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 birthing person 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 birthing people with medical complications or those at risk for postpartum depression, such as:

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

All birthing people, 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 their recent history and current symptoms. All postpartum patients 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. All appropriate contraceptive methods should be discussed and an initiation plan established. An appropriate physical exam should be performed including, at a minimum, vital signs and examination of the breasts, abdomen, pelvis, perineum, and extremities.

All pregnancy and post-partum problems needing follow up should be addressed (e.g., hypertension, diabetes, incomplete vaccination series).

  1. Wisner KL, et al. Postpartum depression. New England Journal of Medicine. 2002;347(3):194–99.
  2. Screening for perinatal depression. ACOG Committee Opinion No. 757. November 2018. American College of Obstetricians and Gynecologists.
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