What does the 6-week postnatal review cover?

The 6-week review covers two people simultaneously: the mother and the baby. For the mother: physical recovery (perineal or caesarean wound healing, lochia, anaemia), breastfeeding assessment and troubleshooting, mood screening with the EPDS, contraception discussion, pelvic floor, chronic disease follow-up (particularly GDM — 75 g OGTT at 6–12 weeks), vaccination review, and cervical screening if due. For the infant: weight and growth assessment, feeding review (breast or formula), general examination including red reflex, heart sounds, and hip assessment (Ortolani and Barlow tests), review of newborn bloodspot screening results, hearing screen confirmation, and administration of the 6-week National Immunisation Program vaccines. This encounter often runs long — a Level D consultation (item 44) or combined items are appropriate.

What is the EPDS and what do the scores mean?

The Edinburgh Postnatal Depression Scale (EPDS) is a validated 10-item self-report questionnaire designed for perinatal depression screening. Each item is scored 0–3 and the total score ranges from 0 to 30. A score of 13 or more is the standard clinical cut-off for probable postnatal depression, though some settings use 10 or more to trigger further assessment. Question 10 asks specifically about thoughts of self-harm — any positive response requires immediate clinical assessment regardless of the total score. The EPDS is recommended by COPE (Centre of Perinatal Excellence), beyondblue, and the RACGP. It should be offered at 6 weeks, again at 3 months, and again at 6–12 months if concerns persist.

Which contraceptive methods are safe immediately after birth?

Several options are safe to start immediately postpartum or within weeks of delivery. The progestogen-only pill (POP), etonogestrel implant (Implanon NXT), and depot medroxyprogesterone acetate (DMPA/Depo-Provera) are all safe to start immediately postpartum, including while breastfeeding, with no evidence of adverse effect on milk supply. The levonorgestrel-IUD (Mirena, Kyleena) and copper IUD can be inserted from 4 weeks postpartum. Combined oral contraceptives should be avoided for at least 6 weeks postpartum due to elevated VTE risk in the postpartum period; if the woman is breastfeeding, many guidelines recommend waiting until feeding is established. The lactational amenorrhoea method (LAM) requires all three conditions: the baby is under 6 months, exclusive breastfeeding, and the mother remains amenorrhoeic.

What is the GDM follow-up requirement at 6 weeks?

Women who had gestational diabetes mellitus (GDM) during pregnancy have a 50% lifetime risk of developing type 2 diabetes within 10–15 years. The Australasian Diabetes in Pregnancy Society (ADIPS) and RACGP recommend a 75 g oral glucose tolerance test (OGTT) at 6–12 weeks postpartum to identify women who have retained glucose intolerance or developed overt type 2 diabetes. If the 6–12 week OGTT is normal, HbA1c or OGTT should be repeated every 1–3 years. Breastfeeding reduces future T2DM risk and should be encouraged. The 6-week postnatal review is the trigger point for this test — add it to the investigation order at the visit.

What is postpartum psychosis and how is it different from baby blues?

Baby blues affect the majority of new mothers — typically peaks at day 3–5 after birth, is characterised by weeping, irritability, and emotional lability, and resolves spontaneously within 2 weeks without specific treatment. Postnatal depression is distinct — it typically develops over weeks to months, involves persistent low mood, loss of interest, poor sleep (beyond infant-related disruption), guilt, worthlessness, and sometimes intrusive thoughts about harming the baby. It affects approximately 15% of mothers and requires active treatment. Postpartum psychosis is a psychiatric emergency affecting 1–2 per 1,000 women — usually within the first 2 weeks after birth. Features include rapid onset hallucinations, delusions, severe mood swings, disorganised behaviour, and sometimes infanticidal ideation. Immediate referral to perinatal psychiatry and potential mother–baby unit admission is required.

