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.

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.

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.

Resources

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.

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