The postpartum period can be challenging for many patients. Adjustments to an altered sleep schedule, pain management, medical follow-up and learning to breastfeed are only a few of the factors that can leave women and their partners overwhelmed. A clinician’s guidance can encourage patients throughout this trying time. The following are some issues frequently encountered in the postpartum period and guidance on how providers can help make a difference.
set your patient’s expectations
It is vital that patients be given a realistic idea of the discomfort they may experience following childbirth. Research suggests that an emerging factor in maternal death is abuse of prescription pain medications. Patients should be given realistic expectations of cessation for discomfort, a clear picture of their pain management options and be assessed for adequacy of pain control. If necessary, patients should be referred to a pain specialist. Other topics that are frequently overlooked are education on lochia pattern, incontinence, constipation and the importance of restoring tone to the pelvic floor through exercise.
the importance of the postpartum visit
Immediately following delivery, the importance of the postpartum visit should be stressed with the patient. During the postpartum visit, discuss issues that may complicate future pregnancies — diabetes, hypertension, preterm birth, intrauterine growth restriction, the possibility of vaginal birth if she has had a cesarean delivery, the need for immunizations for her and her family members and the importance of early entry into prenatal care with her next pregnancy.
Clinicians should also assess women for postpartum depression, adequacy of infant bonding and the progress of wound healing.
Breastfeeding should be assessed during the postpartum visit and referral to a lactation consultant should be made if there is any concern about the mothers’ comfort or adequacy of the baby’s latch. The Healthcare Provider’s Guide to Breastfeeding is a smartphone app that has been developed to support providers.
Birth spacing should be discussed with the patient during the postpartum visit and selection of a birth control method should be based on her current lifestyle and circumstances. It’s also important to discuss resuming coitus with both partners if possible, so that expectations can be clear and partners can be prepared for the possible challenges of finding time for intimacy with a new baby.
know before they go
Too often parents are discharged from the hospital without a clear understanding of how to care for themselves and their new baby, how to recognize danger signs in the baby and when to call for help. Parents must be considered partners in discharge care planning. Coordination with the primary care provider and linkage to services is essential in assuring follow-up during this overwhelming and confusing time for parents. In 2009, the Vermont Oxford Network developed “Improving Discharge Management”, a quality improvement kit to help with discharge quality care.
Recognizing Perinatal Depression
Many new mothers experience significant emotional changes following the birth of their children. Perinatal Depression is a common problem — both during and following pregnancy — affecting an estimated one in eight new moms. Health care professionals must be adept at recognizing and addressing its signs.
Perinatal depression is most common in women who:
- Are younger than 20 years old
- Have had PPD or other mood disorders previously
- Have a family history of depression
- Are experiencing additional stressful events in their lives (death or illness of a loved one, financial problems, domestic abuse, personal health problems, drug use, etc.)
The Edinburgh Postnatal Depression Scale (EPDS) is a validated tool for assessment of PPD and is easy to administer. The questionnaire consists of 10 questions that the mother completes herself. Instructions for scoring are attached to the tool — a score of 10 or greater warrants further investigation. The tool is available for reproduction without permission as long as the authors’ names are included. A copy of EPDS can be downloaded here.
Treating Perinatal Depression
If you find that your patient is likely experiencing PPD, your treatment options include the referral to counseling, support groups or medication as appropriate.
You can get more information about treating postpartum depression from the March of Dimes.
For additional resources and tools to support you in your assessment and treatment of perinatal depression, click here.
Our Men’s and Women’s Heath Tips card for Spanish-speaking audiences outlines simple tips for daily wellness.