If you’ve had a baby, you know the final – and often first – appointment at six weeks postpartum. But have you ever wondered why this is the standard and how we can improve postpartum care?
I vividly remember the anxiety that I felt after my six-week checkup. Suddenly, there were no more appointments with my midwife, and I felt lost. There were so many unanswered questions, doubts, and emotions.
After the birth of my first baby, I had undiagnosed postpartum depression.
The symptoms I was experiencing I thought were just signs that I wasn’t trying hard enough or that more sleep would fix it. The second time, I experienced depression and anxiety throughout both my pregnancy and postpartum period.
Never once did I receive an assessment other than a health nurse asking if I was experiencing any thoughts of self-harm or suicide. I wasn’t experiencing either, so I assumed that meant I wasn’t depressed.
It took me five years to seek counseling on my own, and there weren’t a lot of options for counselors who specifically dealt with postpartum challenges.
That life-changing experience inspired me to focus my career as a clinical counselor on supporting women during their pregnancy, postpartum period, and early motherhood.
Current challenges with the current six-week care window
- Unrealistic expectations placed on mothers
- Many left at risk of mental health challenges
- A significant shift in care from mom to baby
- “Siloed” care between postpartum practitioners
- Patients don’t know when – or if – they should follow up
At the six-week appointment, women are often given the “all clear” for everything from sexual activity to everyday life. This can create unrealistic expectations that things should return to normal immediately.
But in reality, it’s far from the case. Many women are left at risk of mental health challenges, frustration, shame, guilt, loneliness, and worry. We often have to become our advocates — something that takes time, awareness, and resources to do.
After giving birth, it’s common to feel a significant shift in care, with the focus turning solely to the newborn. The attention to a mother’s well-being often dwindles. It’s easy to believe that if the medical professionals prioritize the baby, so should we.
But this neglect leaves women feeling isolated and overwhelmed.
What exacerbates the situation is the siloed approach to postpartum care. Practitioners don’t always share information or refer to other specialists, leaving women confused and unsure where to turn. This sense of “now what?” can be paralyzing during a time filled with challenges.
I remember being uncertain about whether I should follow up with my family doctor or not. I didn’t feel back to normal, but I also didn’t know of any of my friends who had continued any postpartum care with their doctors.
I assumed my experience was typical. I’ve since learned that although my experience was common, many aspects weren’t normal, and had treatment options available if only I had a practitioner overseeing my care.
A call for change in postpartum care
- The ACOG recently suggested changes in postpartum care
- Extend the current six-week timeframe to a minimum of 12
- Prioritize the well-being of new mothers (not just babies!)
- Allow birthing parents to co-create their postpartum care
- Appointments should be comprehensive and individualized
- Encourage parents to ask questions and process information
- Unfortunately, no changes have been made as of yet
Recent discussions among pregnancy and postpartum care providers in the US and Canada have highlighted the urgent need for change. The primary recommendation – according to ACOG – is to extend the six-week timeframe to no earlier than 12 weeks, allowing for personalized care plans.
It’s crucial to prioritize the well-being of new mothers.
They also felt that women should co-create their postpartum care as every woman will have different needs. They agreed that the well-being of new mothers should be made a priority.
Many women currently feel as if they are on a conveyor belt of care, with each woman receiving the exact outline of care.
Instead, appointments should be comprehensive and individualized, with time allowed for women to process information and ask questions as needed. Unfortunately, at the time of publishing this article, no changes have been made within the healthcare system.
What a 12-week minimum timeframe can do for postpartum care and maternal well-being
- A chance to heal and regain strength
- Space to consider contraception and additional pregnancies
- Time for adequate rehabilitation
- A stronger consideration of maternal mental health
- Better assessment of sexual challenges and discomfort
A 12-week minimum timeframe would open up vital conversations about labor and delivery experiences, mental health, contraception choices, sexual functioning, and the safe return to physical activity.
A chance to heal and regain strength
It would give women the support they need to heal and regain strength. This is particularly important for women who have experienced birth trauma. The chance to debrief and ask questions of our practitioners can be an essential aspect of processing and healing from our experiences.
Space to consider contraception and additional pregnancies
Choosing the right contraception and determining the ideal spacing between future pregnancies are crucial decisions. A longer window of care ensures you have the information and guidance to make choices that align with your goals and well-being.
Time for adequate rehabilitation
Just like any significant injury, postpartum recovery should involve a rehabilitation program. A few years ago, my husband tore his ACL and Meniscus, and I witnessed him experience a higher level of care than I ever had during the postpartum period.
He received referrals to practitioners, had imaging to assess healing progress, and received a complete rehab plan.
Considering that our pelvic floors stretch to 250% of their usual length during delivery and take approximately 4-6 months to heal, this highlights one of the many reasons the go-ahead to return to exercise at six weeks doesn’t make sense.
Considering how much a woman’s body changes and goes through, there should be a rehabilitation program or at least a conversation with healthcare practitioners on how to start exercising again safely.
Unfortunately, this is not the case, and there currently exists no standard protocols on how to return to exercise after birth, leaving women to try and figure it out on their own. Healing after childbirth takes time, and women need guidance.
A stronger consideration of maternal mental health
Perinatal mood and anxiety disorders (also known as PMADs), including depression and anxiety, can go unnoticed in the early weeks.
