What to Expect at Your Postpartum Exams

After spending nine months in and out of doctors' offices, sonography rooms, and, finally, the hospital, you may be sick of donning that ubiquitous blue gown. But experts agree you definitely shouldn't miss your postpartum checkups. While giving birth may be a normal process, some people experience a few health aftershocks, and it's important that they be examined and treated promptly.

"Now that you have a baby to take care of, you need to take even better care of yourself," says Judith Reichman, M.D., a gynecologist at Cedars-Sinai Medical Center in Los Angeles and the author of Relax, This Won't Hurt: Painless Answers to Women's Most Pressing Health Questions.

The consequences of skipping your postpartum appointments can be serious: incomplete healing, an unintended pregnancy, an overlooked infection, undiagnosed postpartum depression, and more. Taking the time to keep these appointments can pay off in many ways, physically and emotionally.

When Should I Schedule Postpartum Exams?

In the past, people usually had a four-week or six-week postpartum exam, but the American College of Obstetricians and Gynecologists (ACOG) updated their guidance in recent years. The organization now recommends appointments be conducted within the first three weeks postpartum instead. "This initial assessment should be followed up with ongoing care as needed, concluding with a comprehensive postpartum visit no later than 12 weeks after birth," says the ACOG.

Still, the comprehensive exam (recommended before 12 weeks) resembles the previous six-week postpartum exam. You should also call or visit your doctor for any concerning postpartum symptoms, no matter when they appear.

What Happens At Your Postpartum Checkup?

Your postpartum exam will be conducted by your OB or midwife. As your checkup includes an internal examination, you might prefer to ask someone else to watch your baby—but most practitioners are accommodating and welcome babies into the exam room.

Your medical practitioner will be looking at the following items, but remember that every doctor and patient is different.

1. Your Incision

If you had an episiotomy or tear during vaginal delivery, "checking that incision is the first thing on your doctor's list," says Siobhan Dolan, M.D., assistant medical director of the March of Dimes in White Plains, New York. They will observe your outside genitalia to ensure you're healing well and will also use a speculum to check internally.

Most incision problems occur within 10 days of giving birth, according to Tekoa King, a certified nurse-midwife in San Francisco. If at any time postpartum you notice unusual redness, pain, or fluid coming from an incision, contact your doctor—no need to wait until a scheduled appointment.

Note that, if you've had a C-section, you'll probably have a preliminary incision checkup at around two weeks and another at six weeks.

2. Your Uterus, Ovaries, and Cervix

Expect yet another pelvic exam, but this one has a twist—your doctor is making sure that your reproductive organs are returning to their pre-pregnancy state (amazingly, your uterus will shrink back to the size of a fist). They'll also check your uterus for tenderness and other signs of infection. And since this checkup counts for your annual exam, your doctor will feel your ovaries for growths and perform a Pap smear to check for abnormal cervical cells.

3. Your Breasts

Your breasts go through many changes during pregnancy and after delivery; it's important for your doctor to keep track of what's normal and what isn't. First, your doctor will give your breasts a thorough exam for blocked milk ducts, which feel like little knots.

According to Dr. Dolan, these can develop into mastitis, an infection that occurs when bacteria gets trapped in a milk duct. If you have it, the area around the infection becomes red and hot, and you may also develop flu-like symptoms, such as a fever and body aches. Mastitis can occur any time postpartum, so report any breast pain to your doctor or midwife. An antibiotic that's safe for nursing parents can clear up the infection. Your doctor will also check your breasts for lumps or masses.

4. Your General Health

As you've probably surmised, pregnancy affects just about every body function you can think of, which is why it's important to get an overall health check. Much of this exam is just like a regular physical: Your doctor checks your weight and blood pressure, and may even take your pulse or listen to your chest. They'll also run any necessary tests, such as blood work if they're worried about anemia.

From there, the exam addresses more specific postpartum concerns. Your doctor will ask if you're still taking your prenatal vitamins; if you're nursing, it's especially important that you replenish your body with calcium, iron, and other vital nutrients.

