The 6-Week Postpartum Appointment is a Lie

You know what happens at the six week postpartum appointment?

They weigh you. Check your blood pressure. Take a look at your incision or your perineum. You will be asked about bleeding. They will ask you if you have been feeling sad + they will wait for you to say no. Then they tell you that you are cleared for sex + exercise. They will book your next annual + maybe ask you about a birth control plan. Then you will leave until said annual or next pregnancy whichever comes first.

Following one of the most traumatic transitions a body can go through, they give you twenty minutes. And that’s on a good day. Much less time if the office happens to be running behind or short staffed.

The message that is embedded in that twenty minutes, is the message that nobody actually says out loud but every single woman feels + absorbs is: you’re done now. You’re cleared. Good to go. Whatever you may still be feeling is something that you should be over by now.

Booooooooo. Tomato tomato tomato chile.

By the time I had my six week visit with my own daughter Khyra, I was SO fried dyed + laid to the side. I had spent almost 2 weeks in the NICU with her, was over producing + was barely sleeping. I didn’t know which way was up. All I knew was in that six-week visit, I needed to say that I was fine. That everything was ok. If I didn’t, they might think I was unfit or worse try to take my baby because I had a tough couple of weeks.

The six-week appointment is not a call to the principal’s office. It is not a clearance. It is a checkpoint. What burns my biscuits is the way the system pretends it’s a finish line + that’s a big part of the reason why some women never recover the way they could.

Even the ACOG says one visit isn’t enough. The guidance they provide on postpartum care says the care should be an ongoing process, not a single appointment. If we followed their guidelines directly there would be at least one check-in the 1st three weeks home + a full visit no later than twelve weeks.

What the 6 week postpartum checkup doesn’t check for

You know what that twenty minute visit doesn’t check for?

It doesn’t check to see if your hormones are still in freefall. Spoiler. At six weeks, they still are. Your estrogen + progesterone drop to the lowest of levels once the placenta is delivered. Your body then works overtime to recalibrate + balance out. This is a every day process post delivery. At six weeks, you are nowhere near your baseline + every part of your being is affected. For some women, they do not see a baseline for a year post baby. It can be even longer for those who are nursing.

They don’t check whether your nervous system is regulated, because it likely isn’t. You have been on alert for WEEKS! Possibly months depending on your own unique experience. Your body has been responding to a newborns cry at 3am, 5:30am + 8:15am. Your cortisol has been shifted into a whole new gear. The blood pressure cuff in that one moment wont tell the full story of all you are moving through.

This visit doesn’t check for whether or not you recognize yourself.

Whether your relationship with your partner has shifted + you are not sure if you are imagining it. If you have started avoiding mirrors. If you have Googled “am I a bad mom” at 3am after finally settling a crying baby. This visit most certainly doesn’t check whether you are keeping it together because you have to or because you are.

That twenty minutes doesn’t check for the slow burn rage that can show up in the second or third month, when the help at home is gone, your partner is back to work, check-ins have stopped coming + you are alone with your baby, in a body you don’t recognize, with brain fog + a thousand thoughts you can’t say out loud.

This twenty minute check-in is for blood pressure. Bleeding. And sending you home “cleared”.

Truth Moment?

I LOATHE when people call the fourth trimester a recovery period. Recovery implies that you are getting back somewhere. Back to who you once were. Let me be completely honest with you. The woman who gave birth + the woman who walked out of the birthing room are not the same person. They never were supposed to be. Postpartum is more like a reconstruction project. Cell by cell, sleepless night by sleepless night, you are building the person who is going to mother this baby for the rest of her life. This is a process that takes longer than six weeks. It takes longer than six months. For some of the women I have walked with on this journey it has taken more like two or three years before they fully land into the new version of themselves. For those mommas with back to back births, that can take even longer.

The system doesn’t have a billing code for “re-construction project”. Current society doesn’t hold space for reconstruction. There is a billing code however, for the six-week visit. So that’s what you get.

The cost of pretending six weeks is the finish line is enormous

Partners + support people go back to acting normal because they also received the memo that postpartum ended at six weeks. Family begins to stop checking in. Workplaces expect the old you to be walking back through the door like nothing at all happened. The reality is you are still in the woods, still figuring out who you are, still grieving the version of yourself that doesn’t exist anymore all while learning the new one.

It’s understandable to start thinking something is wrong with you. Because everything around you says you should be moving forward, that everything is fine. Everything might not be fine. You are in the middle of one of the most significant developmental shifts the human body + brain can go through simultaneously. Being handed a wellness pamphlet + being sent on your way is not enough.

What a real fourth trimester looks like

Here is what a real fourth trimester looks like, when somebody is actually paying attention.

It looks like rest that lasts longer than your maternity leave. Like food brought to your house by people who know + care about you. It looks like a postpartum doula, friend or family member who stays after the casserole drop-off + actually helps. It’s the permission to not be okay. It looks like getting your hormone levels checked when you feel like something is off. Not being dismissed + told it’s just the baby blues. Having someone in your corner who knows the difference between the normal hard + the not normal hard, and who will tell you which one you’re in.

It looks like being witnessed for longer than twenty minutes.

What I’d tell you before your 6 week postpartum appointment

If you or someone you know has a six-week appointment coming up, this is what I would tell them: Bring a list to the appointment. Ask how much bleeding is too much at this point. Have them check your iron + thyroid if you are still feeling exhausted. Ask for a referral, who could you call if your mood gets worse after today. Write the answers down. Twenty minutes stretches a lot further when you walk in with your own questions.

If you are in your fourth trimester right now, or your sixth month, or your ninth, or even your eighteenth + you are still adjusting, still tired + still figuring out who you are now, you are not behind. You are not failing or doing it wrong.

You are right on time. The timeline you were given was a lie. Your body knows what it’s doing. The healing is happening, slower + deeper than anyone told you it would be. Heck, maybe someone did tell you + you had no idea until you were deep in it.

The six-week appointment is a checkpoint at best. Not a finish line.

Tell every single postpartum woman you love them. I mean it.

6 week postpartum checkup questions, answered

• How long does postpartum bleeding last + how much is too much?
  • Up to around six weeks. Call your provider if you are soaking more than one pad an hour, passing clots bigger than a golf ball or it’s still heavy like a period after four days. Same plan if bleeding slows down, stops + then comes back after more than a few days.
• Do I have to wait until my 6 week postpartum appointment to see someone?
  • No. If you are struggling, call right now. You don’t have to wait for week six to ask for help. ACOG says women should ideally have contact with a provider within the very first three weeks.
• Am I ready for sex + exercise just because I got cleared?
  • Cleared doesn’t equate to ready. Sex is usually okay around six weeks once bleeding has stopped, but it is also normal for it to not feel the same way it used to due to vaginal changes, stitches or scarring. Gentle movement is usually fine a few days after an uncomplicated vaginal birth if you feel ready. Ideally you would wait until six weeks for more impact activities like running, dancing, or lifting weights. Had a C-section? Ask your provider for your timeline.
• When should I call someone about how I am feeling?
  • If you’ve felt hopeless for more than ten days after delivery, ACOG says call your ob-gyn. If things begin to feel heavier than just tired at any point, call or text the National Maternal Mental Health Hotline at 1-833-852-6262. If you’re in danger, call or text 988.

XO

Denawa Deniece

P.S. In Charlotte + want somebody in your corner past six weeks? That’s what I do through QCity Doula.