Postnatal care

Postnatal care: the GP 6-week maternal and infant review

By Dr HB Lo, FACRRM Reviewed 22 June 2026 10 min read

The 6-week postnatal review is the cornerstone general practice encounter after birth, covering maternal physical recovery, mood, breastfeeding, contraception, and infant health. MBS items 16591 and 16407 are specifically designed for this visit.

The Edinburgh Postnatal Depression Scale should be administered at every review. Postnatal depression affects 15% of Australian mothers; any positive response to question 10 requires same-day assessment.

The review also covers 6-week National Immunisation Program vaccines, GDM follow-up OGTT, and breastfeeding support via the Australian Breastfeeding Association on 1800 686 268.

Why the 6-week postnatal review matters

The 6-week postnatal period is a significant transition point: the acute physiology of pregnancy is resolving, breastfeeding is established or ending, postnatal depression is emerging, and infants are due their first immunisations. General practice is the most common health touchpoint for this period outside of hospital, and the quality of the 6-week review directly affects both maternal and infant outcomes.

Missed postnatal depression causes prolonged maternal suffering and has downstream effects on infant attachment and development. Undiagnosed GDM persistence leads to preventable type 2 diabetes. Delayed infant immunisation leaves babies unprotected during the highest-risk period for pertussis and other vaccine-preventable infections.

The RANZCOG Postnatal Care Statement and the COPE Australian Perinatal Mental Health Clinical Practice Guideline define the standard of care. RACGP resources provide general practice-specific guidance.

A. Core clinical — the AU general-practice framework

The maternal 6-week review

Physical recovery

Lochia: Physiological vaginal discharge progresses from bright red (lochia rubra, days 1–4) to pinkish-brown (lochia serosa, days 5–10) to yellowish-white (lochia alba, weeks 2–6). Persistence beyond 6 weeks, foul odour, or return of bright red bleeding warrants assessment for retained products of conception, endometritis, or uterine subinvolution.

Perineum: Episiotomy and perineal tear sutures are typically dissolvable. At 6 weeks, assess healing and any residual pain or dyspareunia. Superficial dyspareunia at 6 weeks is common; topical lubricant and pelvic floor physiotherapy (especially women’s health physiotherapy) address most cases.

Caesarean section: Wound should be fully healed by 6 weeks. Diastasis recti (rectus abdominis separation) is common and usually resolves — refer to women’s health physiotherapy if symptomatic. Discuss VBAC options for subsequent pregnancies.

Haematological: Haemoglobin and ferritin assessment if anaemia suspected — particularly after postpartum haemorrhage, in women with poor dietary iron intake, or in those who are vegetarian or vegan. Oral iron first-line (ferrous sulphate or Maltofer); IV iron (ferric carboxymaltose, iron sucrose — PBS Authority for severe anaemia or intolerance).

VTE risk: Hypercoagulable state persists approximately 6 weeks postpartum, with highest VTE risk in the first 2 weeks. Ask about calf pain and breathlessness. Women on oestrogen-containing contraception during this window carry additional risk.

Postnatal mood screening with EPDS

The Edinburgh Postnatal Depression Scale should be administered at the 6-week review, at 3 months, and whenever concerns arise. COPE and beyondblue recommend universal EPDS screening:

Score ≥13: probable postnatal depression — warrants immediate clinical assessment and management plan
Score ≥10: possible postnatal depression — arrange early follow-up
Question 10 (self-harm): any positive response requires same-day clinical response regardless of total score

Postnatal depression affects approximately 15% of Australian mothers. Risk factors include previous depression or anxiety, traumatic birth, NICU admission, breastfeeding difficulties, social isolation, partner violence, low socioeconomic status, migrant or refugee background, and ATSI status.

