The postpartum visit: it's time for a change in order to optimally initiate contraception

Abstract

The 6-week postpartum visit is an anachronism. Performing the initial pelvic examination at this duration after delivery is based upon statements in old textbooks and teachings from a time when infection was prevalent and before modern methods of contraception were available. The basis for this clinical advice was derived from the understanding that a 6-week period of time would result in sufficient involution of the changes of pregnancy to allow an effective pelvic examination that would confirm the return of normal pelvic anatomy. Many women resume sexual activity before the sixth postpartum week and because ovulation frequently occurs before 6 weeks the obstetrical tradition of scheduling the postpartum visit at 6 weeks should be changed. A 3-week visit would be more effective in preventing postpartum conception by initiating effective contraception at this time instead of after the 6-week visit. There is no reason why a complete physical examination cannot be deferred in an asymptomatic woman until the 3-month follow-up visit that is part of good contraceptive care. (excerpt)