“Preparing for Your Postpartum Visit” – with Dr. Stephanie Melka

Dr. Fox: Welcome to today’s episode of “Healthful Woman,” a podcast designed to explore topics in women’s health at all stages of life. I’m your host, Dr. Nathan Fox, an OB/GYN and maternal-fetal medicine specialist practicing in New York City. At “Healthful Woman,” I speak with leaders in the field to help you learn more about women’s health, pregnancy, and wellness.

All right, Melka, welcome back to the podcast. It’s been a while.

Dr. Melka: I know. We’re delayed.

Dr. Fox: I know. I feel like you’re avoiding me. Maybe you don’t like podcasting anymore.

Dr. Melka: How’d you figure it out that I was avoiding you?

Dr. Fox: Yeah, yeah. If you’re trying to avoid me, you’re not doing a good job because I see you 12 times a week.

Dr. Melka: This is true.

Dr. Fox: But, all right, well, listen, we’re happy to have you back. I’m certain our listeners are excited to see you back or hear you back on the podcast. We decided we’re going to talk a little bit about the postpartum visit and preparing for the postpartum visits really just to give our listeners a sense of what to expect, what’s going to happen, A, because it’s good to know and B, because sometimes it’s things you want to, sort of, either prepare for or know what’s going to happen so you can, you know, either have the right questions ready or your expectations are set. Is this something that you talk to your patients about, like in the hospital, or how do you set them up for their postpartum visits?

Dr. Melka: I usually do. It’s something we go over at the day we send them home from the hospital. And there’s such a wealth of information that’s thrown at you the day you’re going home, that a lot of it gets forgotten. And it happened to me. My doctors told me something when I was going home, completely forgot it a week later.

Dr. Fox: Oh, really?

Dr. Melka: Yeah.

Dr. Fox: What was it?

Dr. Melka: I don’t even… It was something about timing of one of the appointments, and I just completely forgot what they told me.

Dr. Fox: Oh, dear.

Dr. Melka: I know.

Dr. Fox: All right. Well, no, it is true when people all the time feel like, “No one told me that when I left the hospital.” I was like, “A guarantee I told you there’s a piece of paper that was written on it.” And they’re like, “Oh, yeah, because it’s understandable. You got 4,000 things you’re dealing with the day you’re leaving the hospital, including recovering from delivery and having a newborn.”

Dr. Melka: And you’re sleep deprived.

Dr. Fox: Yeah.

Dr. Melka: Yeah, brain doesn’t work.

Dr. Fox: Yeah, and it’s one of the reasons we, sort of, developed this postpartum pamphlet that we give out that’s in writing. And also we don’t even give it to them in the hospital. We give it to them when they’re pregnant because we’re like, “You’re going to forget about this.”

Dr. Melka: Yes.

Dr. Fox: “Here it is now. Read up before you deliver.”

Dr. Melka: And that’s another thing I tell patients when I’m sending them home. If you go on our website, the booklet is there. We printed it… We published it on the website and people still don’t remember that.

Dr. Fox: Yeah, yeah, yeah, which is totally understandable. So someone leaves the hospital after delivery, vaginal delivery, C-section, whatever it is, right? So they’re going home. They got their baby. Hopefully, obviously, with them, unless the baby has to stay in the hospital longer, but they’re going home. They’re all going together. When do we typically need to see people or want to see people in our office as an outpatient after they’ve gone home after their birth?

Dr. Melka: In general, it’s about six weeks after delivery.

Dr. Fox: Right. So why six weeks? What’s magical about six weeks?

Dr. Melka: I don’t know. I don’t know if anybody knows.

Dr. Fox: It’s tradition. Yeah. So, I mean… Well, let’s put this way. Why not wait six months?

Dr. Melka: So I think six weeks in general is when people have physically recovered and are going to be getting back to regular activity. Some people heal sooner than that, but some people don’t. So if you’re bringing people in at three weeks, then you’re going to have people that are still healing and you’ll say, “Okay, come back in another three weeks.”

Dr. Fox: Right.

Dr. Melka: And that’s just hard to do for a new parent.

