What to Expect at Your First Postpartum Appointment

Dr. Gianni Rodriguez Ayala is a board-certified OB/GYN and assistant professor at Donald and Barbara Zucker School of Medicine at Hofstra/Northwell.

When you’re pregnant, most women usually look forward to each doctor visit—it’s a chance to get an update on your unborn child’s growth and development, hear the heartbeat, and sometimes even see your baby on the ultrasound screen.

Once you give birth, though, you’re often so wrapped up with caring for your baby and adjusting to life with a newborn that you may not give much thought to your own health. But that first post-birth visit with your OB/GYN is an important one.

Typically, many doctors want to schedule the first postpartum visit six weeks after you deliver. But in my opinion, that’s too late. If a woman has a vaginal delivery and doesn’t have any complications during or after giving birth, I like to see her at two to four weeks postpartum. I don’t want to miss out on a chance to diagnose and treat someone should an issue arise.

Women who’ve had C-sections or complications during pregnancy or delivery need to be seen even earlier—usually within a week or so of giving birth. This is especially true if a patient had preeclampsia, a complication during pregnancy that involves high blood pressure and protein in the urine, because we need to make sure her blood pressure is OK. And we want to determine whether the amount of medication she was given at the hospital is still appropriate, or if we can decrease the dose.

Here’s what you can expect at your first postpartum appointment with your OB/GYN:

I always start with blood pressure, because preeclampsia is not something that happens only during pregnancy—it can begin during the postpartum period and cause a woman to get very sick and possibly even have seizures. Postpartum preeclampsia is an underdiagnosed issue because many patients go home after giving birth and don’t follow up with their own doctors, so they don’t even know they have elevated blood pressures.

I don’t routinely do a pelvic exam at that first visit, but if a woman had lacerations or an episiotomy during delivery, I will take a look to see if everything is healing well and make sure there’s no sign of infection. For patients who had C-sections, we remove the negative pressure wound vacuum system (a covering placed over the incision site to aid in healing) if one was used.

One of the biggest reasons I like to see women at two to four weeks postpartum rather than wait six weeks is to check on their emotional health. If a woman is still exhibiting signs of the blues after two weeks, it’s likely she is experiencing postpartum depression, which affects one in seven women.

Usually my first question is, “Are you feeling overwhelmed? How are you doing with the new baby? Do you feel like you’re crying more?” Usually those simple questions will lead to a discussion about what’s going on for mom. It doesn’t matter if it’s someone’s first, third or sixth child—postpartum depression can happen to any new mom at any time. But when it first happens after a second or third pregnancy, postpartum depression really comes as a big surprise, because they were likely expecting things to be just the way they were after the first baby. When it’s different, it can be a shock.

Even before a woman has given birth, I always go over her options for contraception. If she wants to breastfeed, we talk about which types of birth control are safest and least likely to interfere with milk production. If she knows she wants to use an IUD, we can usually schedule the insertion to take place at the four week postpartum appointment.

The question all women are thinking, even if they’re not asking it, is when can they start having sex again. The general rule is six weeks postpartum, but for many women, that feels way too soon. If a woman feels ready, I tell her to give it a try. But make sure to communicate with your partner—certain positions that were comfortable before childbirth may not be comfortable now.

Plus if you’re breastfeeding, estrogen levels are low, which causes vaginal dryness. I reassure patients that this is normal. I recommend using lubricant, even if you don’t feel like you need it, because if, in the middle of sex it starts to feel uncomfortable, you may not want to try it again.

For women who’ve had C-sections, certain positions or movements are going to feel really weird for a while. My advice is to start slow and keep communication lines open. Don’t be afraid to let your partner know what feels comfortable—and what doesn’t—and take it from there.

• Meet Dr. Gianni Rodriguez Ayala, OB/GYN.
• Find an OB/GYN near you and set up an appointment.
• Read more stories about life after baby. 
• Learn about masked hypertension, a postpartum health risk most women don't know about.