13.

1 Postpartum Visit Schedule 

Rachel Twelmeyer 
 
The 24-hour Visit 
 
The 24 hour visit is an important time to check in on the physical and emotional well
being of the client. The birth is still very recent, and recovery isn’t fully established. The
midwife will check the birthing person’s vitals, including blood pressure, pulse, and temperature.
These are important indicators of general well being, and can be good for ensuring that healing is
going well, without infection or excessive blood loss. Lochia will still be heavy, and should be
assessed - either verbally or through visual inspection. The client should be asked about any clots
larger than her fist, and how many pads she has bled through in the past 24 hours. The midwife
may also ask about afterbirth pains, and recommend an herbal or allopathic remedy as needed.
This is also an important time to check the uterus, to ensure adequate involution. The midwife
should also check on the client’s ability to pee normally, and whether there is any discomfort
associated with urination; a bowel movement is unlikely this early, but is worth asking about.
The midwife should also ask about perineal healing, particularly if the client had stitches,
inquiring as to general feeling, soreness, or swelling. The midwife will also either inspect or
inquire about the client’s lower extremities for redness, swelling, or varicosities. What has the
client eaten since the birth? Is she nourishing her recovering body well? Hydrating adequately
(especially if breastfeeding)? Does her support team know what kinds of food will best nourish
her postpartum body?
The midwife will also observe the client’s affect - whether she seems to be coping well
since the birth, and how her spirits seem to be. Does the client have adequate support for
childcare, household chores, and meals? This may be an appropriate time to discuss the birth if
the client wishes.
Another key aspect of the 24 hour visit is to provide breastfeeding support. The midwife
should observe the breastfeeding relationship, and correct any latch or positional issues. The
midwife will also want to visually examine the nipples to ensure that there are not any warning
signs of future nipple trauma. The midwife will also inquire regarding feeding frequency. The
midwife may want to discuss what to expect when milk comes in - how to deal with
engorgement, how long it lasts, when to call the midwife, etc. If there are any issues with
breastfeeding, the midwife should boost the client’s confidence in her own ability, and screen for
any issues that may require additional counsel from a lactation specialist.
This is an important time to check on baby and his recovery from birth. Vitals should be
taken (including heart rate, respirations, and temperature) as well as a visual scan to ensure that
breathing does not require excessive effort. Has the baby passed meconium? Passed urine? The
midwife should alert the client as to range of normal so that the mother can observe diapers and
be able to assess nutritional intake on her own. The midwife should also observe general well
being - does baby exhibit signs of colic? Of craniosacral malalignment? Etc. The midwife will
perform the first metabolic screen test.
The midwife will also discuss baby’s sleeping, assuring the client that it will take a while
for everyone to adjust. The midwife should inspect the baby’s sleeping arrangement - bassinet?
Co-sleeping? Crib? The midwife should discuss benefits of close sleeping, and encourage family
to touch baby during the day (even if baby is sleeping) to encourage establishment of circadian
rhythms.
The midwife may also inquire as to the dynamic of extended family - are there family
members trespassing on the family’s privacy? Does the client need support in dealing with
excessive visitors? The midwife may also suggest a postpartum doula should she feel the need.
 
 
 
