Your 6-Week Checkup Is NOT Enough — What to Actually Ask For

The 6-week postpartum visit — if it happens at all (up to 40% of women don't attend) — is a relic of a system that was designed to confirm you were no longer bleeding and could resume sex and work. It was never designed to comprehensively assess your physical and mental recovery.

In practice, the standard visit is often 15 minutes. Your provider checks your incision or tear healing, does a brief pelvic exam, asks if you have questions, discusses contraception, and sends you on your way. If everything looks "normal" on the surface, you're cleared — and the implicit message is that recovery is complete.

But recovery at 6 weeks is barely beginning. Your uterus has only recently returned to its pre-pregnancy size. Pelvic floor muscles that stretched or tore during delivery are still healing. Abdominal muscles that separated (diastasis recti) haven't reconnected. Hormones are still in flux. Sleep deprivation is at its peak. And postpartum mood disorders can develop or worsen well beyond this window.

ACOG updated its guidelines in 2018 to recommend that postpartum care be an ongoing process — not a single visit — with initial contact within 3 weeks and a comprehensive assessment by 12 weeks. But implementation has been slow, and many practices still default to the single 6-week visit.

You deserve more. This means coming prepared with specific requests and not accepting a surface-level check as your comprehensive postpartum evaluation.

Yes — absolutely. A pelvic floor assessment is arguably the most important thing missing from standard postpartum care in the United States, despite being routine in countries like France, where postpartum pelvic floor rehabilitation is covered by the national health system.

Your pelvic floor muscles support your bladder, uterus, and rectum. During vaginal delivery, these muscles stretch to accommodate the baby — and they can sustain varying degrees of injury. Even C-section births involve pelvic floor stress, because 9 months of pregnancy itself places significant load on these muscles.

Common pelvic floor issues postpartum include stress urinary incontinence (leaking when you cough, sneeze, laugh, or jump), urge incontinence (sudden, intense need to urinate), pelvic organ prolapse (feeling of heaviness or "something falling" in the pelvis), pain during intercourse, and fecal incontinence or difficulty controlling gas.

These issues affect an estimated 35% of women postpartum, yet many women don't mention them because they've been told it's "normal after having a baby." Leaking is common. That doesn't make it normal, and it certainly doesn't make it untreatable.

A pelvic floor physical therapist can assess your muscle function, identify specific weaknesses or coordination issues, and develop a targeted rehabilitation plan. Early intervention (starting around 6–8 weeks postpartum, or when cleared by your provider) prevents chronic issues. Kegels alone are not sufficient for many women — and doing them incorrectly can actually worsen certain conditions.

Ask your provider for a referral. If they dismiss the request, consider self-referring — many pelvic floor PTs accept patients without a physician referral.

Diastasis recti is the separation of the rectus abdominis muscles — the "six-pack" muscles — along the midline of the abdomen. During pregnancy, the growing uterus stretches these muscles apart, and the connective tissue (linea alba) between them thins and widens. Some degree of separation occurs in virtually all pregnancies; clinically significant diastasis recti (defined as a gap of more than 2 finger-widths, or approximately 2 cm) affects an estimated 60% of women at 6 weeks postpartum and still affects about 30% at 12 months.

Signs of diastasis recti include a visible ridge or "doming" along the midline of your abdomen when you do a sit-up motion, a persistent postpartum "pooch" that doesn't respond to exercise, lower back pain, pelvic floor dysfunction (the abdominal wall and pelvic floor work as a system), and difficulty with core stability during everyday activities.

Checking for diastasis recti is a simple physical exam that takes about 30 seconds — your provider places their fingers along the midline of your abdomen while you do a small crunch and measures the gap. Despite its simplicity, this check is not routinely performed at the 6-week visit. Ask for it specifically.

If diastasis recti is present, a physical therapist specializing in postpartum recovery can teach you targeted exercises to rehabilitate the deep core muscles and help close the gap. Generic core exercises — especially crunches and planks — can actually worsen diastasis recti if done before the deep stabilizers are functioning properly.

Early detection and proper rehabilitation make a significant difference. Unaddressed diastasis recti can lead to chronic back pain, ongoing pelvic floor problems, and functional limitations that persist for years.

At minimum, you should receive a validated screening tool for postpartum depression and anxiety — not just a conversational "how are you feeling?" which misses the vast majority of cases.