Management:

Mild to moderate: psychotherapy (CBT, interpersonal therapy) via Better Access — MHCP item 2715, 10 psychology sessions (items 80000–80020); perinatal-specialist psychologist via Gidget Foundation (telehealth, bulk-billed) or COPE directory
Moderate to severe: SSRI — sertraline is first-line in lactation (low milk transfer, long safety record); escitalopram also acceptable; avoid fluoxetine in newborns (long half-life); paroxetine acceptable in lactation but avoid in first trimester of any subsequent pregnancy
Postpartum psychosis — psychiatric emergency: refer to perinatal psychiatry immediately; mother–baby unit admission likely needed; lithium, antipsychotics, or ECT as specialist-directed

PANDA 1300 726 306 — Monday to Saturday; consumer and clinician support line. Beyond Blue 1300 22 4636, Lifeline 13 11 14.

Breastfeeding

NHMRC Infant Feeding Guidelines recommend exclusive breastfeeding to 6 months, with continued breastfeeding alongside complementary foods to 2 years and beyond.

Common breastfeeding issues at 6 weeks:

Sore/cracked nipples: almost always due to poor positioning or attachment — refer to the Australian Breastfeeding Association (1800 686 268, 24/7) or an IBCLC lactation consultant
Mastitis: flu-like symptoms plus localised breast tenderness, redness, and warmth. Management: continue feeding or expressing from the affected breast; cool compresses; NSAIDs (ibuprofen). If symptoms persist beyond 24 hours or are severe: dicloxacillin or flucloxacillin 500 mg six-hourly for 5–7 days per eTG Antibiotics (cefalexin if penicillin allergy; clindamycin if MRSA suspected). Breast abscess — ultrasound-guided aspiration first-line; surgical referral if needed
Low milk supply: Assess actual intake (infant weight gain, wet nappies, feeding frequency) before concluding supply is low — perceived low supply is common. Domperidone 10 mg three times daily is used off-label for lactation in Australia (TGA issued caution re QT prolongation risk; reserve for cases where positioning, frequency, and ABA support have failed; not first-line)
Returning to work: workplace lactation rights (Fair Work Act); expressing plan; ABA resources

Contraception after birth

The contraception discussion is one of the most time-sensitive at the postnatal review — ovulation can return from 3 weeks postpartum in non-breastfeeding women:

Safe from immediately postpartum: progestogen-only pill, etonogestrel implant (Implanon NXT), DMPA (Depo-Provera) — no effect on milk supply
From 4 weeks postpartum: levonorgestrel-IUD (Mirena, Kyleena — MBS item 39666 for insertion) and copper IUD
Combined oral contraceptive: avoid for at least 6 weeks postpartum (VTE risk); if breastfeeding, many guidelines recommend ≥6 weeks and until feeding established
LAM: only effective when all three conditions met — baby under 6 months, exclusive breastfeeding, and maternal amenorrhoea

Chronic disease follow-up

GDM: 75 g OGTT at 6–12 weeks postpartum (ADIPS / RACGP). Lifetime type 2 diabetes risk approximately 50% over 10–15 years. Repeat HbA1c or OGTT every 1–3 years if initial test is normal. Breastfeeding reduces long-term T2DM risk — reinforce and support.

Postpartum thyroiditis: affects 5–10% of women in the first postpartum year. Triphasic course — hyperthyroid 1–4 months, then hypothyroid 4–8 months, usually resolving by 12 months in 80%. Approximately 20–30% develop permanent hypothyroidism. Check TSH if symptoms suggest thyroid dysfunction. Differentiate from Graves disease if TRAb positive or scan required.

Hypertensive disorders: blood pressure should be normalised by 6 weeks. Women with pregnancy-induced hypertension or pre-eclampsia require blood pressure monitoring and, if persistent, antihypertensive therapy.

Vaccinations

dTpa: if not given antenatally (ideally weeks 20–32 of pregnancy under NIP); give postpartum and offer to all close household contacts (cocooning strategy for infant pertussis protection)
Influenza: annual; safe in lactation
COVID-19: per ATAGI current recommendations; safe in lactation
MMR and varicella: if non-immune; live vaccines are safe in lactation; avoid pregnancy for 28 days after administration
Hepatitis B: if non-immune; complete 3-dose course

Cervical screening

Australia’s 5-yearly HPV-based cervical screening test (CST) has been in place since 2017. Self-collection (vaginal swab) is available since 2022 — particularly valuable for under-screened ATSI women, CALD communities, and survivors of trauma for whom speculum examination is distressing. The 6-week postnatal review is an appropriate opportunity to check if CST is due and, if so, to offer it or schedule it.