Dr. Fox: Yeah, it’s kind of a balance. You don’t want to wait forever because there’s things that we’ll talk about and there’s things we want to address. We want to look at, we want to examine, we want to talk about, you know, all these things we want to do, so we don’t want to wait, you know, a year or six months or something like that. But on the other hand, you know, again, to bring everybody in early is challenging if they’re going to have to come back anyways.

I mean, I recall the time when I was training, everybody who had a C-section would come back in two weeks. That was just a thing. You had a C-section, come back in two weeks. And I think that is like that in some places still where, you know, C-section come back in two weeks, vaginal six weeks. So I guess the question would be, why would someone come back after a C-section at two weeks? And part B of that question is, why do we not have them come back after two weeks within our practice?

Dr. Melka: Yeah. The two-week visit specifically tends to be an incision check. Look at the incision. If there’s Steri-Strips, the little Band-Aids, take them off. Look, make sure that it’s healing well. And what we’ve found over the years is that if patients are having issues with their incision, it’s usually, A, happening before the two week point and B, they know about it. So it’s very rare that someone comes in in two weeks and says, “I feel totally fine.” And then we do an exam and we find that they have a fluid collection or it’s not healing well.

Dr. Fox: Yeah, yeah. I mean, I tell people the same. I say that, you know, if we brought everybody back in two weeks… In a C-section, you still have some pain. You got a newborn, you’re tired. You come to our office, we look at you and say, “You’re fine, go home.” You’re like, “What?” You’re like, “This is why I’m here?” And so we say, if you have a problem, just call us and we’ll see the same day or the next day or whatever it is. And so for the, whatever, 5% to 10% of people who call with questions about their wound that we can’t figure out over the phone, we’ll just bring those people in and everyone else can just stay unless there’s an issue.

Dr. Melka: Yeah, and we have a small number of people that want to come in in two weeks.

Dr. Fox: Yeah.

Dr. Melka: They will say, “I’m nervous. I want to make sure I’m healing well. I don’t want to take the strips off myself. Last time I had a wound separation. I want someone else to look at it.” We’ll always see people. We just stopped requiring it for everybody.

Dr. Fox: Yeah. And so I guess in part of the conversation of, you know, not waiting too much longer than six weeks, there are circumstances where we would ask someone to come back sooner, right? So it’s not routine after a C-section, but there’s definitely people who we want to see earlier than six weeks. And so who might those people be, for example?

Dr. Melka: Generally anybody that had a complicated delivery. So people that had heavy bleeding, maybe they needed a D&C, blood transfusion. People with high blood pressure, we’ll want to bring them back for a blood pressure check. Sometimes it’s patients that had an unplanned emergency C-section and had a more traumatic delivery and want to be coming back in to meet with one of us a little bit sooner.

Dr. Fox: Yeah. I mean, there’s several reasons why you might want to be seen sooner than six weeks. Some of them are purely medical/physical… like, to make sure you’re well like you needed a blood transfusion. We could see how you’re doing, check your blood count, or if you had let’s say a really bad tear at delivery, you know, just to make sure is it healing well, you know, that type of thing, because people are in pain and they don’t look as much as they do at their C-section scars.

So, you know, we’ll take a look, make sure everything’s okay there or, you know, just to debrief and talk about the delivery, people sort of are working through, again, if it was traumatic in whatever way. And that’s obviously a wide range of what experiences would be traumatic and traumatic for whom. But sometimes to talk about it…

And so there are definitely reasons why we suggest it’s good to come back earlier. We want people to come back earlier or, like you said, some people want to either they know they want to or they call they’re not feeling well. That’s another reason. You know, whatever the concern might be, obviously we will see someone earlier.

So let’s assume that none of those are happening, right? So either they had a relatively uncomplicated vaginal delivery or a C-section where we do not need them to come back sooner than expected, what should people expect is going to happen when we see them at the postpartum visit and then consequently we’ll talk about what do people have to sort of prepare for in a certain sense?

