The six weeks after birth: what mother and baby should be checked for
A mother and baby should be checked several times in the first six weeks, not once: in the hours after birth, around the third day, at the end of the first week, and again at about six weeks. The checks look for bleeding and infection in the mother, feeding and warmth in the baby, and the danger signs in either that mean returning the same day. The first week carries the most risk for both of them, which is why the early visits matter more than the six week one that families tend to remember.
- Four points of contact: the hours after delivery, about day three, the end of the first week, and about six weeks.
- The mother's checks are bleeding, fever, the womb tightening down, blood pressure, breasts and mood.
- The baby's checks are feeding, warmth, weight, the cord stump, breathing and the colour of the eyes and skin.
- A newborn who stops feeding, is cold to touch, or is unusually quiet needs a health worker today, not tomorrow.
- The six week visit is also where immunisation and the conversation about spacing the next pregnancy usually happen.
General information, not medical advice. If you are worried about a mother or a child, go to your nearest health facility or speak to your village health team.
Why the first week matters more than the sixth
Families plan for the six week visit because it is the one with a date on the card. The risky period is earlier than that. Heavy bleeding, infection and the sudden blood pressure problems that follow some births arrive in the first days, and newborn illness moves fast.
The practical consequence is simple. Do not treat the postnatal period as a wait until six weeks. Treat the first week as the part that needs attention, and the six week visit as the check that everything settled.
This is also the week when a household is busiest with visitors and least likely to notice that the mother is not right. Somebody in the house should be given the job of watching her, not just the baby.
What the mother should be checked for, and when
In the hours after delivery, the midwife checks bleeding, blood pressure, and whether the womb is contracting down as it should. That is why you stay in the facility for a period of observation rather than leaving as soon as the baby cries.
Around day three and again at the end of the first week, the check covers bleeding, any fever or foul-smelling discharge, how any stitches or an operation wound are healing, whether the breasts are sore or hard, whether she is passing urine normally, and how she is in herself.
At about six weeks the check is broader: has the bleeding stopped, has she recovered her strength, is she eating, is she feeding the baby comfortably, and does she want to talk about spacing the next pregnancy. Anaemia is often picked up here in a mother who never quite got her energy back.
What the baby should be checked for, and when
Before you leave the facility the baby is weighed, examined, and started on feeding. Ask for the child health card and check the birth weight is written on it. That number is the reference point for every weight check afterwards.
In the first week the checks are feeding, warmth, the cord stump, breathing, and whether the baby is passing urine and stool. Weight normally dips a little in the first days and should be climbing again by the end of the first week or so. A baby who is still going down needs a health worker to look at the feeding.
At about six weeks the baby is weighed and examined again, and the immunisation schedule continues. Bring the child health card to every contact, including a home visit, and keep it in the same place as your own card.
Which danger signs in a mother mean going back the same day
These are the signs that should end whatever else is happening in the house. They are not a wait and see list.
If any of them appear at night, go anyway. Every one of them is easier to treat early than at dawn.
- Bleeding that soaks a pad in under an hour, or that gets heavier instead of lighter
- Fever, chills, or a discharge that smells bad
- A severe headache, blurred vision, or swelling of the face and hands
- Fits or convulsions, which mean going to the nearest facility immediately
- Pain, redness or swelling in one calf, or sudden difficulty breathing
- A wound or stitches that open, weep or become hot and painful
- Thoughts of harming herself or the baby, or a low mood she cannot lift
Which danger signs in a newborn mean going back the same day
A newborn does not look dramatically ill until quite late, which is what makes these signs worth memorising. The first three on the list are the ones mothers most often notice and most often wait on.
Trust the change rather than the absolute. A baby who fed well yesterday and will not feed today is telling you something, even if he looks the same to a visitor.
- Stops feeding, or feeds much less than the day before
- Is cold to touch, or unusually hot
- Is unusually quiet, floppy, or hard to wake
- Breathes fast, grunts, or the chest pulls in under the ribs
- Yellow colour in the eyes or on the palms and soles
- Redness, swelling or pus around the cord stump
- Fits or convulsions, or repeated vomiting
What a home visit actually covers
Where a village health team member visits in the first six weeks, the visit is short and practical. She weighs the baby if she has a scale, looks at the cord, watches a feed, asks the mother the danger sign questions, and checks the mother is not bleeding heavily or feverish.
The most useful part is often the feed she watches. Cracked nipples, a poor latch and a baby who is not getting enough are the commonest fixable problems in the first fortnight, and they are much easier to correct in week one than in week four.
Have the child health card and your own card ready, and say honestly how you are sleeping and eating. A visit where the mother says everything is fine because there are visitors in the compound is a wasted visit.
What nobody warns you about in the first weeks
Afterpains, cramping that comes on while breastfeeding, are normal in the first days and are the womb tightening. Bleeding starts red and heavy, then reduces and changes colour over the weeks. Bleeding that goes the other way, lighter then suddenly heavier, is worth a check.
Sore and cracked nipples are common and usually a latch problem rather than a reason to stop. Breasts that become hard, hot and painful, with a fever, are not the same thing and need a health worker.
Tiredness is expected. A flat, tearful few days in the first week is common too and usually passes. A low mood that lasts beyond a fortnight, or any thought of harming yourself or the baby, is a reason to tell a health worker, and it is treatable.
What to do if you delivered at home or missed the early checks
Go to the health centre with the baby as soon as you can, even if a week or more has passed. The baby needs to be weighed, examined and put on the immunisation schedule, and the child health card started. There is no point at which it becomes too late to begin.
Say plainly that the birth was at home and give the date. Nobody is going to refuse you care for it, and the date matters for the baby's schedule.
Tell your village health team member as well, so the household is on her list for follow-up rather than invisible until something goes wrong.
This guide describes what generally happens, not what will happen at your facility or your school. Costs, timetables and rules differ between districts and they change. Check anything that matters with your health worker, the head teacher, or your district office. If something here is wrong or out of date, tell us and we will correct it.
Questions people ask
- How long should the bleeding last after birth?
- It normally starts heavy and red and reduces over the following weeks, changing colour as it goes. What matters more than the exact length is the direction. Bleeding that becomes heavier again, soaks a pad in under an hour, or smells bad needs to be seen the same day.
- My baby lost weight in the first days. Is something wrong?
- A small dip in the first days is expected, and the weight should be climbing again by around the end of the first week. If it is still falling, or the baby is feeding much less, take him to be weighed and ask a health worker to watch a feed. It is usually a feeding problem that can be fixed.
- Do I need to go for the six week visit if we are both well?
- Yes. It is where the baby's immunisation continues, where a mother's anaemia or slow recovery gets picked up, and where the conversation about spacing the next pregnancy usually starts. Going while well is the point of it.
- Can a village health team member replace the facility visit?
- No. A home visit is for finding problems early and for practical help with feeding. Weighing, immunisation and examination of the mother still happen at the facility. Treat the two as parts of the same six weeks rather than alternatives.
- I feel flat and tearful. Is that normal?
- A few low days in the first week are common and usually pass. A mood that stays low beyond a couple of weeks, or any thought of harming yourself or the baby, is a reason to speak to a health worker. It is common, it is not a failing, and it can be treated.