The infant 6-week review

Growth assessment: weight (re-gain of birthweight expected by 2 weeks; ~150–250 g/week gain from then); length; head circumference plotted on the WHO growth charts in the Personal Health Record (state-specific Blue/Pink/Yellow Book).

Examination:

Eyes — red reflex (rules out cataract and retinoblastoma); intermittent squint usually normal at 6 weeks
Mouth — palate integrity, tongue tie if feeding affected
Heart — sounds, murmurs (refer innocent-vs-pathological differentiation to paediatric cardiology if uncertain), femoral pulses
Abdomen — masses, inguinal hernia
Hips — Ortolani and Barlow manoeuvres for DDH; hip ultrasound at 6 weeks for at-risk infants (breech presentation, family history, female sex, first-born)
Neurology — tone, primitive reflexes (Moro, grasp, root, suck, stepping), social smile (expected by 6 weeks), visual fixation and tracking
Newborn bloodspot screening — confirm results received and any action taken; 25+ conditions tested nationally
Hearing screen — confirm pass; if failed or not done, arrange audiology

6-week NIP immunisations:

Hexavalent vaccine (DTPa-HepB-IPV-Hib) — 1 dose IM thigh
Rotavirus (Rotarix or RotaTeq, state-specific) — oral
Pneumococcal conjugate (Prevenar 13 or equivalent) — IM thigh

Record in the Australian Immunisation Register (AIR) within 24 hours. ATSI infants receive additional vaccines per state-specific NIP schedule.

B. Evidence for key components

Intervention	Evidence	Notes
Universal EPDS at 6 weeks	🟢 Strong (COPE, beyondblue; Cox et al. validation)	Sensitivity 80–90% for PND
Sertraline first-line for PND in lactation	🟢 Strong (LACTMED; LactMed database; AMH)	Low infant exposure
75 g OGTT post-GDM at 6–12 weeks	🟢 Strong (ADIPS)	Detects T2DM, prediabetes
Pelvic floor physiotherapy for postpartum incontinence	🟢 Strong (Cochrane)	Refer early
POP/implant/IUD safe in lactation	🟢 Strong	No effect on milk supply
Avoid combined hormonal contraception before 6 weeks	🟢 Strong	VTE risk
Exclusive breastfeeding to 6 months	🟢 Strong (NHMRC, WHO)	Reduces infections, obesity, maternal T2DM
dTpa cocoon vaccination for household contacts	🟢 Moderate	Reduces infant pertussis exposure
Anti-D for Rh-negative women with Rh-positive infant	🟢 Strong	625 IU within 72 hours of delivery (Lifeblood)
Domperidone for refractory low supply	🟡 Moderate (TGA caution re QT)	Not first-line; reserve after ABA support fails

C. Australian operations — MBS and pathways

MBS items for the postnatal visit:

Standard consultations: items 23 (Level B), 36 (Level C), 44 (Level D — appropriate for comprehensive 6-week review covering multiple issues)
Item 16591 — postnatal attendance (up to 8 weeks postpartum)
Item 16407 — postnatal home visit by GP (one per pregnancy, within 4 weeks of birth, by usual GP/practice)
MHCP and review: items 2715 / 2717; Better Access psychology: items 80000–80020
IUD insertion: item 39666
ATSI health assessment: item 715 (can be used for the mother within first 6 months; covers child to 14 years)
CCDMP (chronic disease management): items 132 / 133; allied health referrals items 10954 / 10953 / 10960
Pathology: Hb/ferritin if anaemia suspected; 75 g OGTT; TSH; cervical screening

Key referral pathways:

PANDA 1300 726 306 — perinatal mental health
ABA 1800 686 268 — 24/7 breastfeeding support
Gidget Foundation — bulk-billed telehealth perinatal psychology
COPE — clinician resources and directory; 1300 800 117
Mother–baby psychiatric units — Helen Mayo House (SA), Northpark/Werribee (VIC), Royal Hospital for Women (NSW), Belmont (QLD), King Edward Memorial (WA)
Early parenting centres — Tresillian (NSW), Karitane (NSW), Queen Elizabeth Centre (VIC), Ngala (WA), CaFHS (SA) — sleep, settling, and feeding
Women’s health physiotherapy — pelvic floor, incontinence, prolapse, perineal pain; Continence Foundation 1800 33 00 66
Birth Trauma Australia — peer support for traumatic birth experience

D. Australian operations — cultural safety and special situations

Aboriginal and Torres Strait Islander families: Coordinate with ACCHS (Aboriginal Community Controlled Health Services); female Aboriginal Health Worker or chaperone for genital examination; ATSI 715 health assessment covers both mother and infant; Birthing on Country programs; Closing the Gap PBS co-payment for medications. Smoking — Quitline 13 7848 (ATSI-specific service); IPV — family violence safety planning.

CALD communities: Use TIS National (131 450) for professional interpreting — not a family member for intimate history. Respect postpartum cultural practices (40-day lying-in period in many cultures); explore family support structure; address vitamin D supplementation in covered women; be aware of dietary restrictions.

LGBTQI+ families: Affirming language — “birth parent,” “co-parent,” “chest feeding” where appropriate; same-sex couples have the same access to NIP vaccines and Medicare; legal parentage documentation varies by state.

Preterm and NICU graduates: Developmental milestones should use corrected age (actual age minus weeks of prematurity); multidisciplinary follow-up including paediatrics, allied health, and early childhood services.

E. Special populations — mental health

Birth trauma and PTSD: Up to 30% of women describe their birth as traumatic; approximately 3–4% meet full PTSD diagnostic criteria. Symptoms include intrusive memories or flashbacks, nightmares, avoidance of pregnancy-related topics, and hyperarousal. Birth debrief with the maternity team; trauma-focused CBT or EMDR (MHCP pathway); Birth Trauma Australia for peer support.

Partner / co-parent mental health: Paternal postnatal depression affects approximately 10% of partners. Offer the EPDS to partners at the 6-week review; normalise help-seeking; refer to beyondblue or Relationships Australia if indicated.

When to escalate

EPDS question 10 positive (self-harm thoughts) — same-day assessment; mental health crisis pathway
Suspected postpartum psychosis — immediate psychiatric referral; may need emergency services
Postpartum haemoglobin below 80 g/L or symptomatic anaemia — IV iron; haematology referral
Mastitis not responding to antibiotics at 48–72 hours — ultrasound to exclude abscess; surgical referral if abscess confirmed
Infant with suspected DDH — paediatric orthopaedic referral with hip ultrasound
Infant failing red reflex — urgent paediatric ophthalmology (exclude retinoblastoma)
Infant with unexplained heart murmur — paediatric cardiology referral
Prolonged neonatal jaundice (>2 weeks) with conjugated component — urgent paediatric review (biliary atresia)
GDM OGTT confirming type 2 diabetes — endocrinology referral; NDSS registration; lifestyle programme

What this article is and is not

This is general health information drawn from current Australian guidelines — RANZCOG Postnatal Care Statement, COPE Perinatal Mental Health Guidelines, NHMRC Infant Feeding Guidelines, eTG, Australian Immunisation Handbook, and ADIPS. It is not personal medical advice and does not create a doctor–patient relationship. Individual assessment by a GP, midwife, or treating clinician is essential for all postnatal care decisions.

For consumer resources: Pregnancy, Birth and Baby, Raising Children Network, PANDA 1300 726 306, ABA 1800 686 268, HealthDirect.

Sources cited

Frequently asked questions

What does the 6-week postnatal review cover?

