Almost every woman in the UK is offered a postnatal check at around six to eight weeks after birth. Most come away having been told everything is fine.

That is usually accurate as far as it goes. The difficulty is how far it goes — and the gap between what the appointment actually assesses and what most women assume it has assessed.

What the check is designed to do

The six-week check is a screening appointment. Its purpose is to identify complications: high blood pressure, signs of infection, wound problems, anaemia, and — importantly — postnatal depression and anxiety. It also covers contraception and, usually, your baby's development.

Those are all worth doing. The appointment does that job reasonably well.

What it is not designed to do is assess whether your body has recovered from nine months of pregnancy and the birth itself.

What it does not usually include

In a typical appointment lasting around ten minutes, and covering everything above, the following are rarely assessed at all:

  • Pelvic floor function. Whether you can contract, how strongly, for how long, whether you can relax again, and whether you are doing it correctly at all.
  • Abdominal separation. Whether the gap between your abdominal muscles has closed, and — more importantly — whether you can generate tension across it.
  • Prolapse. Whether there is any descent of the vaginal walls, uterus or bladder, and if so to what degree.
  • Scar tissue. Whether a caesarean scar is tethered, or a perineal tear or episiotomy has healed with a tender or restricted scar.
  • Bowel function. Whether you can control wind and stool — particularly significant if you had a third or fourth degree tear.
  • Readiness to return to exercise. Whether your pelvic floor and abdominal wall can tolerate running, lifting or impact.

So being told "everything is fine" at six weeks means no obvious complication was found. It does not mean your pelvic floor has recovered, and it was probably never examined.

The symptoms women are told are normal

Common, yes. Normal in the sense of "acceptable and untreatable", no. Every one of these responds to treatment:

  • Leaking urine when you cough, sneeze, laugh, lift your baby or exercise
  • A feeling of heaviness, dragging or a bulge, especially by the end of the day
  • A gap in your abdominal muscles that has not closed, or a "pooch" that will not shift
  • Doming or coning along your midline when you sit up or lift
  • Pain with intercourse
  • Difficulty controlling wind, or urgency to open your bowels
  • Back pain that started after the birth and has not settled
  • Being unable to run without leaking or heaviness

The distinction matters because "common" gets translated into "nothing can be done", and women then wait years. Surveys of women with urinary incontinence repeatedly find average delays before seeking help measured in years rather than months.

What a postnatal physiotherapy assessment adds

A dedicated postnatal assessment is an hour rather than ten minutes, and it looks at recovery rather than screening for complications.

It covers your history — how the pregnancy and birth went, any intervention or tearing, how feeding is going, your bladder and bowel habits, and what you actually want to get back to. Then how you breathe, how your ribcage and pelvis sit relative to each other, and how pressure moves through your abdomen when you lift, which is usually where the mechanical cause of persistent symptoms shows up.

It includes measurement of any abdominal separation at several points along the midline, and assessment of the tension you can generate across it — which is far more clinically useful than the width of the gap. Pelvic floor assessment is offered, including internal examination if you want it, because that is the most accurate way to establish strength, endurance, coordination, prolapse grade and scar tissue. It is entirely optional, and external assessment with real-time biofeedback is an effective alternative.

You leave with a written, individualised programme rather than a generic handout.

When to go

Six to twelve weeks after birth works well for a routine check. That allows initial tissue healing to settle while still being early enough to correct unhelpful patterns before they become habits.

Go sooner if you have pain that is worsening rather than easing, a wound that feels wrong, sudden onset of incontinence, or a feeling of something bulging.

And there is no upper limit. Pelvic floor muscle training improves strength and reduces symptoms regardless of how long ago you gave birth, because muscle responds to appropriate load rather than to the calendar. A significant proportion of postnatal patients seen in clinic are several years or more past the birth in question — including women now approaching menopause, who find symptoms they had learned to manage are returning as oestrogen falls.

Seek medical advice rather than physiotherapy if

You have heavy bleeding, fever, a wound that is hot or discharging, calf pain or swelling, or a severe headache. Contact your midwife, GP or NHS 111. Physiotherapy is for recovery, not for acute complications.

The short version

The six-week check is a screening appointment that does its job. It is not a recovery assessment, and it was never intended to be one. If you are still leaking, still feeling heaviness, still have a gap, still find sex painful, or still cannot run — you were not given a clean bill of health on any of those things. Nobody checked.