Dr. Melka: Yeah. So we check in with them in terms of how their recovery is going, both physically, emotionally, mentally. We do a physical exam. If they had a C-section, check the scar, the skin/scar, make sure it’s healed well. Pelvic exam, speculum exam, look at the cervix, feel the uterus, make sure that it’s now back to normal size. If they had a vaginal delivery, look at any lacerations or tears, make sure that those have healed well.

Emotionally, we do a depression screen for all of our patients at the postpartum visit, screening for postpartum depression, anxiety, other mood issues. And then the next big thing is sort of getting them now back from having delivered and recovered to now adjusting back to normal life. So sort of “clearing for things” like exercise, talking about returning to sexual activity with their partner and then birth control.

Dr. Fox: All right, so let’s take each of those, I guess, separately. So let’s talk about, I guess, physical, right? So you say we do an exam, we look at the wound, we look at the laceration, we check the uterus. Are there things that sometimes we find that they don’t know about? You said before, people know if they have an issue with their wound typically. So are these exams sort of perfunctory or do we sometimes pick up things as, “Oh, you know, we need to do A, B and C,” and if that happens, is it common, I guess I would ask?

Dr. Melka: Sometimes we pick up things like a vaginal laceration that maybe has a little bit of what we call granulation tissue where it’s, sort of, still healing and they may notice some bleeding over the coming weeks. Sometimes we pick up on pelvic floor issues like prolapse, cystocele, weakened muscle, diastasis, which is the separation of the rectus muscle. Talking about getting into pelvic physical therapy to address those issues.

Dr. Fox: Right. And I think that one of the things that sometimes gets addressed is related to people’s bleeding.

Dr. Melka: Yes.

Dr. Fox: Right? Because people don’t always know what to expect for their bleeding after delivery. And when we talk to them or examine them, we might think that there’s something. Again, not necessarily serious or dangerous, but something that needs to be addressed. So, what should people expect in terms of their bleeding from delivery until the sixth week mark? And what things might prompt us to do something investigative?

Dr. Melka: So usually bleeding has gotten better by six weeks, not always. I think in women that are breastfeeding or pumping, they’ll often notice their bleeding’s often gone by four to five weeks. Women that are formula-feeding often notice their bleeding goes away and then sometimes they’re even getting their first menstrual cycle back by five, six weeks.

Usually we want to know about it in advance if it’s any bleeding that’s more than just light, irregular spotting like people that are still using pads multiple times a day, soaking through pads. If people had a difficult delivery of the placenta, if they needed a D&C for the placenta, the worry is that there might still be pieces of placenta inside. And knowing about it in advance helps if we need to do a sonogram or other imaging studies

Dr. Fox: Right. I mean, it’s not… A lot of people… The way it’s going to work is to go to the doctor’s office or the midwife and say, “Oh, I’m having A, B, and C.” And you’re like, “All right, let’s double check and get an ultrasound,” which is perfectly fine. And we’ll get done the next day, the next week, you know, whatever it is, because, again, these things don’t tend to be life threatening or anything. They’re just sort of whatever. Maybe it needs to be addressed, maybe it doesn’t, which is fine. That’s totally fine.

In some practices like ours, we would prefer to know that in advance. Yeah. Right. Because we can actually get the ultrasound before your postpartum visits so that when we see you, it’s a little more productive. We could say, “All right, I know you’re having this issue. We’ve done the ultrasound. It’s normal. It’s abnormal.” Whatever it is. And we can maybe address it, sort of, to reduce the time spent after this visit, trying to investigate what’s going on. So, that’s something that definitely can come up or, you know, we notice irregular bleeding or hear about irregular bleeding from a physical standpoint.

Dr. Melka: I’ll put in a plug for our podcast episode on retained placenta where we talk about this. And I think, in that one, we talk about how it’s not typically dangerous, but it’s annoying. When people come in at six weeks, they want to be better. They want to be back to normal life. They’re still bleeding. And then we’re like, “Okay, come back for an ultrasound.” Then they need to wait a few days to get it scheduled or when can they get child care to come in again. And then if they have something and they need another procedure, it’s just sort of like more drawn out.

