The six-week visit is not a finish line
ACOG says that in its own words, and has said it since 2018.
You get one date after a birth. Six weeks. Nobody says out loud what it is supposed to mean, so it collects a meaning of its own: by then you will be back.
That model was dropped by ACOG in 2018. Here is the sentence, word for word:
Rather than an arbitrary '6-week check,' the American College of Obstetricians and Gynecologists recommends that the timing of the comprehensive postpartum visit be individualized and woman centered.
And here is the sentence that this whole part of the guide rests on:
However timed, the comprehensive postpartum visit is a medical appointment; it is not an 'all-clear' signal. Obstetrician-gynecologists and other obstetric care providers should ensure that women, their families, and their employers understand that completion of the comprehensive postpartum visit does not obviate the need for continued recovery and support through 6 weeks postpartum and beyond.
What ACOG asks for instead is contact within the first three weeks, then care as often as you need it, ending with a full visit no later than twelve weeks. That is more contact than the single visit you were expecting, and the last of it is not a discharge.
ACOG also spells out why this matters so much in the United States. It cites a federal family and medical leave survey: Today, however, 23% of employed women return to work within 10 days postpartum and an additional 22% return to work between 10 days and 40 days.
Read that next to the sentence above. Most women are back at work long before anyone would claim they are recovered.
The researchers who put the phrase fourth trimester into use said it this way: After childbirth, most American women are not scheduled for follow-up care for 6 weeks, and this visit is poorly attended. Many new mothers feel unprepared for the common health issues they encounter and are uncertain of whom to contact.
"If I still have this at six weeks, is that a reason to be seen again, or a reason to wait?"
"Who is the person I call between visits?"