What are the recommended follow-up procedures during the first post-partum (after birth) visit?

Recommended Follow-up During First Postpartum Visit

The first postpartum visit should occur within 3 weeks after delivery, with a comprehensive assessment completed by 12 weeks postpartum, focusing on physical health, mental health, breastfeeding support, contraception planning, and chronic disease management. 1, 2

Timing of Postpartum Care

• Initial contact within 3 weeks postpartum (in person or by phone) 1
• Comprehensive assessment no later than 12 weeks postpartum 1
• For women with hypertensive disorders, blood pressure check within 7 days of delivery 3
• For women with gestational diabetes, 75g two-hour oral glucose tolerance test between 4-12 weeks postpartum 2, 3

Physical Health Assessment

• Vital signs with special attention to blood pressure 2
• Uterine involution assessment 2
• Surgical wound check if applicable (cesarean delivery or episiotomy) 2
• Pelvic exam to evaluate healing and pelvic floor status 1
• Screening for urinary or fecal incontinence (affects 8-12% of postpartum women) 2
• Assessment for pelvic organ prolapse (occurs in 1.4-4.5% of women after childbirth) 2
• Complete blood count only if symptomatic anemia or significant bleeding 4

Mental Health Screening

• Postpartum depression screening (affects 9.5-20.1% of women) 2
• Anxiety assessment (affects approximately 16% of women) 2
• Evaluation of mother-child bonding 2
• Assessment of family adjustment and support systems 2
• Screening for intimate partner violence 1

Breastfeeding Support

• Evaluation of breastfeeding technique and challenges 2
• Education that breastfeeding does not impact quality or quantity of milk during physical activity 5
• Guidance on managing breast engorgement through massage, continued breastfeeding, and pain relief 6
• Reassurance that women can safely engage in physical activity while breastfeeding 5

Contraception and Family Planning

• Review contraceptive options and prescribe effective method 1
• If breastfeeding, progestin-only methods are preferred initially 2
• Combined hormonal contraceptives not recommended before 6 weeks postpartum due to thromboembolism risk 4
• Discussion of birth spacing and future pregnancy planning 1
• Consideration of immediate postpartum long-acting reversible contraception if not already placed 5

Chronic Disease Management

• For women with gestational diabetes: counsel on 10-fold higher risk of developing type 2 diabetes and recommend weight loss 2
• For women with hypertensive disorders: establish plan for long-term cardiovascular risk reduction 2
• Transition of care to primary care provider for ongoing management of chronic conditions 1

Physical Activity Guidance

• By 10 months postpartum, encourage return to regular physical activity based on pre-pregnancy fitness level 2
• For previously active women: continue usual physical activity 2
• For previously inactive women: aim for at least 150 minutes/week of moderate intensity aerobic activity 2
• Limit sedentary behavior with breaks every 20-30 minutes during prolonged sitting 2
• Pelvic floor rehabilitation for persistent urinary incontinence at 3 months postpartum 4

Immunization Status

• Review vaccination status and update as needed 2
• Recommend measles-mumps-rubella, varicella, HPV, and Tdap vaccines for non-immune individuals 6
• Avoid smallpox and yellow fever vaccines 6

Common Pitfalls to Avoid

• Failing to screen for postpartum depression, which affects up to 20% of women 2, 7
• Missing the opportunity to diagnose and manage chronic conditions that manifested during pregnancy 3
• Delaying contraception counseling (should start effective contraception no later than 21 days after delivery) 4
• Overlooking the need for close follow-up in women with pregnancy complications 1
• Treating postpartum care as a single visit rather than an ongoing process 1

The postpartum period represents a critical transition time that sets the stage for long-term maternal and infant health. A comprehensive, systematic approach to the first postpartum visit helps ensure that all important aspects of maternal health are addressed and appropriate follow-up is arranged.