Dr. Fox: Right. So, yeah, definitely. And thanks for the plug for the podcast. I think another thing that is such a fascinating topic and it’s come up on so many different podcasts that we’ve done is this idea of screening for postpartum depression and anxiety. And I think that fortunately nowadays for most people, this isn’t the first time they’re getting screened because nowadays, thank God, a lot of pediatricians do this in their office, which is terrific because, again, after you deliver not necessarily the mother but usually she’s going to be the pediatrician’s office, I don’t know, four times between… Whatever. At least between birth and the six-week visit.

And so if she’s having, you know, whatever it is, depression, anxiety, she will probably already have been screened, picked up and addressing it by the time they see us but not always. Either it could be that she didn’t go to any of those visits. It could be that they didn’t screen. She didn’t know. Or sometimes these things don’t present. She could have been “fine” for, let’s say, four or five weeks and then it starts to come up. But it’s definitely something that we do religiously. We absolutely do it in everybody. And people are sometimes surprised to learn that the symptoms that they’re having might not be “normal,” right? They would say, “I just figured this is like… I had a baby and I’m supposed to be miserable.”

Dr. Melka: Right, “I’m supposed to be crying every day. I’m supposed to be sad. I’m supposed to be regretting what I did, because that’s what all my friends talk about. And they joke about it.” But yeah, it definitely affects some people a lot more.

Dr. Fox: Yeah. And so I think that that’s really… For many people, it does come as a surprise to them, A, that we’re doing this and B, that we find things that they didn’t realize was, A, not typical and B, potentially treatable. You know, who knows? I mean, it could be nothing. It could be therapy. It could be medication, whatever it is. But that is definitely an important part.

And so in the same regard that if you think you’re having like irregular bleeding, it’s good to tell people advance. There’s also no reason one has to wait for the postpartum visit to tell somebody that you’re not doing well emotionally or you’re not sure if you’re not doing well emotionally. You just go, “Hey, this normal like A, B and C and so on.” You’re good. Very typical versus, you know, maybe we should come in and talk about it or maybe you should see somebody or whatever it might be. And that’s an important thing. You are allowed to reach out to the providers before the scheduled postpartum visit, particularly if it’s over something that might be concerning and might be addressable. You don’t have to wait for six weeks. And I think that that’s really an important part.

Now, another thing in terms of preparing, because you mentioned birth control, right? So obviously it’s something that people were going to talk about them in a six-week visit. Few questions that come up beforehand, well, what if I want to start having sex before the six-week visit? Number one, can I? Number two, will I get pregnant again?

Dr. Melka: Yes.

Dr. Fox: Right?

Dr. Melka: Surprise.

Dr. Fox: Yeah, you might. So, it’s unusual, obviously, and particularly in people who are nursing and haven’t gotten their period back yet. But it’s not impossible. And so that is something that’s important to know. And what do you tell people about let’s say the safety of having sex before they’re seen at the six-week visits?

Dr. Melka: I’m laughing because I was just talking about this with a friend who had her third baby and is like, “I didn’t have any tears. Really? My cervix is so open that it’s like a huge infection risk if I have sex at four weeks or my uterus… What’s going to happen if I start exercising at three weeks if I’m feeling better?” You know, and a lot of this… There’s no great data behind it. And I think over the years, it’s just become the standard has been we see you at six weeks. Don’t do anything before then. That way, you’re checking in with one of us. We’re getting you on birth control, making sure that everything is healed.

Dr. Fox: Right. I generally tell people, with exercise, I’m pretty lenient before the six weeks. And I usually say, “Again, depends on their delivery in this essay.” If you’re doing something and it doesn’t hurt and you feel fine, it’s probably fine, particularly if you have vaginal delivery. It’s hard to exercise after a C-section before six weeks. It’s painful. And maybe someone’s ready at five weeks, but typically not before. But vaginal delivery, if it wasn’t a big tear and frequently they are ready, I usually tell them with sex to wait until six weeks because, again, we do want to look at the cervix. We do want to look at any tear they had, any stitches they had.

