What are the components of postpartum (post-partum) care and potential treatments?

From the Guidelines

Postpartum care should prioritize comprehensive support for mothers during the 6-8 weeks after childbirth, focusing on physical recovery, mental health, and addressing complications, with an emphasis on extending care beyond 6 weeks postpartum to address medium-to-long term consequences of labour and childbirth. This approach is supported by the most recent evidence from 1, which highlights the importance of good-quality care at birth, systematic clinical assessments, screening of postpartum women to identify those at risk, and prompt management.

Key Components of Postpartum Care

• Regular check-ups at 1-2 weeks and 6 weeks postpartum to monitor physical recovery, mental health, and address complications
• Physical recovery focusing on uterine involution, perineal healing, and management of lochia (vaginal discharge)
• Breastfeeding support, with potential issues like engorgement treated with warm compresses, gentle massage, and proper latching techniques
• Mental health screening for postpartum depression using tools like the Edinburgh Postnatal Depression Scale, with treatment options including counseling, support groups, and medications like sertraline (50-200mg daily) or fluoxetine (20-60mg daily) when indicated
• Contraception counseling should be provided before the 6-week visit, as ovulation can occur as early as 4 weeks postpartum, and should address the safety, effectiveness, accessibility, affordability, and acceptability of the full range of options, as recommended by 1

Medium-to-Long Term Consequences of Labour and Childbirth

• Dyspareunia, low back pain, urinary incontinence, anxiety, anal incontinence, depression, tokophobia, perineal pain, and secondary infertility are common conditions that occur as a consequence of labour and childbirth, as reported by 1
• These conditions can have severe effects on women’s health and wellbeing, and require prompt identification and management
• Broader and more comprehensive health service opportunities are needed to address these conditions, which should extend beyond 6 weeks postpartum and embrace multidisciplinary models of care, as recommended by 1

Counseling and Support

• Counseling should address a woman’s physical health after pregnancy, including signs and symptoms of both immediately life-threatening conditions, such as hemorrhage and sepsis, and common but less severe physical changes, such as incontinence and fatigue, as recommended by 1
• Mental health conditions, such as postpartum depression, anxiety, and substance use disorder, should be addressed through counseling and connection to community resources, as recommended by 1
• Women should be counseled about risks and prevention of subsequent pregnancies, including the risks of a short interpregnancy interval, and should receive counseling about the management of chronic conditions during the interpregnancy period, as recommended by 1

From the FDA Drug Label

Oxytocin Injection, USP (synthetic) is indicated to produce uterine contractions during the third stage of labor and to control postpartum bleeding or hemorrhage. To control postpartum bleeding, 10 to 40 units of oxytocin may be added to 1,000 mL of a nonhydrating diluent and run at a rate necessary to control uterine atony 1 mL (10 units) of oxytocin can be given after delivery of the placenta.

Postpartum care involves the use of oxytocin to produce uterine contractions during the third stage of labor and to control postpartum bleeding or hemorrhage.

• The treatment options for postpartum bleeding include:
  • Intravenous infusion of oxytocin at a rate necessary to control uterine atony
  • Intramuscular administration of 1 mL (10 units) of oxytocin after delivery of the placenta The dosage of oxytocin is determined by uterine response, and the infusion rate should be adjusted accordingly 2, 2.

From the Research

Postpartum Care

• Postpartum care is crucial for preventing and managing postpartum hemorrhage (PPH), which is a common complication of childbirth and a leading cause of maternal deaths worldwide 3, 4, 5, 6.
• Active management of the third stage of labor, including the administration of oxytocin, can help reduce the incidence of PPH 3, 4, 5.
• Routine episiotomy should be avoided to decrease blood loss and the risk of anal laceration 4.

Potential Treatments

• Treatment of PPH typically involves identifying the underlying cause, estimating blood loss, and initiating a resuscitation protocol with fluid replacement, blood transfusion, and close monitoring of the woman 3.
• Uterine massage, bimanual uterine compression, and administration of uterotonics are recommended for uterine atony, with minor discrepancies regarding optimal regimens 3.
• Intrauterine balloon tamponade or other surgical interventions may be necessary if initial measures fail 3.
• Massive transfusion protocols can help minimize morbidity and mortality associated with PPH, although guidelines are not consistent 3, 4.

Prevention and Management

• The Four T's mnemonic (Tone, Trauma, Tissue, and Thrombin) can be used to identify and address common causes of PPH 4.
• Rapid team-based care and standardized bundles of care can help reduce morbidity and mortality associated with PPH 4, 6.
• Screening for postpartum depression and providing breastfeeding support and counseling are also important aspects of postpartum care 7.