What Postpartum Care Should Include

It doesn’t end at six weeks

Postpartum care is supposed to be an ongoing process, not one visit at six weeks. This is what it should include, what to arrange before you deliver and what happened when my care ended before my recovery did.

Key points

ACOG, the professional organization for OB-GYNs, recommends contact with a maternal care provider within 3 weeks of birth, and a comprehensive visit no later than 12 weeks. Book both before you leave the hospital.
In CDC’s 2017–2019 review from 36 states, 53% of pregnancy-related deaths with known timing occurred 7 to 365 days after pregnancy ended, including 30% at 43 to 365 days. Mental health conditions were the leading underlying cause in that review, and more than 80% of deaths were judged preventable. Keep the urgent warning signs where your household can see them for the full year.
If you had high blood pressure in pregnancy, ACOG recommends a blood pressure check within 7 to 10 days of birth, and within 72 hours if it was severe. Ask for that appointment before discharge.

What postpartum care is supposed to be

ACOG describes postpartum care as “an ongoing process, rather than a single encounter,” with a plan that starts during pregnancy. The comprehensive visit should be a full assessment of your physical, social and psychological well-being. Its areas, and what I’d ask about each:

Mood and emotional well-being: Will you screen me for depression and anxiety, and who do I call if I’m struggling between visits?
Feeding your baby: Who can I see for feeding problems, and is lactation support covered?
Contraception and spacing: What’s the safest spacing for my next pregnancy, given how I delivered?
Sleep and fatigue: Is how tired I am within the normal range, or should we check for anemia or thyroid problems?
Physical recovery: Is my incision or tear healing as expected? Do I need pelvic floor physical therapy?
Chronic conditions: Who follows my blood pressure, blood sugar or other conditions from here?
Health maintenance: Which screenings or vaccines am I due for, and who is my doctor now?

Who provides care after. ACOG says follow-up for chronic conditions should continue with an OB-GYN or a primary care provider. If a high-risk practice cared for you in pregnancy, it may not be your long-term practice. Ask before you deliver who takes over.

Coverage. Many people lose coverage after birth. Most states now offer 12 months of postpartum Medicaid coverage. Check your state on the tracker from KFF, a health policy research group.

Showing up is hard. As many as 40% of women don’t attend a postpartum visit. Plan childcare and a ride for your own appointments, so you’re not choosing between your care and your baby.

My first weeks

My first child was born by cesarean, and I came home on blood pressure medication. Within days, I had chest pain and two sets of blood pressure instructions that didn’t match.

About two weeks after the birth, I wrote to my doctor with everything I was feeling:

Swelling in Hands and Feet. Faster Heart Rate. Stomach Pains increasing (since Sunday). Significant Increase in vaginal bleeding (since Sunday). Pus leaking from incision site.

I asked: “Should we discuss tomorrow or should I come in today to be seen at Labor & Delivery?”

A week later, the incision had opened further. One thing I’d arranged in advance helped: because of my history of severe keloids (thick, raised scars), I had a plastic surgery appointment booked, and that team took care of the wound. (“Healing After a Cesarean: My Nine-Month Recovery”)

When my postpartum care ran out

When my child was almost nine months old, a painful lump formed under my scar. I had an appointment with the maternal-fetal medicine (MFM) practice, the high-risk pregnancy specialists who had cared for me in pregnancy. I was on my way there when it was cancelled, because of a policy of not seeing patients beyond six weeks postpartum. I had been told to see a general OB-GYN, but as I wrote to them, “I never received a referral from your office.” No OB-GYN was available that day, and the soonest new-patient appointment was weeks away.

That day, I wrote: “I feel like the MFM is trying to pass me off… I need them to attend to me.”

I told the practice I was nearby and would wait. I waited near the office for hours with my nine-month-old, and I wasn’t seen. The practice’s reply that afternoon said the appointment had been “mistakenly scheduled,” and “however, it was not canceled at the last minute.”

That night, I took my baby with me to the emergency room. They partially drained the lump, an abscess, and did an ultrasound, but didn’t find what had caused it, and recommended I see an OB-GYN as soon as possible. Three days later, I did. (“Working With Your Doctor”)

It took hours of waiting and a night in the ER with my baby to get to the start of an answer. The six-week cutoff was the practice’s rule. My recovery hadn’t ended.

How I’m arranging it this time

I’m pregnant again, and this is what I’m setting up before delivery:

The handoff, before delivery: who manages my recovery, who sees an urgent wound concern and who my OB-GYN is once the high-risk specialists stop following me. I want the referral in hand, not promised.
A blood pressure check within the window ACOG recommends.
I book ahead for my known risks. It worked with plastic surgery last time.
My operative report, discharge summary, medication list and follow-up plan in one place.
A plan for urgent visits: who takes the baby and who drives me.

Help in the first months

Ask whether a free postpartum nurse visit is offered where you live. Family Connects NJ sends a nurse to any family in participating counties, regardless of income or insurance, usually within two weeks of birth. New York City’s New Family Home Visits serves families in certain neighborhoods. Other states’ programs are in “Help That Costs Less, or Nothing.”
For mental health, the National Maternal Mental Health Hotline is free and open 24/7: call or text 1-833-TLC-MAMA.

Take this back

To discuss with your care team:

Who manages my recovery after discharge, and who after the postpartum window closes?
Can we book my 3-week contact, my blood pressure check and my comprehensive visit now?
If my incision opens or drains, where do I go, and how fast?
Can you refer me now to an OB-GYN or primary care doctor for long-term care?
When will I get my operative report, and who will explain it?

To discuss with the people in your life: If I need to be seen urgently after the baby comes, who takes the baby and who drives me? Will you learn the warning signs with me?

Don’t wait if

The CDC’s urgent maternal warning signs apply during pregnancy and for a year after birth. Seek medical care immediately for any of these signs, including a persistent or worsening headache, vision changes, fever of 100.4°F or higher, chest pain, trouble breathing, severe belly pain or heavy bleeding. If you can’t reach your care team, go to the emergency department. Increasing incision pain, warmth, pus, a bad smell or an opening also needs prompt assessment.

Next in the series: “Healing After a Cesarean: My Nine-Month Recovery”