The Edinburgh Postnatal Depression Scale (EPDS) is the most widely used and validated screening tool. It's a 10-question self-report questionnaire that takes about 5 minutes. A score of 10 or higher suggests possible depression requiring further evaluation. A score of 13+ strongly suggests depression. Question 10 specifically asks about self-harm thoughts.

However, the EPDS has limitations. It was designed primarily to screen for depression and doesn't comprehensively capture anxiety, rage, or OCD symptoms — all of which are common postpartum presentations. If your EPDS score is low but you're experiencing significant anxiety, irritability, intrusive thoughts, or rage, tell your provider explicitly. The screening tool may not catch what you're going through.

Screening should happen at every postpartum visit, not just once at 6 weeks. PPD and PPA can develop at any point during the first year — a normal screen at 6 weeks does not mean you're in the clear. AAP guidelines also recommend screening at well-baby visits (1, 2, 4, and 6 months), recognizing that pediatric appointments are often the most frequent touchpoint for new mothers.

If screening suggests a mood disorder, your provider should offer specific next steps: referral to a therapist experienced in perinatal mental health, discussion of medication options if appropriate, and follow-up within 1–2 weeks. A positive screen followed by "let's see how you feel next month" is not adequate care.

Yes, especially if you're experiencing symptoms that could be attributed to "just being a new mom" but might actually indicate thyroid dysfunction — fatigue beyond what's expected, unexplained weight changes, hair loss that seems excessive, mood changes, anxiety or depression, brain fog, feeling unusually cold, or constipation.

Postpartum thyroiditis affects 5–10% of women, making it one of the most common postpartum medical conditions. It occurs when the immune system, which is naturally suppressed during pregnancy, "rebounds" after delivery and can attack the thyroid gland in susceptible women.

The condition typically follows a biphasic pattern. The initial phase (1–4 months postpartum) is hyperthyroid — anxiety, rapid heart rate, weight loss, tremors, and irritability as the inflamed thyroid dumps stored hormone. This transitions to a hypothyroid phase (4–8 months postpartum) — fatigue, weight gain, depression, dry skin, hair loss, and cold intolerance.

The challenge is that many of these symptoms overlap with normal postpartum adjustment and PPD, which is why thyroid dysfunction is frequently missed. A simple blood test can differentiate them. Request a full thyroid panel: TSH, free T4, free T3, and thyroid peroxidase (TPO) antibodies. TPO antibodies are important because women who test positive are at higher risk for developing postpartum thyroiditis and for progressing to permanent hypothyroidism.

Women at higher risk include those with a personal or family history of thyroid disease, type 1 diabetes, or other autoimmune conditions. But any woman can develop postpartum thyroiditis. If your provider is dismissive, advocate firmly — this is a common, testable, treatable condition.

The 6-week visit is a critical moment for contraception planning because a common and dangerous misconception is that you can't get pregnant while breastfeeding or before your period returns. You absolutely can. Ovulation can occur as early as 25 days postpartum, and it happens before your first postpartum period — meaning you can conceive without ever seeing a period.

The Lactational Amenorrhea Method (LAM) is a legitimate contraceptive method — but only if all three conditions are met simultaneously: your baby is less than 6 months old, you are exclusively breastfeeding (no supplements, no pacifiers, feeding at least every 4 hours during the day and every 6 hours at night), AND your period has not returned. If any single condition is not met, LAM is unreliable and you need another method.

Contraceptive options postpartum include progestin-only methods (safe during breastfeeding): the mini-pill, hormonal IUD (Mirena, Kyleena), the implant (Nexplanon), or the Depo-Provera shot. These don't affect milk supply. Combined hormonal methods (estrogen + progestin: combo pill, patch, ring) are generally avoided until at least 4–6 weeks postpartum due to increased blood clot risk, and may reduce milk supply in some women.

The copper IUD (Paragard) is a highly effective non-hormonal option. Both IUDs and the implant can be placed at the 6-week visit or even immediately postpartum.

Short interpregnancy intervals (less than 18 months between delivery and next conception) are associated with higher risks of preterm birth, low birth weight, and maternal complications. This isn't about judgment — it's about giving your body time to recover fully. Have a real conversation about your family planning goals and choose a method that aligns with them.