The 72-hour Visit 
 
By the 72 hour visit, the client may appear back to her normal self, but recovery is still in
its early stages, and diligently checking on mother and baby’s well being is essential. The
midwife will check the mother’s vitals, including blood pressure, pulse, and temperature. Lochia
may still be heavy, and should be assessed - either verbally or through visual inspection. The
client should be asked about any clots larger than her fist, and how she is bleeding through pads.
The midwife will also check the uterus, to ensure adequate involution. The midwife should ask
about urination, and discuss passing a bowel movement as this is about the time that will happen.
The midwife should also ask about perineal healing, particularly if the client had stitches,
inquiring as to general feeling, soreness, or swelling. The midwife will also either inspect or
inquire about the client’s lower extremities for redness, swelling, or varicosities
For many clients, day 3 is a time where emotions can be vulnerable. The midwife will
want to inquire regarding the client’s feelings about the birth - things that she remembers, things
that were frustrating that she may need to process. The midwife should highlight the client’s
perseverance and provide positive feedback. The midwife will also observe the client’s spirits -
does she seem like herself? Does it appear that she is feeling bonded to baby? The midwife may
want to discuss what the next few weeks and months look like for recovery. It is important to
establish expectations of what physical and emotional recovery will look like. She should
understand that the first 6-12 weeks can be the hardest as everyone adjusts to a new normal. The
midwife may want to review coping mechanisms for when the baby is up in the night, and
everyone is cranky, and the mother’s body still hurts. The midwife should also encourage the
client that it will get better, and that the client will eventually return to having a sense of self.
Even if now is not the time to go get her nails done or spend time away from baby, the client
should understand that she will need to take time to maintain her own identity. The midwife may
also discuss navigating a shifted family dynamic. Are there older children? How are they
adjusting to a new little one? Does the client’s partner feel involved? The midwife may advise
the client to prioritize her own healing, and to gently incorporate the needs of those around her as
time goes on.
Does the client still have adequate support for childcare, household chores, and meals?
The client should be aware of her body’s nutritional needs, that it is important to maintain
adequate stores for taking care of a newborn and breastfeeding. The midwife should encourage
the client to feed her body well, continue taking supplements, and stay hydrated to aid recovery
and supply breast milk with nutrients. The midwife should also discuss that the client should be
getting 8-10 hours of ​sleep p​ er day, including naps. If sleep is not occurring in the nighttime
hours, the client should seek out support to take naps. The midwife may need to discuss the
correlation between sleep and postpartum mood.
 The midwife should again observe the breastfeeding relationship, and correct any latch or
positional issues. The midwife will also want to visually examine the nipples to ensure that there
are not any warning signs of future nipple trauma. The midwife will also inquire regarding
feeding frequency. If there are any issues with breastfeeding, the midwife should boost the
client’s confidence in her own ability, and screen for any issues that may require additional
counsel from a lactation specialist.
Vitals for baby should also be taken (including heart rate, respirations, and temperature)
as well as a visual scan to ensure that baby is adjusting to extrauterine life. Has the baby passed
meconium? Passed urine? The midwife should alert the client as to range of normal so that the
mother can observe diapers and be able to assess nutritional intake on her own. The midwife
should observe for jaundice. If present, the midwife should recommend skin exposure to sunlight
by a window and breastfeeding.
 
 
 