But we don’t know. Again, if someone is fine and they’re not bleeding and they feel well, probably nothing would happen. Probably. But it’s hard. In my experience, not that many people are clamoring to have sex before the six-week visit anyways. But okay, for those who are, God bless them. And we usually advise against it, but not because we know it to be dangerous. But that’s just sort of typically everyone advises. And we don’t really know what would happen to everyone. And presumably most people would be fine, but it’s hard to prove that.

More than interesting things about birth control is… So, we definitely discuss all the options at the postpartum visit and a decision could be made at that time. But there are certain options where if they are going to make that decision, there’s some lead time that needs to happen. It’s like if you come to a six-week visit and someone says, “Let’s start a pill,” and they prescribe it, you’ll have it that day, the next day, whatever the pharmacy gets at you, that’s easy. But what things might people want to know in advance or at least know that either they have to prepare for or they won’t have their birth control ready on the day of their six-week visit?

Dr. Melka: Yeah, it’s mainly the devices, the IUDs, the intrauterine device and the Nexplanon. The Nexplanon is the implantable progesterone rod that goes into the arm.

Dr. Fox: Right. And so if someone thinks they want them, what are the options?

Dr. Melka: So for us, I don’t think we have many patients that have wanted this, but you can get the Nexplanon placed in the hospital after delivery because it’s only progesterone, so it doesn’t have any risk of blood clotting. We don’t physically stock the device in the office, so it has to be ordered. So for patients that want it, if they come in at the six-week visit and then we order it, then it’s another three to four weeks for it to come in. And then they get the appointment set up. So for patients that want that one, I usually tell them as soon as they can, “Call the office. We’ll get it arranged,” and then do our best to schedule it with the postpartum visit.

Dr. Fox: Right. And then what about IUDs?

Dr. Melka: The IUDs, so similar thing. We stock some but not all of them. The ones we stock, it has to go through insurance first if there’s any kind of copay. Those don’t typically get placed until six weeks or maybe even later, just making sure that the uterus has shrunk back down to a normal size. And, again, having that lead time in advance is helpful.

Dr. Fox: Yeah. I mean, this is done so differently around the city, around the country, around the world. And, you know, you can have IUDs placed at the time of delivery in theory, right? You can do a vaginal delivery, C-section, and people do that. And it definitely can work. We don’t do it. There’s a lot of logistics involved with that because you have to sort of get the IUD in this and whatever. And frequently they fall out and this and they’re in the wrong position. You got to get it replaced. So we typically don’t place them before the six-week visit. Also, most of our patients are happy to come back for the six-week visit and so it’s not like we have an issue of finding them again and then finding us. So it doesn’t tend to be sort of needed to do it at the time of delivery, so to speak. But again, it’s one of those things where if you want to place at your six-week visit, because, you know, you’re not nursing. You want to resume having sex right away and you don’t want to get pregnant, you have to let people know in advance typically. Otherwise, you may not be able to get placed at that time.

And so obviously, you know, we’re talking about our practice, but for all of our listeners who are not part of our practice, it’s really important to talk to your doctors or midwives at some point during pregnancy or after you deliver in the hospital. Hey, I think I want an IUD. How does it work in your office? Do you place it at delivery? Do you place it at six weeks? Do I have to order it? What has to be done to get it placed? And you may not care, right? You may not say, “No, it’s fine. I can wait two, three months.” But certainly if it’s timely for you, that’s something you want to just work out in advance. Is there any other considerations people might have related to birth control that they need to know beforehand?

Dr. Melka: That’s probably it. You know, for patients that had… Again, this is the specific subset that needed like a D&C for the placenta where we’re worried they might still have placenta tissue. We’re going to want to do a sonogram first. But usually everything else can be started at that time.

Dr. Fox: Yeah, that does make sense.

Dr. Melka: Progesterone pills, some patients like to start before six weeks. The combined estrogen-progesterone for patients doing those, which is your traditional birth control pill, we typically wait till the six-week visit just because of the slightly increased risk of blood clotting from pregnancy and postpartum and then adding the estrogen into it.

Dr. Fox: Right, now people… Yeah.