The 6-week review covers two people simultaneously: the mother and the baby. For the mother: physical recovery (perineal or caesarean wound healing, lochia, anaemia), breastfeeding assessment and troubleshooting, mood screening with the EPDS, contraception discussion, pelvic floor, chronic disease follow-up (particularly GDM — 75 g OGTT at 6–12 weeks), vaccination review, and cervical screening if due. For the infant: weight and growth assessment, feeding review (breast or formula), general examination including red reflex, heart sounds, and hip assessment (Ortolani and Barlow tests), review of newborn bloodspot screening results, hearing screen confirmation, and administration of the 6-week National Immunisation Program vaccines. This encounter often runs long — a Level D consultation (item 44) or combined items are appropriate.
What is the EPDS and what do the scores mean?

The Edinburgh Postnatal Depression Scale (EPDS) is a validated 10-item self-report questionnaire designed for perinatal depression screening. Each item is scored 0–3 and the total score ranges from 0 to 30. A score of 13 or more is the standard clinical cut-off for probable postnatal depression, though some settings use 10 or more to trigger further assessment. Question 10 asks specifically about thoughts of self-harm — any positive response requires immediate clinical assessment regardless of the total score. The EPDS is recommended by COPE (Centre of Perinatal Excellence), beyondblue, and the RACGP. It should be offered at 6 weeks, again at 3 months, and again at 6–12 months if concerns persist.
Which contraceptive methods are safe immediately after birth?

Several options are safe to start immediately postpartum or within weeks of delivery. The progestogen-only pill (POP), etonogestrel implant (Implanon NXT), and depot medroxyprogesterone acetate (DMPA/Depo-Provera) are all safe to start immediately postpartum, including while breastfeeding, with no evidence of adverse effect on milk supply. The levonorgestrel-IUD (Mirena, Kyleena) and copper IUD can be inserted from 4 weeks postpartum. Combined oral contraceptives should be avoided for at least 6 weeks postpartum due to elevated VTE risk in the postpartum period; if the woman is breastfeeding, many guidelines recommend waiting until feeding is established. The lactational amenorrhoea method (LAM) requires all three conditions: the baby is under 6 months, exclusive breastfeeding, and the mother remains amenorrhoeic.
What is the GDM follow-up requirement at 6 weeks?

Women who had gestational diabetes mellitus (GDM) during pregnancy have a 50% lifetime risk of developing type 2 diabetes within 10–15 years. The Australasian Diabetes in Pregnancy Society (ADIPS) and RACGP recommend a 75 g oral glucose tolerance test (OGTT) at 6–12 weeks postpartum to identify women who have retained glucose intolerance or developed overt type 2 diabetes. If the 6–12 week OGTT is normal, HbA1c or OGTT should be repeated every 1–3 years. Breastfeeding reduces future T2DM risk and should be encouraged. The 6-week postnatal review is the trigger point for this test — add it to the investigation order at the visit.
What is postpartum psychosis and how is it different from baby blues?

Baby blues affect the majority of new mothers — typically peaks at day 3–5 after birth, is characterised by weeping, irritability, and emotional lability, and resolves spontaneously within 2 weeks without specific treatment. Postnatal depression is distinct — it typically develops over weeks to months, involves persistent low mood, loss of interest, poor sleep (beyond infant-related disruption), guilt, worthlessness, and sometimes intrusive thoughts about harming the baby. It affects approximately 15% of mothers and requires active treatment. Postpartum psychosis is a psychiatric emergency affecting 1–2 per 1,000 women — usually within the first 2 weeks after birth. Features include rapid onset hallucinations, delusions, severe mood swings, disorganised behaviour, and sometimes infanticidal ideation. Immediate referral to perinatal psychiatry and potential mother–baby unit admission is required.

Source quality

Sources grouped by evidence tier. AU primary tier first; international where AU is silent or lagging; named-author reconstruction where guidelines have not yet caught up. How tiers work.

T1 AU primary 14 sources