The Seven Day Visit 
 
The seven day visit is an important opportunity to check in with the client; the client is
hopefully recovering well, the baby may be starting to have a semblance of a routine, and the
client’s support may be going back to work, or returning home. The midwife will check the
mother’s vitals, including blood pressure, pulse, and temperature. Lochia is hopefully lessening,
and at this point may be a good indicator of over-activity. The midwife should advise the client
to track any bright red or heavier bleeding, and mark it as a signal of overactivity. Bleeding
should be assessed - either verbally or through visual inspection. The client should be asked
about any clots larger than her fist, and how she is bleeding through pads. The midwife will also
check the uterus, to ensure adequate involution. The midwife should ask about elimination,
whether urination and bowel movements are returning to normal or not. The midwife will advise
if either is abnormal. The midwife should also ask about perineal healing, particularly if the
client had stitches, inquiring as to general feeling, soreness, or swelling. The midwife will also
either inspect or inquire about the client’s lower extremities for redness, swelling, or varicosities
The midwife will also observe the client’s spirits - does she seem like herself? Does it
appear that she is feeling bonded to baby? The midwife will assess eye contact, the client’s
response to baby’s crying, how the client discusses the changes that baby brought? The midwife
will advise regarding promotion of bonding if needed. The midwife amy want to discuss the
client’s emotional healing. Does the client keep a journal, or have a friend or family member she
can turn to in order to process the changes occuring? The midwife will remind the client that this
is a very demanding period for baby, and that she needs a way to process this shift. The midwife
may also inquire about small things the client is doing for herself daily - is she taking a shower?
Spending time reading or relaxing? Is there something that she looks forward to everyday? The
midwife may want to review coping mechanisms.
The client may be wondering about getting back to “normal.” The midwife should advise
the client that it is a gradual transition, and that the emphasis should be on establishing a “new”
normal. This may include shifting interactions with other children, and reincorporating new
traditions that meet the needs of everyone at home. If the client is feeling ready for an outing, she
should be encouraged to keep baby in a wrap, and to be very gentle at first. Does the client still
have adequate support for childcare, household chores, and meals? The client should still not be
sweeping, vacuuming, or pushing a stroller. The client should be aware of her body’s nutritional
needs, that it is important to maintain adequate stores for taking care of a newborn and
breastfeeding. The midwife should encourage the client to feed her body well, continue taking
supplements, and stay hydrated to aid recovery and supply breast milk with nutrients. The
midwife should also discuss that the client should be getting 8-10 hours of ​sleep p​ er day,
including naps. If sleep is not occurring in the nighttime hours, the client should seek out support
to take naps. The midwife may need to discuss the correlation between sleep and postpartum
mood.
The midwife should again observe the breastfeeding relationship, ensuring that the
newborn is actually being nourished, and that no nipple trauma is incurred. The midwife will
also inquire regarding feeding frequency. If there are any issues with breastfeeding, the midwife
should boost the client’s confidence in her own ability, and screen for any issues that may
require additional counsel from a lactation specialist.
Vitals for baby should be taken (including heart rate, respirations, and temperature) as
well as a visual scan to ensure that baby is doing well. How many bowel movements and wet
diapers does baby have per day? The midwife should alert the client as to range of normal so that
the mother can observe diapers and be able to assess nutritional intake on her own. The midwife
should observe for jaundice. If present, the midwife should recommend skin exposure to sunlight
by a window and breastfeeding. The midwife may also want to discuss basic care of baby - when
to introduce a pacifier, how often to bathe baby, what kinds of products to use on baby, how to
take baby into public, how to prevent sickness in the home, etc. The midwife will make sure that
she gives the client time to ask any questions, and to write down concerns as they come up.
 
 
 