I remember the first six weeks after childbirth were a blur of learning to care for my child, adjusting to the change in family dynamics, recovering physically, managing hormones, and more.
I didn’t begin to realize that my mental health was suffering until well past the six-week mark. A 12+ week timeframe would allow for thorough assessments and the opportunity to seek support.
And yes, delayed postpartum depression absolutely is a thing.
Better assessment of sexual challenges and discomfort
Upwards of 80% of women report sexual challenges postpartum, yet this topic is often left unaddressed.
This lack of sexual education or screening can have a significant impact on a woman’s mental health, quality of life, and relationship satisfaction. Longer postpartum care windows would provide practitioners with the opportunity to discuss these changes and offer guidance to new mothers.
Final thoughts on six week postpartum care
The current practice of six weeks of postpartum care is falling short in many ways. As a provider, the more I learn about how it’s failing, the more passionate I become about advocating for change in my community, with my clients, and the overall system.
New mothers deserve more attention and support during this transformative period—your well-being and postpartum journey matter.
We need the system to care for us and give us space in the postpartum period so we can navigate this transformative time with confidence, support, and, most importantly, good mental and physical health.
Other postpartum care articles you might find helpful
- C-Section? Here’s What Your Doctor Probably Won’t Share At Your Six-Week Appointment
- Get the Help and Support You Need After Birth (Even After You’ve Asked Repeatedly)
- What You Should Know About Postpartum Bloodwork (And How to Test Without a Doctor’s Order)
Article references
ACOG Committee Opinion No. 736 (2018). Optimizing postpartum care. Obstetrics & Gynecology, 131(5), e140-e150. DOI: 10.1097/AOG.00000 00000002633.
Bouwina, M., Buurman, R., Leonarda, A. & Lagro-Janssen, M. (2013). Women’s perceptions of postpartum pelvic floor dysfunction and their help-seeking behaviour: A qualitative interview study. Scandinavian Journal of Caring Sciences, 27, 406-413. DOI: 10.1111/j.1471-6712.2012.01044.x
Bryant, A., Blake-Lamb, T., Hatoum, I. & Kotelchuck, M. (2016). Women’s use of health care in the first 2 years postpartum: Occurrence and correlates. Matern Child Health, 20, S81-S91. DOI: 10.1007/s0995-016-2168-9.
Constantinou, G., Varela, S. & Buckby, B. (2020). Reviewing the experiences of maternal guilt – the “motherhood myth” influence. Health Care for Women International. DOI: 10.1080/07399332.2020.1835917
Cornell, A., McCoy, C., Stampfel, C., Bonzon, E. & Verbiest, S. (2016). Creating new strategies to enhance postpartum health and wellness. Maternal Child Health Journal, 20, S39-S42. DOI: 10.1007/s10995-01602182-y.
Gutzeit, O., Levy, G. & Lowensetin, L. (2019). Postpartum female sexual function: Risk factors for postpartum sexual dysfunction. Journal of the International Society for Sexual Medicine, 8(1). DOI: 10.1016/j.esxm.2019.10.005
Henderson, J. & Redshaw, M. (2013) Anxiety in the perinatal period: Antenatal and postnatal indluences and women’s experience of care. Journal of Reproductive and Infant Psychology, 31(5). DOI: 10.1080/02646838.2013.835037
Liva, S.J., Hall, W.A. & Oliffe, J. (2021) Reconciling relationships with physical activity: A qualitative study of women’s postnatal physical activity decision-making. BMC Pregnancy and Childbirth, 21(81). DOI: 10.1186/s12884-020-03537-z
O’Malley, D., Higgins, A., Begley, C., Daly, D. & Smith, V. (2018). Prevalence of and risk factors associated with sexual health issues in primiparous women at 6 and 12 months postpartum: A longitudinal prospective cohort study (the MAMMI study). BMC Pregnancy and Childbirth, 18. DOI: 10.1186/s12884-018-1838-6
Poon, Z., Lee, E.C.W., Ang, L.P. & Tan, N.C. (2021) Experiences of primary care physicians managing postpartum care: A qualitative research study. BMC Family Practice, 22(139). DOI: 10.1186/s12875-021-01494-w
Ryan, G., O’Doherty, K.C., Devane, D., McAuliffe, F. & Morrison, J. (2019). Questionnaire survey on women’s views after a first cesarean delivery in two tertiary centres in Ireland and their preference for involvement in a future randomised trial on mode of birth. BMJ Open, 9. DOI: 10.1136/bmjopen-2019-031766
Selman, R., Early, K., Battles, B., Seidenburg, M., Wendel, E. & Westerlund, S. (2022). Maximizing recovery in the postpartum period: A timeline for rehabilitation from pregnancy through return to sport. International Journal of Sports Physical Therapy, 17(6). DOI: 10.26603/001c.37863
Woolhouse, H., McDonald, E. & Brown, S. (2012). Women’s experience of sex and intimacy after childbirth: Making the adjustment to motherhood. Journal of Psychosomatic Obstetrics & Gynecology, 33(4), 185-190.
Yelland, J., Sutherland, G., Brown, S. (2010). Postpartum anxiety, depression and social health:Findings from a population based survey of Australian women. BMC Public Health, 10(771). DOI: 10.1186/1471-2458-10-771
