What are the discharge instructions for a new mother after a normal vaginal delivery or cesarean section (C-section)?

Discharge Instructions for New Mothers

All new mothers should receive standardized written discharge instructions covering infant care, maternal recovery, warning signs of complications, and scheduled follow-up within 24-72 hours of discharge, regardless of delivery mode. 1

Core Discharge Education Components

Infant Care Instructions

Every mother must receive education on the following before discharge 1:

• Breastfeeding benefits and technique - including proper latch, positioning, and signs of adequate milk transfer 1
• Normal urination and stooling patterns - what frequency to expect in the first days 1
• Umbilical cord care, skin care, and genital hygiene - specific cleaning instructions 1
• Temperature assessment - how to properly use a thermometer and what temperatures require medical attention 1
• Jaundice recognition - yellowing of skin/eyes as a warning sign requiring immediate evaluation 1
• Infant safety protocols - appropriate car seat use, supine sleep positioning only, and avoiding co-sleeping 1

Maternal Recovery Instructions

For Vaginal Delivery

• Activity resumption - previously active women can continue their pre-pregnancy activity levels gradually, while previously inactive women should start slowly with a few minutes daily and progress to 150 minutes/week of moderate activity 1
• Perineal care - specific instructions for managing perineal damage if present 1

For Cesarean Section

Women who had cesarean delivery require specific additional instructions 1:

• Wound care and infection signs - since >80% of surgical site infections (occurring in ~10% of patients) develop after discharge, mothers must know to watch for fever, foul-smelling discharge, increasing redness, or wound separation 1
• Activity restrictions - no lifting heavier than the baby for at least 6 weeks; avoid pulling up from lying to sitting position 1
• Exercise timeline - resume physical activity at 8-12 weeks (versus 4-8 weeks for vaginal delivery); delay abdominal exercises until 4 months postpartum; wait 3-4 months before high-impact exercise 1
• Pain management - continue multimodal analgesia with scheduled paracetamol and NSAIDs, which are safe for breastfeeding 1
• Diet - regular diet immediately, with adequate fiber to prevent constipation and extra servings of milk, fruit, vegetables, and calories to support breastfeeding 1

Warning Signs Requiring Immediate Medical Attention

Mothers must be instructed to seek care immediately for 1:

• Heavy vaginal bleeding - soaking more than one pad per hour
• Fever - temperature >38°C (100.4°F), especially with foul-smelling discharge suggesting endometritis
• Severe abdominal pain - may indicate retained placental tissue or cesarean scar complications
• Chest pain or shortness of breath - concerning for pulmonary embolism
• Severe headache with visual changes - may indicate postpartum preeclampsia
• Signs of postpartum depression - persistent sadness, inability to care for infant, thoughts of harm

Mandatory Follow-Up Care

Infant Follow-Up

For infants discharged before 48 hours after delivery, an appointment must be scheduled for examination within 48 hours of discharge - if this cannot be ensured, discharge should be deferred 1. This visit should 1:

• Assess infant weight, hydration, jaundice, and general health
• Observe breastfeeding technique directly
• Review stool and urine patterns
• Screen for maternal postpartum depression
• Verify the medical home is established with emergency contact information

Maternal Follow-Up

• Establish a medical home for both mother and infant with clear instructions on how to reach providers and schedule appointments 1
• Schedule postpartum visit - typically at 6-8 weeks, but earlier if complications arise 1

Risk Factor Assessment Before Discharge

Discharge should be delayed or a safety plan established when the following risk factors are present 1:

• Untreated parental substance use or positive toxicology screens
• History of child abuse or neglect by any anticipated caregiver
• Parental mental illness
• Lack of social support, especially for single first-time mothers
• No fixed home address
• History of domestic violence during pregnancy
• Adolescent mother with other risk factors
• Barriers to follow-up care (no transportation, no phone access, language barriers)

Critical Pitfalls to Avoid

• Never assume fertility protection - counsel that ovulation can return before 6 weeks postpartum even without menstruation 2
• Never perform blind digital examination before excluding placental abnormalities or vascular complications in women with postpartum bleeding 2
• Do not delay addressing maternal concerns - 40% of women experience uncertainty in the postpartum period, most commonly about breastfeeding 3
• Avoid aggressive curettage if retained products require removal, as the cesarean scar is thinned and at risk for perforation 2

Medication Safety

• NSAIDs and paracetamol are safe and recommended for postpartum pain management while breastfeeding 1
• Tdap vaccination should be administered to the mother immediately postpartum if not previously received 1
• Influenza vaccination should be given if delivering during flu season and not previously immunized 1

Physical Activity and Sedentary Behavior

• Minimize prolonged sitting - take breaks every 20-30 minutes to walk or perform light activity 1
• Early mobilization is recommended after both vaginal and cesarean delivery 1
• Adequate hydration and nutrition are essential when resuming physical activity, especially for breastfeeding mothers 1