The Two-week Visit 
 
The two-week visit is typically in the office, and is a good time to assess the client
outside of the home environment. The midwife will check the mother’s vitals, including blood
pressure, pulse, and temperature. Lochia is hopefully lessening, and at this point may be a good
indicator of over-activity. The midwife should advise the client to track any bright red or heavier
bleeding, and mark it as a signal of overactivity. Bleeding should be assessed - either verbally or
through visual inspection. At this visit, it is not necessary to check the uterus unless there are any
concerns; the uterus should barely be palpable below the pubic bone. The midwife should ask
about elimination, whether urination and bowel movements are returning to normal or not. The
midwife will advise if either is abnormal. The midwife should also ask about perineal healing,
particularly if the client had stitches, inquiring as to general feeling, soreness, or swelling. The
midwife will also either inspect or inquire about the client’s lower extremities for redness,
swelling, or varicosities. Hopefully the client’s physical healing is going well, and the client is
feeling herself returning to normal.
The midwife should inquire as to the client’s emotions, particularly from a partner or
family member whose observations may be very beneficial. The midwife may want to discuss
what kinds of thoughts or feelings or actions might be a marker for a postpartum mood disorder,
and clarify the difference between baby blues and PPD. The midwife may want to discuss what
the greatest challenge is at this point, is it a lack of support? The adjustment of family members?
Her own physical healing? A fussy baby? Feeling cooped up? A lack of sleep? It may be an
important time to go over other sources of support. Does the client need informational support
about some piece of her or baby’s current experience? Does the client need instrumental support
for meals or carpool to ease her stress? Does the client need additional emotional support from
her partner or friends? The midwife should provide a open conversation for the client to discuss
whatever she needs to, even if it is simply to go over the birth or recent experiences. The
midwife should give space for the client to ask about what’s going on, and to assure her that
what she’s going through is normal, even if it is difficult. Is there something that the client looks
forward to everyday? The midwife may want to review coping mechanisms.
The client may be wondering about getting back to “normal.” The midwife should advise
the client that it is a gradual transition, and that the emphasis should be on establishing a “new”
normal. This may be an important time to discuss family dynamics, with both immediate and
extended family. This may include shifting interactions with other children, and reincorporating
new traditions that meet the needs of everyone at home. Often after this point, the client’s circle
may expect her to jump back in, but the client should know that she can take the time she needs
to resume activities. Is the client returning to work before the six-week appointment? Does she
have questions about that transitions? Is she experiencing trepidation or excitement? The
midwife will help the client prepare any support she may need to mobilize in anticipation of that
transition.
The midwife should encourage the client to feed her body well, continue taking
supplements, and stay hydrated to aid recovery and supply breast milk with nutrients. The
midwife should also discuss that the client should be getting 8-10 hours of ​sleep p​ er day,
including naps. If sleep is not occurring in the nighttime hours, the client should seek out support
to take naps. The midwife may need to discuss the correlation between sleep and postpartum
mood.
The midwife should inquire about the breastfeeding relationship, ensuring that the
newborn is actually being nourished, and that no nipple trauma is incurred. The midwife will
also inquire regarding feeding frequency. By this time, a breastfeeding relationship should be
well established, but the midwife should screen for any issues that may require the assistance of
a certified lactation specialist.
Vitals for baby should be taken (including heart rate, respirations, and temperature) as
well as a visual scan to ensure that baby is doing well. The baby should also be weighed at this
appointment. The infant should have returned to birth weight (after a drop in weight following
the birth). If this does not occur, the midwife may need to inquire more closely about the
breastfeeding relationship and diapers. How many bowel movements and wet diapers does baby
have per day? The midwife should alert the client as to range of normal so that the mother can
observe diapers and be able to assess nutritional intake on her own. If concerned, the midwife
may need to give additional support, either through observation, identifying alternative sources
of milk (donor milk, formula, etc). Has the client taken the baby to see a pediatrician? Been
circumcised? The midwife should observe for jaundice. If present, the midwife should
recommend skin exposure to sunlight by a window and breastfeeding. The midwife will perform
the second metabolic screen if the pediatrician has not already done so.The midwife will make
sure that she gives the client time to ask any questions, and to write down concerns as they come
up.
The midwife may also discuss intercourse and sexuality with the client at this visit,
inquiring as to any concerns or questions the client may have. The midwife will assure the client
that intimacy may take some time to re-establish, especially with decreased privacy, increased
exhaustion, and a major shift in hormones. The midwife will advise the client to wait until her
bleeding stops, and then wait two days before resuming intercourse to ensure that the placental
site is healing adequately - thought the client should know that resuming intercourse is totally
dependent on her desire. The client should also be advised to have lots of foreplay, use lots of
lubrication before penetration, and to explore other forms of intimacy and sensuality beyond
penetrative intercourse. The midwife may also want to inquire about birth control, should the
client want counsel, or arrange for an extra visit with the midwife.