Dr. Melka: And, again, some groups do start sooner than six weeks, but we’ve just opted for consistency given our large patient base. And we have a lot of people that have additional risks, waiting till the six-week visit.

Dr. Fox: Yeah. And then what about taking with your time, the traditional birth control pill, estrogen and progesterone while someone’s nursing?

Dr. Melka: A little controversial in that it can potentially decrease or disrupt milk supply. So some women out there will say, “Great, I have an oversupply. Give it to me, that’s fine.” Others will say, “I’m only going to breastfeed another three weeks and then I’m going back to work and then I’m ready to stop. I’ll start it now.” And then there’s the opposite of people that don’t want to take any risk of it affecting the milk supply. They don’t want to take the chance. They’re having a hard time. They may have a low supply to begin with, and they’ll tend to stay away from the estrogen pills.

Dr. Fox: Right. And then they can just take the progesterone only or another form of contraception.

Dr. Melka: Exactly.

Dr. Fox: Obviously. Now, a few sort of random questions. Should people come to their postpartum visit with their partner and with their baby?

Dr. Melka: Whatever they want. I love it when they bring their baby. It’s fun. You get to see the six-week old baby. Often I’m seeing patients I delivered, I get to see the baby, but it’s hard. It’s hard to leave the house with a six-week old. And patients often see that because, like you said, they have three or four pediatrician visits. And often by the time they get to their own six-week visit, they’re just like, “Forget it. Someone else take the baby. I’m going out.” It’s like their own little time.

Dr. Fox: Yeah. Yeah, I mean, again, we’re happy when people bring their babies. It’s delightful. It’s a lot of fun. I mean, Silverstein used to steal them and walk around the hallway with them and, I don’t know, burp them or whatever you would do. And it is nice, but it’s not required, right? We’re not examining the baby. We’re not talking about the baby’s health. We’re not the baby’s doctors at that point, so it’s really just like for social reasons. And for some people, it’s more convenient to bring the baby. For some people, it’s more convenient not to bring the baby. So whatever…

Or, something that comes up rarely but is really important to know is with health insurance, right? So people have commercial health insurance, whatever it is. Sometimes they, for whatever reason, have an option to either drop it or to change plans or something and they do it after they deliver. But if you do it before the postpartum visit, I would be very, very careful and ask before you do that, because the way commercial insurance deals with pregnancies, they cover the whole pregnancy up through the postpartum visit.

So if you had, you know, whatever insurance and it covered your pregnancy, your delivery, and then three days after delivering, you go home, your insurance changes or you drop that insurance or whatever it is, and then you go to your postpartum visit, it might not be covered with your old plan and it might not be covered with your new plan. And then you might get stuck with a big bill. So before you do that, double check with the people taking care of you. You know, usually they’ll have a billing team or whoever it is that can advise you on that just to make sure.

And again, if someone says, well, I’m paying X amount for my insurance, I’d rather pay less than X for my postpartum visit. Fine. God bless if that’s a financial decision, but just be aware that it’s not always… Your postpartum visit might not be covered if you dropped your insurance or change your insurance. That’s something that comes up. All right. So do you need to see the person who delivered you when you go to your postpartum visit?

Dr. Melka: It’s like bringing the baby. It’s not required, but I think it’s really nice. It’s nice for us when we see the patients we delivered, and we can sort of see how they’re healing, how they’ve been recovering. I think patients often like to see the doctor that delivered them, but there are some that don’t for whatever reason. Sometimes they followed closer with another physician and they prefer to do the follow-up with that one. Sometimes it’s just logistics. They can only come in on a certain day. So they can only see the doctors that are there on that day of the week.

Dr. Fox: Right. Right. And again, it also depends why you’re coming in. If the visit is more just for making sure I’m okay and planning for the future, you know, like you said, birth control and exercise, when’s my next visit, you know, asking questions, all stuff, it doesn’t make as much of a difference. If the purpose of the visit is I want to debrief about the delivery, I have questions about what happened or, you know, specifics related to the operation, to laceration repair, this or that, then it’s often more helpful that it’s the person who was there again, if possible. It’s not always possible, but certainly that’d be ideal. So some of it is based on that.

