Current Guidelines for Postpartum Follow-up After 6 Weeks
The current guidelines recommend that postpartum care should be an ongoing process rather than a single visit, with an initial assessment within the first 3 weeks after delivery followed by ongoing care as needed, concluding with a comprehensive postpartum visit no later than 12 weeks after birth. 1, 2
Timeline for Postpartum Care
- Initial contact should occur within the first 3 weeks postpartum, either in person or by phone 1, 2
- High-risk individuals (particularly those with hypertensive disorders) should have a blood pressure check within 3-10 days of delivery 3, 4
- A comprehensive postpartum visit should be completed no later than 12 weeks after birth 1, 2
- For women with specific risk factors such as hypertensive disorders, additional monitoring may be required throughout the postpartum period 3
Components of the Comprehensive Postpartum Visit
The comprehensive postpartum visit should include assessment of:
- Physical recovery from birth 1, 2
- Mood and emotional well-being with validated screening tools (e.g., PHQ-9, GAD-7) 3, 1
- Infant care and feeding 1, 2
- Sexuality, contraception, and birth spacing 1, 2
- Sleep and fatigue 1, 2
- Chronic disease management 1, 2
- Health maintenance 1, 2
- Blood pressure measurement and management 3
- Weight and waist circumference measurement 3
- Assessment of social determinants of health 3
Special Considerations for Specific Conditions
Hypertensive Disorders of Pregnancy
- Blood pressure check within 7 days of delivery 4
- Follow-up visits may include telehealth, in-person, or home visits based on patient needs 3
- Transition to primary care for long-term follow-up 3
Gestational Diabetes
- 75-g two-hour fasting oral glucose tolerance test between 4-12 weeks postpartum 4
- Additional labs to consider include lipid profile (after 12 weeks postpartum) 3
Venous Thromboembolism Risk
- For women with specific risk factors (e.g., thrombophilias, family history of VTE), prophylaxis may be continued for 6 weeks postpartum 3
- Clinical surveillance or prophylactic anticoagulation based on risk factors 3
Physical Activity Recommendations
- Gradual resumption of physical activity after the 6-8 week postnatal visit if no medical contraindications exist 3
- Previously active women can generally continue their pre-pregnancy activity levels if they remain healthy and have no complications 3
- For previously inactive women, start slowly and gradually increase frequency and intensity 3
- Different recommendations based on delivery type:
Contraception Counseling
- Effective contraception should be started no later than 21 days after delivery 5
- Long-acting reversible contraception options are strongly recommended for appropriate candidates 3
- For women with hypertension, combined hormonal contraceptives are contraindicated if blood pressure is >160/110 mmHg 3
Transition of Care
- During the postpartum period, identify the healthcare provider who will assume primary responsibility for ongoing care 1, 2
- Women with chronic medical conditions should be counseled on the importance of timely follow-up with their primary care providers 1, 2
- A warm handoff to primary care may improve transitions of care 3
Common Pitfalls to Avoid
- Treating postpartum care as a single visit rather than an ongoing process 1, 2
- Missing early follow-up for high-risk conditions like hypertensive disorders 3
- Failing to screen for postpartum depression, which is the most common psychological complication 5
- Overlooking the need for contraception counseling and provision 3, 5
- Neglecting to establish a transition plan to primary care for ongoing health maintenance 3, 1