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OB Guideline 31: Postpartum Care

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In-Hospital Care

Patients should be seen each day of their hospitalization by an obstetrical provider. This person assesses for medical complications and psychosocial issues, addresses any questions or concerns, and arranges for discharge.

Each institution shall have a process or program to instruct each patient regarding normal postpartum events. These instructions should include care of the breasts, perineum, bladder, the incision (if appropriate), and signs of complications. Instruction about infant care, infant feeding (including the benefits of breastfeeding), and subsequent maternal and newborn medical examinations should also be included. Verbal instructions should be supplemented with written instructions and reinforced by providers. The need for and timing of follow up should be clearly communicated to the patient.

Plans for management or referral of ongoing problems should be instituted when appropriate, including evaluation of problems identified during the pregnancy. Vaccine status should be assessed and vaccination for TdaP, influenza, rubella and varicella should be initiated if indicated. Contraception should be discussed and a plan established with the patient.

After Discharge 

Consideration should be given to an early follow-up postpartum visit for women with medical complications or those women at risk for postpartum depression, such as:

  • past episodes of depression,
  • family history of mood disorder, or
  • unusually stressful life events.1

All women, including those with an earlier visit (as above), should be advised to have a visit four to eight weeks postpartum. That visit should include a complete review of the pregnancy and events that occurred during labor, delivery, and the immediate postpartum period for the outpatient medical record if not already completed. The patient should be asked about her recent history and current symptoms. All postpartum women should be assessed for and counseled about postpartum depression and domestic violence and should be informed about support services offered through the institution or community.2  Use of one of the validated screening tools for postpartum depression may be helpful. An appropriate physical exam should be performed including, at a minimum, vital signs and examination of the breasts, abdomen, pelvis, perineum, and extremities.


 

  1. Wisner KL, et al. Postpartum depression. N Eng J Med. 2002;347(3):194–99.
  2. Screening for depression during and after pregnancy. ACOG Committee Opinion No. 453. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2010;115:394–95.

 

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April 30, 2014
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