Next on the list are your bladder and intestines. Pregnancy and delivery can really take their toll on these organs, even if you've been religious about your Kegel exercises, so your health care provider will ask whether or not you've had any leaking urine, extreme bowel urgency, or bothersome constipation.

"It's also important that your doctor manually check your thyroid, a butterfly-shaped gland in your neck that is very active in producing hormones during pregnancy, to make sure it's a normal size," according to midwife King. If it's oversized, it might not be working properly, and you may need some blood work to determine if you need medication.

Those with special health conditions during pregnancy will likely need follow-up care. For example, if you had gestational diabetes, your doctor may check your blood sugar and suggest continued drug treatment or a diet regimen if the problem continues.

Finally, your doctor will make sure you're up-to-date on all recommended vaccinations.

5. Your Mental Health

Assessing your emotional welfare at a postpartum checkup is just as vital as checking your physical health, experts say. "It's important for everyone's well-being to talk about how [parenthood] is going," says Dr. Dolan. If you're feeling overwhelmed, your doctor may be able to put you in touch with postpartum helpers, such as doulas or baby nurses.

You may also undergo screening for postpartum depression. "It's one of the most important things to look for at this checkup, and it's a common problem," says King. Up to one in eight birthing parents may experience depression in the postpartum period, according to the Centers for Disease Control and Prevention (CDC). It's important to discuss any symptoms with your doctor, including feelings of anxiety, sadness, numbness or anger.

6. Family Planning

Another postpartum conversation topic will be contraception. "One of the most important parts of this checkup is family planning. It's possible to become pregnant right after coming home from the hospital," says Margaret Comerford Freda, a registered nurse and certified health-education specialist at Albert Einstein College of Medicine in New York City.

You may want to change birth control methods entirely; what worked for you before may not fit your new life. If you used to take the birth control pill, for example, you may decide to try an IUD because taking medicine may now be the last thing you want to remember each day. Also, barrier methods of birth control, such as a diaphragm, need to be checked for fit since your cervix may have changed size after pregnancy.

Getting Back to Normal After Birth

If all is well with your health and well-being, your doctor will likely give the all-clear to resume normal activities, which might include exercising, driving, and lifting heavy objects. The timeline for these activities usually differs for vaginal births and C-sections.

Your provider will also tell you when it's safe to start having sex again. Most experts advise against putting anything inside the vagina for a few weeks after C-section or vaginal delivery. In the past, most people got the green light to resume sexual activity at the six-week postpartum exam, assuming everything was healing well. However, many doctors now advise people to take it slow but go with their own comfort level and judgment to know when they're ready to have sex again.

What to Ask During Postpartum Exams

Before you leave your doctor's office, take the opportunity to ask any lingering questions about your body, mind, or life as a new parent. Getting the answers you need will make the transition to life with a baby much smoother.

The topics you'll want to discuss will be personal to you, but you may consider bringing up the following questions:

• Do you have a reference for a lactation consultant? (Depending on your needs, you might ask for recommendations for a mental health specialist, pelvic floor therapist, etc.)
• How can I manage my postpartum symptoms?
• Is my tenderness, bleeding, or discomfort normal?
• What supplements should I be taking now?
• Should I be checked for diastasis recti?
• When can I return to certain prepregnancy activities?
• Do I need any vaccinations?
• Should I make changes to my postpartum diet or exercise plan?
• Clarifications about your labor and delivery experience
• Questions about caring for your baby, including feeding and sleeping needs

Reasons to Get to the Doctor Faster

You don't want to wait until your scheduled postpartum checkup to report any of the following:

• Fever above 100.4° F
• Nausea and vomiting
• Pain or burning during urination
• Bleeding that increases or is heavier than a normal menstrual period
• Severe pain in your lower abdomen
• Pain, swelling or tenderness in your legs
• Red streaks on your breasts or painful new lumps
• Redness, discharge or pain from an episiotomy, perineal tear, or abdominal incision that doesn't subside or that worsens
• Foul-smelling vaginal discharge
• Severe depression