Last year, after Sarah Darby gave birth to her daughter, Eleanor, she was ready to be discharged and go home. There was only one issue — her blood pressure was starting to creep up. It wasn’t so high that it stopped her medical team from proceeding with the discharge, but it was enough to give Darby some pause. She asked her OB/GYN if she could have a check-in earlier than the standard six-week mark and got an appointment just four days after she left the hospital.
Despite continued high blood pressure readings, she was able to regularly monitor these levels with weekly visits to her OB/GYN's office until her blood pressure dropped to normal a few weeks later. “Asking for this tailored follow-up care let me stress less about my own health in the postpartum period and soak up my new baby,” she says.
Postpartum can be a dangerous time for new moms — nearly two in three maternal deaths occur in the first year after birth, per the Centers for Disease Control and Prevention (CDC).[1] Meeting with your care provider and speaking up if something doesn't feel right can save your life.
There’s no prescription for postpartum care, but knowing what you can ask for will help ensure you get the support you need and deserve after birth.
You have the right to ask for an appointment before six weeks
The six-week checkup has been the norm for so long, primarily because that’s the time it takes for wound healing to occur and for the uterus to return to normal size, says Melissa Lozano, M.D., medical director of postpartum at Mount Sinai West. “If anything persists beyond that, then we have given adequate time for the body to heal and we can say, ‘Okay, now we really need to address these things,’” she says.
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However, that thinking is slowly shifting, and for good reason. Moms are especially vulnerable to health conditions in the first year after birth, with common concerns including heart conditions, hemorrhage and deep vein thrombosis. Without dedicated access to medical care, the symptoms of these potentially fatal conditions can easily be overlooked by exhausted new parents.
The World Health Organization (WHO) now recommends three to four health contacts in the first six weeks following birth, followed by the standard six-week appointment.[2] And the American College of Obstetrics and Gynecology (ACOG) issued guidelines in 2018 urging physicians to do earlier check-ins, within the first three weeks of giving birth, with care that’s more personalized to each patient.[3]
Most U.S. moms, however, are still only offered one postpartum appointment at the six-week mark. But that doesn’t mean that you have to wait six weeks if you think you might need care sooner. You can request an appointment before six weeks — and you can do it at any point when your spidey sense goes off, even if you’ve already gone home from the hospital.
“We're understanding more now and really trying to make it a little bit more personalized, really broaden that timeframe because we do recognize that early check-ins are important,” says Dr. Lozano. “And it's not like everything stops and it's back to normal right at six weeks either.”
You have the right to call your doctor if you’re uncomfortable
There’s no sugar coating it: The first six weeks postpartum are tough. There are hormonal fluctuations that cause emotional rollercoasters, sleep deprivation, bleeding and the physical recovery from labor. Some discomfort should be expected.
The key is to raise the red flag when you think the postpartum symptoms you’re experiencing may not be normal. And that can be really hard to know. If you’ve got a gut feeling that something isn’t right — either physically or mentally — know that it’s okay to call your doctor and ask for support.
“I always make sure to tell my patients, ‘If something feels wrong to you, you’ve got to trust that sense,’” says Dr. Lozano.
It’s important to be as direct and specific as possible when communicating with your provider about needing extra care. “Use words like, ‘I'm concerned about what's happening with my mood. I don't feel like myself and I'm worried,’” says Katayune Kaeni, Psy.D., a psychologist specializing in perinatal mental health. Conveying urgency is also important to help you get the earliest appointment available.
And you don’t have to feel the worst you’ve ever felt to make the call. “I actually prefer people to not wait until the last moment because by the time you get to feeling desperate, you've probably been suffering for a long time,” she says.
While it can be hard to decipher normal symptoms of postpartum from ones that require additional medical care, here are some worrisome signs that would warrant calling your healthcare provider right away, says Dr. Lozano:
Excessive bleeding (soaking pads back-to-back) or blood clots the size of a lemon or larger
Shortness of breath and feelings of weakness or faintness
A fever higher than 100.4 degrees Fahrenheit
Green, yellow, or foul-smelling discharge from any lacerations
Pain that’s not improving day to day
When it comes to your mental health, some tearfulness and sadness could be expected. About 80% of women will experience the “baby blues,” says Dr. Kaeni. Most will feel relief within about two weeks.
If the symptoms are more intense or last longer than two weeks, it could be a sign of a perinatal mental health condition such as depression, anxiety, OCD, PTSD or, in more severe cases, postpartum bipolar disorder or psychosis, says Dr. Kaeni. “Symptoms can develop any time within the first year of pregnancy,” she adds. “But that two- to three-week period of time is a little bit more vulnerable because of obviously the big change in life.”