Now, another question. So you do the postpartum visits, right, and do everything you need to do. When do you routinely see people after the postpartum visit? And then my second question is going to be, when do you want to see them sooner than that regular time?

Dr. Melka: Usually from there, provided all is healthy, no issues, I tell them to come back in about a year. And then just use that as the start of their next annual exam. And what I tell patients is when you’re planning the baby’s first birthday, use that as your reminder of like, “Oh, I need to schedule my GYN visit.”

Dr. Fox: Oh, that’s very helpful.

Dr. Melka: Well, people forget like…

Dr. Fox: Yeah, when you buy the cake…

Dr. Melka: Exactly.

Dr. Fox: …call your office.

Dr. Melka: And it’s just, if that becomes the new annual visit, some people may need to come in sooner. They had an abnormal pap. They need a pap a little bit sooner than that. They need to be set up for a mammogram. So we may bring in sooner for those reasons. Patients that had a complex delivery that want to get pregnant soon, I’ll always bring them in sooner to go over things as well. You know, sometimes there are tests you want to do before the next pregnancy, where it’s helpful to see them before they get pregnant. Then there are others that say, you know, “I don’t care what you’re going to tell me. I’m getting pregnant again. I’ll do all the consults when I’m pregnant in a year.” I’m like, “Great.”

Dr. Fox: I mean, again, for uncomplicated pregnancies and deliveries, it’s unusual. Again, unless there was a problem in the postpartum period, it’s unusual that we need to see them earlier than a year. But I think sometimes, you know, again, when I say… I’m going to say people forget. I don’t just mean patients. I mean, doctors. Also, some of the things that happen in pregnancy are things that need to be addressed also when you’re not pregnant. If someone had gestational diabetes, you need to be screened for diabetes when you’re not pregnant. If someone had high blood pressure in pregnancy, you need to have your blood pressure checked when you’re not pregnant, certain, you know, complications that happen in pregnancy. Let’s say you had preterm labor and a preterm delivery of this. It’s possible we’re going to want to have you meet with an MFM, like a specialist, you know, to make sure that this isn’t something that’s going to recur, you know, whatever it is.

So I think that it’s a reminder for patients and obviously it’s a reminder for doctors. And if patients who haven’t had a complicated pregnancy or delivering your doctor doesn’t mention it, you may want to say, “Hey, does anything about my pregnancy that was complicated by A, B, C and D require any follow-up before I get pregnant again? Are there any tests I need to do? Are there any doctors I need to see?” Are there any ultrasounds I need to get? Because I’d rather get on top of that and make sure that’s all addressed rather than just showing up pregnant again and say, “Oh, I wish we could have done this before you got pregnant. I would have done A, B and C.”

And so, again, it should be on the doctor to do all those things, but there’s so much that happens at a postpartum visit. And sometimes we just assume they’re going to come back an X amount of time and they don’t and they show up pregnant. And so it is nice to remind the doctor-midwife, you know, “Hey, remember, I had this complication, A, B and C. Is there anything I need to do?” And they may say, “Oh, no, no, we got it. You’re done,” or they may say, “Oh, yeah, let’s do this and this before your next visit.” And that’s important also… When planning after the postpartum visit, it’s also sort of taking into account what happened in pregnancy. Is there anything we might need to do for your health in the future or for a potential future pregnancy? Good stuff. Postpartum visit. Good job. Covered it.

Dr. Melka: Great.

Dr. Fox: Thanks for coming on, Melka.

Dr. Melka: Happy to be here.

Dr. Fox: Thank you for listening to the “Healthful Woman” podcast. To learn more about our podcast, please visit our website at www.healthfulwoman.com. If you have any questions about this podcast or any other topic you would like us to address, please feel free to email us at hw@healthfulwoman.com. Have a great day.

The information discussed in “Healthful Woman” is intended for educational uses only. It does not replace medical care from your physician. “Healthful Woman” is meant to expand your knowledge of women’s health and does not replace ongoing care from your regular physician or gynecologist. We encourage you to speak with your doctor about specific diagnoses and treatment options for an effective treatment plan.