Postpartum Education

Aka: Postpartum Education

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II. Precautions

  1. Vaginal Bleeding
    1. Expect lochia for 3-4 weeks
    2. Return to clinic for >4 pads/hour for 4 hours
    3. No tampons for 2-4 weeks to allow Laceration healing
  2. Avoid Driving for 1-2 weeks after delivery
    1. "Brake hesitancy" occurs after delivery
    2. Results in higher risk of Motor Vehicle Accidents
    3. Required by state law in some locales (e.g. California)
  3. Tub Baths
    1. Normal Spontaneous Vaginal Delivery Only
    2. Do not soak Cesarean incision for 1-2 weeks
  4. Activity: "if it hurts, don't do it"
    1. Limited lifting to 10 pounds for first 6 weeks
  5. Sex
    1. Abstain from intercourse for 2-4 weeks
      1. Diminished pain
      2. Decreased risk of infection
    2. Use K-Y lubricant jelly for poor lubrication

III. Management: Contraception Options

  1. Abstention from intercourse as above
  2. Condoms with foam until 6 week postpartum visit
  3. Oral Contraceptives
    1. Do not start before 3 weeks postpartum
      1. Risk of provoking Hypercoagulable state
    2. Breast Feeding women
      1. Potential for decreased milk let-down
      2. Do not start before milk completely established
        1. ACOG recommends waiting until after 6 weeks
        2. WHO recommends waiting until after 6 months
      3. Consider Minipill (Progestin-Only Pill)
        1. Preferred hormonal contraceptive per ACOG
        2. Efficacy lower than combined Oral Contraceptive
  4. Depo Provera
  5. Intrauterine Device
    1. Has often been delayed until after 6 week postpartum visit
    2. Consider Intrauterine Device placement within 10 minutes of placental delivery
      1. Lopez (2015) Cochrane Database Syst Rev (6): CD003036 +PMID:26115018 [PubMed]

IV. Management: Miscellaneous

  1. Bowel Care
    1. Colace 100 mg qd-bid until first stool
    2. Call if >5 days without Bowel Movement
  2. Hemorrhoids
    1. Increase Fiber intake while maintaining hydration
      1. Dietary Fiber (e.g. Oatmeal, Fruits, Vegetables)
    2. Fluid Intake exceeds 64 ounces per day
    3. Minimize wiping
    4. Consider topical agents
      1. Tucks pads (Witch Hazel)
      2. Anusol HC in morning and bedtime
      3. Proctofoam
      4. Epifoam
      5. Dermoplast
  3. Analgesia
    1. Ibuprofen 600 mg orally every 6 hours as needed
    2. Tylenol 1000 mg orally every 6 hours as needed
    3. Oxycodone 5 mg orally every 4 hours for breakthrough pain
      1. Exercise caution with postpartum Opioids
      2. Limit to short course (2% of postpartum patients become longterm users)
      3. Peahl (2019) JAMA Netw Open 2(7): e197863 [PubMed]
  4. Edema
    1. Anticipate resolution within 1 week of birth
    2. Unilateral Edema requires immediate venous Ultrasound to evaluate for deep venous thrombosis
  5. Breast Feeding
    1. See Lactation
    2. Recommended as best feeding method for most infants
    3. Frequent feedings: every several hours on demand
    4. Lanolin prn for cracked nipples
  6. Breast Engorgement for those Formula Feeding
    1. See Lactation Suppression
  7. Postpartum Incontinence
    1. See Stress Incontinence
    2. May occur in as many as 20 to 30% postpartum
    3. Perform Kegel Exercises 80-100 times daily
      1. Kegel Exercises may be needed up to 1 year postpartum
    4. References
      1. Glazener (2001) BMJ 323:593-6 [PubMed]

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