

Combined estrogen/progesterone methods (some pills, the patch, and the ring) have benefits — including lightening your period, improving acne, and reducing unwanted hair growth. However, there are risks, too. Combined hormonal birth control can increase the risk of developing blood clots. These can develop in your legs (called deep vein thrombosis or DVT), heart (heart attacks), or brain (strokes). These risks are higher in women over 35 who smoke or have had high blood pressure, DVT, heart attack, stroke, migraine with aura, or breast cancer. 

The estrogen in combined hormone methods could affect your milk supply. For this reason, they aren’t recommended for the first 4 to 6 weeks of breastfeeding.

Progestin-only “mini pills” can also lighten your period. They are an option for people who can’t take or use combined hormone methods for medical reasons. Progestin-only pills are not recommended for those with a history of breast cancer, lupus, or liver disease. Additionally, these pills need to be taken at the exact same time every day. If you forget to take a mini pill for more than 3 hours, you may ovulate so you need a backup method of contraception for 48 hours. 

Of note, in certain states, some forms of hormonal birth control are available directly from a pharmacy, without the need for a doctor’s visit. 

Barrier methods

Barrier methods include condoms (male and female), diaphragms, cervical caps, and sponges. These methods of birth control don’t contain hormones and are less effective. For every 100 times used, they fail 18 to 28 times. 

Condoms are the only form of contraception that prevents sexually transmitted infections (STIs). 

Of note, the cervical cap, diaphragm, and sponge should not be used until at least 6 weeks after childbirth, when the uterus and cervix have returned to their normal size. Additionally, a cervical cap or diaphragm should be refitted after childbirth. 

Sterilization

These procedures result in permanent birth control. 

• In women, a surgical procedure called “tubal ligation” closes off the fallopian tubes and prevents the egg from moving to the uterus to get fertilized. 

• In men, a vasectomy consists of cutting or tying off the vas deferens, the tube that connects the testicles to the urethra. This procedure prevents sperm from entering the urethra and fertilizing an egg. 

Is discussion of mental health or postpartum depression part of a postpartum checkup?

Yes. Your mental health is just as important as your physical health, so expect to talk about it at your visit. You might feel uncomfortable or unsure at first, but know that it’s a safe space for sharing. Here are a few issues to be aware of as you recover.

Baby blues

“Baby blues” describes feeling sad, moody, or worried after having a baby. Emotional highs and lows are expected as your hormone levels change after childbirth. Baby blues typically go away on their own within 2 weeks after delivery. 

Postpartum and perinatal depression

Postpartum depression refers to a medical illness of extreme sadness and/or anxiety after giving birth. However, the term perinatal depression is taking its place. Perinatal depression can happen during pregnancy or up to 12 months after childbirth. And it’s common: It’s estimated that 1 in 7 people experience it. 

Common symptoms include:

• Extreme sadness

• Trouble completing daily activities

• Feelings of guilt, anxiety, and fear

• Loss of pleasure 

• Sleep changes

• Excessive crying

• Thoughts of hurting yourself or the baby

• Difficulty connecting with your baby or others

If you’re experiencing any of these symptoms, please call your healthcare provider. There are treatments to help you, including therapy and medications. 

Postpartum psychosis

Postpartum psychosis is a disorder that may cause a person in the postpartum period to lose touch with reality. Specifically, it may cause hallucinations (seeing or hearing things that aren’t there) and suicidal or homicidal thoughts. There may also be delusions, such as a persistent belief that someone wants to harm the baby (when this isn’t actually happening). Postpartum psychosis is rare but serious. It should be treated as a medical emergency. 

Physical health

The postpartum visit is a great time to revisit any medical issues you had before or during pregnancy. These may include problems with your thyroid, blood pressure, blood sugar, or more. It’s important to follow up on these conditions to see if you need to continue treatment.  

It’s also important to get an overall check on the rest of your health. This includes cancer screenings and vaccinations to protect you from infectious diseases. 

Cancer screenings

Screenings for cancer can include:

• Cervical cancer: You should go back to your regularly scheduled cervical cancer screenings. This consists of collecting cervical cells to inspect under a microscope (also called a “Pap smear”) and testing for human papillomavirus (HPV), which can cause cervical cancer. These screenings may be performed as early as 2 weeks following delivery. 

• Breast cancer: A breast exam will be performed at the postpartum clinic visit, which can help detect breast cancer. Otherwise, plan to return to your recommended breast cancer screening schedule. This may include a yearly mammogram if you’re above the age of 40 years or if you’re at higher risk. 

Will I be given vaccinations at my postpartum checkup?

Yes, if the timing is right. It’s a great idea to get everything done in one visit.

• Influenza vaccine: If you haven’t yet received the influenza vaccine for that season, you may receive it at this clinic visit. 

• COVID-19 vaccine: Women who are breastfeeding may receive a COVID-19 vaccine. 

Keep in mind

The postpartum period isn’t the same for everyone. The disparities in pregnancy-related health in the U.S. are notable. In the postpartum period, Black mothers are more likely to experience complications and death than white mothers. Those who identify as Asian and Pacific Islander are more likely to undergo hysterectomy (surgical removal of the uterus) after childbirth. According to the Centers for Disease Control and Prevention (CDC), “Black, American Indian, and Alaska Native women are two to three times more likely to die from pregnancy-related causes than white women.”

Various groups are advocating for systemic structural changes to address these and other racial disparities. These proposed changes include: 

• Improving access to healthcare

• Expanding paid leave

• Addressing social determinants of health

• Creating initiatives to gather feedback from Black mothers about systemic barriers

• Incorporating additional training in the medical curriculum

• Creating working groups to change policy

The postpartum period can bring many emotions and uncertainties. There’s so much to process, and your body is changing every day. Asking questions, surrounding yourself with support, and listening to your body are critical.

Why trust our experts?

Written by:

Mandy Armitage, MD

Mandy Armitage, MD, has combined her interests in clinical medicine with her passion for education and content development for many years. She served as medical director for the health technology companies HealthLoop (now Get Well) and Doximity.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.

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