 
 
The Six-week Visit 
 
The six-week visit is usually in the office, and should be a meaningful visit as it is
typically the last time a midwife sees her client (unless she becomes pregnant again and returns
to the practice!) The midwife will check the mother’s vitals, including blood pressure, pulse, and
temperature. Lochia should have ceased by this time, though the midwife will inquire when it
ceased, and whether there were any episodes of excessive bleeding. Some clients may have
already experienced their first postpartum menstrual cycle, and this should be discussed. At this
visit, it is not necessary to check the uterus. The midwife should ask about elimination, whether
urination and bowel movements are returning to normal or not. The midwife will advise if either
is abnormal. The midwife should also ask about perineal healing, particularly if the client had
stitches, inquiring as to general feeling, soreness, or swelling. The midwife will ask whether
intercourse has been resumed, and if so, whether there was any pain or discomfort. If there was,
the midwife will advise as to how to mitigate discomfort, as well as screen for any more serious
issues that may require the help of a specialist. The midwife will assure the client that intimacy
may take some time to re-establish, especially with decreased privacy, increased exhaustion, and
a major shift in hormones. The client should be advised to have lots of foreplay, use lots of
lubrication before penetration, and to explore other forms of intimacy and sensuality beyond
penetrative intercourse. The midwife will also discuss contraception, asking which contraceptive
method the client has used or will use. The midwife will answer any questions the client may
have, and give informational support as needed. The client may desire Well-Woman care
services, such as a Pap smear, and the midwife will accommodate.
The midwife should inquire as to the client’s emotions, particularly from a partner or
family member whose observations may be very beneficial. The midwife will observe the client
and assess her temperament, does she seem like herself? Is she exhibiting signs of anxiety? Does
she look healthy? The midwife should provide a open conversation for the client to discuss
whatever she needs to, even if it is simply to go over the birth or recent experiences. The
midwife should give space for the client to ask about what’s going on, and to assure her that
what she’s going through is normal, even if it is difficult. Is there something that the client looks
forward to everyday? The midwife may want to review coping mechanisms. This may also be a
good time to discuss the birth, whether the client has questions about what happened, or needs to
process anything. This is an important time to solidify positive memories and perceptions of the
birth.
How are the family dynamics? Has everyone found a new normal? Are older children
accepting of the new baby? How is the client’s relationship with her partner? Has the client
returned to work? Does she have questions about that transition? Is she experiencing trepidation
or excitement? The midwife will help the client prepare any support she may need to mobilize
for that transition. The client will ask about the client and baby’s sleep patterns. Have they found
a routine and a situation that allows everyone to get sleep? Do they need to make any
adjustments to improve rest? Does the client need additional support or recommendations?
The client will likely want to be “cleared” for exercise. If she hasn’t already resumed an
exercise routine, the midwife should advise the client to start slowly, and to listen to her body.
The midwife may also recommend pelvic floor exercises should the client require them.
The midwife should inquire about the breastfeeding relationship, ensuring that the
newborn is being adequately nourished, and that there is no nipple trauma. The midwife will also
inquire regarding feeding frequency. By this time, a breastfeeding relationship should be well
established, but the midwife should screen for any issues that may require the assistance of a
certified lactation specialist.
Vitals for baby should be taken (including heart rate, respirations, and temperature) as
well as a visual scan to ensure that baby is doing well. The baby should also be weighed at this
appointment. The baby should have gained weight since the 2 week appointment. If this does not
occur, the midwife may need to inquire more closely about the breastfeeding relationship and
diapers. How many bowel movements and wet diapers does baby have per day? If concerned, the
midwife may need to give additional support, either through observation, identifying alternative
sources of milk (donor milk, formula, etc).
As the final visit related to maternity care, the midwife should assure the client that their
relationship is not over even if they don’t have any more appointments scheduled. The client
may reach out for advice if needed. The midwife should advise the client that she may continue
to experience concerns regarding her recovery or baby’s. The client may need to made aware that
Medicaid coverage ends at 2 months postpartum
The midwife will answer questions the client has about taking care of baby, this may
include vaccinations, number of pediatrician visits, cloth diapers, infant feeding, etc. The
midwife should show care and concern for the well being of the client as she transitions to
motherhood/parenthood.