During pregnancy, most women see their doctors more frequently than at any other time in their adult lives. When the baby is born, that abruptly changes. In fact, 40 percent of new mothers do not have a postpartum checkup within six weeks of giving birth as recommended, according to the American College of Obstetricians and Gynecologists, or ACOG. In its recent Committee Opinion, ACOG emphasized the importance of a comprehensive postpartum visit for a variety of reasons that many women may be unaware of.
“The health care system has not done a good job of making that visit valuable to women and explaining why it’s important,” says Dr. Alison Stuebe, lead author of the ACOG opinion and an associate professor of maternal-fetal medicine at the UNC School of Medicine–Chapel Hill. “Women are coping with all sorts of issues in the fourth trimester — and these issues should be front and center in the postpartum visit.”
Here are six sets of issues that should be addressed in a postpartum checkup:
How well you’re healing. In the short term, when women don’t have a postpartum checkup, they miss the chance for their health care provider to evaluate how well they’re recovering from childbirth, including how they’re healing from vaginal or cesarean delivery, and assess whether they’re having problems such as pain, incontinence or persistent bleeding, notes Dr. Ann Borders, a maternal-fetal medicine physician at Evanston Hospital, NorthShore University HealthSystem, in Evanston, Illinois, and a member of the ACOG Committee on Obstetric Practice. If you’re experiencing any of these symptoms, your doctor can recommend appropriate treatments — such as pelvic floor exercises for stress urinary incontinence — or remedies for pain.
[See: 10 Things No One Tells You About Breast-Feeding.]
New symptoms. “Just like during pregnancy, women in the postpartum period remain at increased risk of having a blood clot, due to elevated hormones from the pregnancy, which can lead to a pulmonary embolism if it’s not identified and treated,” Borders notes. That’s why any new shortness of breath, chest pain or increased swelling or persistent pain in one lower leg in the postpartum period needs to checked out — pronto! Similarly, a rapid heartbeat or palpitations, tremor, insomnia and irritability could be signs of postpartum thyroiditis, a thyroid abnormality that affects up to 10 percent of women in the U.S., according to the American Thyroid Association. “It can be hard to tell if the dysregulation is temporary or long term, so it needs to be followed [by a physician],” Stuebe says.
Postpartum mood disorders. Women with a history of depression, anxiety or bipolar disorder are particularly at increased risk of experiencing postpartum depression. At the postpartum visit, new mothers are routinely screened for these conditions. And while “most obstetricians are not trained to thoroughly treat postpartum depression,” notes Dr. Melissa Goist, an assistant professor and OB-GYN at the Ohio State University Wexner Medical Center in Columbus, “we can assess and start treatment” and refer women to a mental health professional who can provide ongoing therapy and treatment.
[See: 11 Simple, Proven Ways to Optimize Your Mental Health.]
New challenges you’re facing or likely to face. At the four- to six-week postpartum check up, your doctor can provide helpful advice for how to deal with fragmented sleep and fatigue, the stress of being a new parent, a healthy diet while caring for an infant, breast- or bottle-feeding, post-pregnancy weight loss, exercise resumption and more. Women need to come with questions related to their birth experience and symptoms that are bothering them, whether it’s hair loss, issues related to sexuality or something else, Stuebe says.
Your “reproductive life plan.” The postpartum checkup is also the perfect time to discuss whether you would like to be done with childbearing or you want to have more children in the future, Borders says. These issues can inform your choice of post-baby birth control, be it sterilization, a long-acting reversible contraceptive, a short-term hormonal method or barrier contraceptive, and so on. If you plan to have more children, you also can discuss the optimal spacing of future pregnancies, given your health status, birth experience and personal preferences. For most women, the optimal interval between delivery and a subsequent pregnancy is between 18 months and 5 years; when the interval is shorter than six months, there’s a higher risk of low birth weight and preterm birth, according to ACOG.
Your future health risks. If you had gestational diabetes, hypertension or pre-eclampsia during pregnancy, your risk of developing certain health problems in the future increases. For example, women who had gestational diabetes are at increased risk of developing Type 2 diabetes over time and should have glucose screening at the postpartum visit. (Interestingly, a 2015 study in the Annals of Internal Medicine found that women with gestational diabetes who breast-fed their babies exclusively for more than 10 months had a 57 percent reduced risk of developing Type 2 diabetes over the subsequent two years.)
Meanwhile, women with high blood pressure or pre-eclampsia have an elevated risk of developing hypertension outside of pregnancy, as well as an increased risk of getting heart disease and metabolic syndrome in the future. A 2013 study from the University of Toronto found that women with pre-eclampsia or gestational hypertension also have a two-fold increased risk of developing diabetes in the future. And a 2016 study from the Pennington Biomedical Research Center in Baton Rouge, Louisiana, found that women with a history of gestational diabetes and gestational hypertension who did not use antihypertensive drugs during pregnancy had a nearly four-fold higher risk of developing Type 2 diabetes than women with gestational diabetes whose blood pressure was normal during pregnancy.
[See: In Vitro Fertilization Grows Up.]
Your OB-GYN can put all of these risks in perspective and discuss how to mitigate them through diet, exercise and other healthy lifestyle habits. You’ll want to discuss strategies to modify your personal risks and a plan to be screened regularly by a primary care physician who knows about your pregnancy history, Borders says.
Ultimately, paying more attention to the transition of care from the pregnancy provider to a mother’s long-term health care provider can help protect a woman’s health into the future, Stuebe says. And that’s as it should be for the sake of both mother and child.
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