If this matches your experience, call your doctor’s office, describe your symptoms in as much detail as possible, and ask for the earliest available appointment.
You have the right to bring a support person to your appointments
Keeping track of your symptoms or day-to-day feelings can be a challenge in the haze of caring for both an infant and yourself in the early days postpartum.
That’s why Dr. Lozano recommends enlisting a support person for a virtual or in-person visit. She says she sometimes checks in with this support person at the appointment to see how her patient’s health and mood have been — mom may be too overwhelmed during this time to realize something is off.
“They are going to think about things, or ask different questions, or hear [advice] in a way that you as a person in the middle of it may not be able to,” says Dr. Lozano.
She also recommends keeping a log of symptoms — the ‘My Journal’ tool in the What to Expect app has a symptom tracker that can help with this. There’s a checklist of likely symptoms to swipe through, making it easy not to miss any. You can also record the medications you’re taking in the notes section. These are tangible pieces of information that you’re unlikely to remember off-hand, but can be helpful details to have at an appointment, Dr. Lozano says.
You have the right to ask for a mental health screening
At your first postpartum appointment, your provider will likely give you either the Patient Health Questionnaire 9 (PHQ-9), a nine-item questionnaire used to screen for and assess the severity of depression, or the Edinburgh Postnatal Depression Scale (EPDS), a questionnaire specifically designed to screen for postpartum depression. Both surveys are designed to have answers quickly tallied by a provider who can use the score to categorize depression severity and put together a treatment plan.
If you don’t receive one, you can ask for it. And you can also ask for them to repeat this screening at a later appointment — just because you felt okay one day doesn't mean you’ll feel the same in the weeks to come. Your hormones are all over the place in the months following birth, and this can really impact your mental health.
Each time you take one of these screenings, your provider should discuss your score with you. If symptoms are mild, a provider may direct you to a resource like a support group. “Or if the symptoms are on the more severe side, then I would hope that the referrals include a therapist, a psychiatrist, a support group and some online resources,” Dr. Kaeni says.
You have the right to request a referral
If you want to see a mental health therapist or psychologist, or another specialist like a pelvic floor physical therapist, you can ask your doctor for a referral. If your insurance requires that referral for coverage, check your policy to see if there are any limitations or requirements.
ACOG’s guidelines also emphasize the importance of referrals to a physical therapist or urogynecologist for issues like fecal or urinary incontinence. The organization suggests establishing communication between the care team, including a primary care provider or specialists, especially for women who have experienced complications during pregnancy or delivery.
You have the right to join a new parent support group
While medication, treatment plans, or therapy may be crucial in some circumstances, there’s also value in seeking out a support group, especially if your symptoms are in the mild to moderate range.
One option is the support groups offered by Postpartum Support International. “They're free, and they run weekly,” says Dr. Kaeni. “That is one of the easiest places to get support relatively quickly.”
You can also look for local support groups through your birth hospital or community center. For example, La Leche League offers breastfeeding support groups online or in person in neighborhoods across the country. If you took a local birthing class during pregnancy, reach out — they might also extend services for postpartum moms.
Jenn Davis, a 41-year-old mom of two from Maryland who navigated postpartum depression and postpartum anxiety after the birth of her two children, says she wishes she’d known support groups were an option after having a baby. “I would have avoided that feeling of being alone, and the feeling that something was wrong with me," she says. "And the feeling of not being able to share it because I [was] ashamed."
Resources for immediate help
National Maternal Mental Health Hotline: Text or call 1-833-TLC-MAMA for free, 24/7 confidential support in both English and Spanish.
Postpartum Support International Helpline: Call (1-800-944-4773) or text (800-944-4773) for basic support, information or resources. This is not a crisis hotline, but calls are returned every day of the week.
Crisis Text Line: Text HOME to 741741 to connect with a volunteer counselor.
Suicide & Crisis Lifeline: Call or text 988 for 24/7 support. Or go to 988lifeline.com to chat with a counselor.
Join What to Expect on July 23 for #BumpDay to show your support for pregnancy and postpartum care that supports every mom, everywhere. Post a baby bump pic — yours or one you love, past or present — or simply share a message of solidarity with the hashtag #BumpDay. And visit whattoexpectproject.org to access a form that will help you email your local representatives and ask them to support policies that prioritize healthy moms and healthy babies.
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