The Postpartum Appointment
When I learned that 40% of women don’t attend a postpartum appointment I got curious about why this might be. Of course there are many barriers to accessing healthcare in the U.S. including but not limited to: cost/lack of insurance, bias, language barriers, transportation, birth trauma (not wanting to revisit provider involved in traumatic experience *see information at bottom of page), lack of time off work, and lack of childcare (note: you can always ask a nurse to hold your baby during your appointment).
Although I don’t have the power to eliminate all barriers, there is one which I can address and that is health literacy which the CDC describes as: “the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.”
I asked myself, could one of the reasons that women don’t attend this postpartum appointment be due to the fact that they have some misconceptions about the purpose of this appointment and how this appointment can improve their overall health?
In doing some research on this topic two themes emerged: 1. the idea that the 6-week postpartum appointment has the primary objective of getting the “green light” for resuming sexual intercourse, and 2. that if a mother is feeling well enough after the birth then it is not necessary to attend this appointment, as the purpose of an appointment is to address problems.
Just to be clear upfront, if you read these and can relate because you’ve held these beliefs yourself, I don’t want you to feel at all judged or shamed. My sole intention is to give some food for thought and additional resources in case you want them and find them helpful.
That being said, circling back to the idea of health literacy, studies have shown that up to 88% of Americans lack sufficient health literacy to be empowered in their healthcare. So if you are ever unsure of something, you are in very good company. Therefore, I hope that this information is empowering, clarifies the benefits of the postpartum appointment, helps you to advocate for your needs, and deepens your understanding of the options available to you so you can receive the care that you deserve.
It is also important to mention here that the 6-week time-frame for the postpartum appointment is just a guideline, NOT a hard and fast rule. From my research it appears that the 6-week mark was chosen likely based off of the 40-day “lying-in rest period” practice around the world by other cultures, during which the mother is closely tended to for the entirety of the 6-weeks. In the U.S. insurance companies decided (for their own benefit) this was therefore when healing should be complete and set the postpartum appointment to take place at this mark. Even the American College of Gynecology disagrees with this approach as many problems can arise prior to the 6-week mark, as well as after. So, it is crucial that you know that if at ANY point during the postpartum period you feel something is off you should be seen by your provider right away. Your postpartum care must be individualized to you, not what is convenient for insurance companies.
Now let’s revisit the two themes mentioned above and I’ll give my take so that you can examine the information provided and decide how it may or may not fit into your unique health journey.
Theme 1: the postpartum appointment is just to get the go ahead for sex.
At six weeks postpartum many mothers are still feeling physically and emotionally worn out. Some might even be feeling “touched out” from the constant physical closeness with a newborn and possibly other children in the household as well. Other mothers may be feeling ready to resume intercourse with their partner at or prior to the six week mark.
When it comes to resuming intimacy there are two things that come to mind 1. put aside perceptions of ‘normal’ and focus on your unique situation and 2. no one can give the “green-light” for sex except for you.
While it is true that during the 6-week appointment it is standard for the provider to perform a pelvic exam to assess for healing (pelvic floor, episiotomy/tearing), bleeding, and pain, this does not fulfill all requirements for “being cleared” to resume sexual activity which includes: preference, mood, desire, mental/emotional readiness, and more that only you can decide for yourself.
Even if you have no interest in resuming intercourse any time soon, this appointment is a great time to discuss plans for birth spacing (aka interconception planning), the time between pregnancies has important health outcome implications for mother and baby. Many women may not know that you can get pregnant again as soon as the first month postpartum - even if your period has not returned and/or you are breastfeeding. The American College of Gynecology has a great article explaining the benefits of interconception planning for maternal and infant health across the lifespan. Some risks of a short period between births include: increased risk of uterine rupture and low birth weight. Therefore, even if sex is not an option now, planning in advance for the future supports the health of mother and baby.
Theme 2: If I am feeling well I don’t need to attend the appointment.
If you are feeling well at the 6-week postpartum mark this is wonderful news and I am happy for you. You are the expert on your body. There’s just a few things that I would like to toss out there and you can take it or leave it, this is just my opinion afterall.
The first thing I would ask you to consider, is to think of the 6-week appointment as good preventative medicine. If you are not experiencing problems now then that is a good sign, but it could be wise to take advantage of this appointment to plan for the future.
We’ve already discussed the importance of interconception planning, but now is also a good time to ask your provider about other referrals/suggestions for postpartum care providers such as a pelvic floor physical therapist. Furthermore you can ask them about recommendations on dietary supplements to improve your quality of sleep, hormone balance and more. Maybe your physical healing is going smoothly but you would like the name of a trusted mental health provider who specializes in postpartum care, for use now or in the future.
Like I said, you are the expert of your body, and there are some things that we just can’t easily assess for ourselves, such as pelvic floor condition and episiotomy healing. Remember, for this reason, even doctors have doctors (and no, Dr. Google doesn’t count, but please see helpful and reliable evidence-based resources below).
Lastly, as a nurse who has spent many years working in cardiology, I feel obligated to mention the old “silent killer”, hypertension. Cardiovascular complications account for 1/3rd of postpartum deaths (between the day after birth and the end of the first year) and is a factor in a majority of chronic conditions related to pregnancy (postpartum morbidity) which can persist for more than 15 years following the birth of a child.
Unfortunately research has shown that there are many more symptoms and conditions such as: leaking of bowel or bladder, pain, issues with scar tissue, hormone imbalances, low libido/painful sex, complications of hypertension and/or diabetes, and untreated mental health concerns, that women experience long after the 6-week mark. Therefore, I feel this appointment is an essential piece of the puzzle for obtaining your optimal health in the postpartum period. I would love to hear from you and know your thoughts in the comments below. For those of you who are gearing up to go to your appointment (at any time in the postpartum period), I have attached some helpful resources below, please enjoy, and be well.
Resources:
Book: How to be a patient: the essential guide to navigating the world of modern medicine by Sana Goldberg, RN. See pages 60-62 for a list of questions for you or your advocate to ask in order to fully understand your options.
Farlex Nursing Dictionary - not just for nurses, this app is free and gives you access to clear and reliable definitions of thousands of conditions, procedures, medications and more.
Epocrates - this app has the invaluable feature of allowing you to identify pills by the shape, color, and imprint plus many more tools to empower you to become an expert on your medications. Another helpful tip from Sana Goldberg, befriend your pharmacist. They have an incredible depth of knowledge and they can really be a great partner in your healthcare team.
LactMed - provides the research available on medications and breastfeeding.
Medline Plus: helpful information searchable by: tests, health topics, drugs and supplements, medical encyclopedia, genetics and even healthy recipes!
PubMed: search research articles in the National Library of Medicine.
Mayo Clinic and Cleveland Clinic - reputable information from trusted sources.
*Note: if you’ve had a traumatic birth experience and are avoiding the postpartum care appointment to avoid interacting with the provider involved in the traumatic event. I see you. This is an incredibly difficult situation to be in. I urge you to take the following steps:
1. You have the RIGHT to request a new provider at your postpartum appointment - call ahead to ask if any providers have training in trauma-informed care.
2. Use the PSI provider directory to find a mental health provider who is trained in the postpartum period and trauma-informed care.
3. Prepare ahead of your appointment by practicing what you want to say and how you want to say it. If it feels right, you can practice what you are going to say with a trusted support person.
4. Know that you can always refuse pelvic exams or any other re-traumatizing triggers. If you decide to get a pelvic exam, you can also change your mind at any point and tell the provider to stop.
5. Bring an advocate with you. A family member, friend, partner or, if available to you, I highly recommend utilizing a postpartum doula.
