Discharge Instructions for Mothers with Newborns
Before discharge, mothers must receive comprehensive education on infant feeding, safety protocols, warning signs requiring immediate medical attention, and have confirmed follow-up appointments scheduled within 3-5 days for the newborn and 6-8 weeks for maternal care. 1, 2, 3
Infant Feeding Education
Breastfeeding Support
- A trained caregiver must directly observe at least one complete breastfeeding session before discharge, documenting successful latch, proper positioning, effective swallowing, and infant satiety. 1, 2, 3
- Mothers should understand that breastfeeding on demand is recommended, with exclusive breastfeeding for 4-6 months providing decreased cardiovascular disease, infection rates, atopic conditions, and childhood obesity while improving cognitive development. 1, 4
- Provide contact information for lactation support services and ensure mothers know how to access help if feeding concerns arise. 1, 2
Feeding Adequacy Indicators
- Educate mothers that newborns should have at least 6 wet diapers and 3-4 stools daily by day 4-5 of life as evidence of adequate intake. 1, 2, 3
- Explain normal feeding frequency (8-12 times per 24 hours for breastfed infants) and signs of adequate milk transfer including audible swallowing and infant appearing satisfied after feeds. 2, 3
Critical Safety Instructions
Sleep Safety
- Infants must sleep on their backs (supine position) on a firm surface without soft bedding, pillows, or toys. 1, 3
- Co-sleeping is dangerous and must be avoided—room-sharing without bed-sharing is recommended. 1, 3
Car Seat Safety
- Verify parents have a properly installed car seat and understand it should only be used for travel, not for positioning at home. 1, 3
- Ensure parents received hands-on demonstration of correct car seat use before discharge. 3
Temperature Monitoring
- Teach parents to take axillary (armpit) temperature and provide a thermometer if needed. 2, 3
- Instruct that any fever ≥38°C (100.4°F) in a newborn requires immediate medical evaluation. 2, 3
Newborn Care Basics
Routine Care
- Demonstrate and have parents practice umbilical cord care (keeping it clean and dry), diaper changes, and basic skin care. 2, 3
- Review normal newborn genital care and hygiene practices. 2, 3
Jaundice Recognition
- Teach mothers to assess for jaundice by pressing on the infant's skin in good lighting—yellowing that extends below the chest or to extremities requires immediate evaluation. 1, 2
- Explain that jaundice typically peaks at days 3-5 and adequate feeding helps prevent severe hyperbilirubinemia. 2, 5
Warning Signs Requiring Immediate Medical Attention
Infant Emergency Signs
Instruct mothers to seek immediate care if the infant develops: 2, 3
- Fever ≥38°C (100.4°F) or temperature <36.5°C (97.7°F)
- Poor feeding, refusal to eat, or weak suck
- Lethargy, difficulty waking, or decreased responsiveness
- Rapid or labored breathing, grunting, or blue discoloration
- Increasing jaundice, especially below the chest
- Persistent vomiting (especially bilious/green) or abdominal distention
- Fewer than 6 wet diapers by day 4-5
Maternal Emergency Signs
Mothers should seek immediate care for: 3, 6
- Heavy vaginal bleeding (soaking more than one pad per hour)
- Fever >38°C (100.4°F)
- Severe abdominal pain
- Chest pain or shortness of breath
- Severe headache with visual changes
- Foul-smelling vaginal discharge
- Painful, red, swollen areas in the breast (possible mastitis)
Maternal Recovery Instructions
Cesarean Delivery Specific Care
- Provide detailed wound care instructions including keeping the incision clean and dry, watching for signs of infection (increasing redness, warmth, drainage, wound separation). 3
- Explain activity restrictions and gradual return to normal activities. 3
Pain Management
- NSAIDs (ibuprofen) and acetaminophen are safe and effective for postpartum pain while breastfeeding and should be used as needed. 3
- For women with preeclampsia history, consider alternative analgesia first due to potential NSAID-related hypertension, though the risk is debated. 1
Physical Activity
- Previously active women can gradually resume pre-pregnancy activity levels, while previously inactive women should start with a few minutes daily and progress toward 150 minutes weekly of moderate activity. 3
- Encourage early mobilization and taking breaks from prolonged sitting every 20-30 minutes. 3
- Sexual activity, housework, driving, stair climbing, and lifting can resume when the mother feels comfortable. 7
Mandatory Follow-Up Appointments
Newborn Follow-Up
- Schedule the newborn visit within 3-5 days (72-120 hours) after discharge, with earlier visits (48-72 hours) required for infants discharged before 48 hours of age. 1, 2, 3
- This visit will assess weight (expected weight loss is up to 7-10% of birth weight), hydration, jaundice, feeding effectiveness, and review all screening test results. 1, 2
Maternal Follow-Up
- Schedule the maternal postpartum visit at 6-8 weeks after delivery with an obstetrician, gynecologist, general practitioner, or midwife. 3, 4
- Initial contact should occur within 3 weeks postpartum (in person or by phone) to address acute needs and concerns. 6
- Women with hypertensive disorders require blood pressure check within 7 days of delivery. 1, 6
- Women with gestational diabetes need a 75-gram 2-hour fasting oral glucose tolerance test between 4-12 weeks postpartum. 6
Laboratory Results and Screening Review
Results to Review Before Discharge
- Confirm completion and review results of newborn metabolic screening (repeat if performed before 24 hours of milk feeding), hearing screening, and critical congenital heart disease screening. 1, 2, 5
- Review maternal laboratory results including syphilis status, hepatitis B surface antigen, and HIV status. 2
- Document blood type and Rh status for both mother and infant, and verify anti-D immune globulin administration if mother is Rh-negative and infant is Rh-positive. 5, 7
Immunizations
Maternal Vaccinations
- Administer Tdap vaccine immediately postpartum if not previously received during pregnancy. 3
- Give influenza vaccine if delivering during flu season and not previously immunized. 3
- Provide measles-mumps-rubella (MMR) and varicella vaccines to non-immune mothers before discharge. 7
Contraception Counseling
Timing and Options
- Effective contraception should be started by 21 days postpartum for women not desiring closely-spaced pregnancies, and ideally prescribed before maternity discharge. 4
- Combined hormonal contraceptives should be avoided before 6 weeks postpartum due to venous thromboembolism risk. 4
- Progestin-only contraceptives are recommended for breastfeeding women and can be started immediately. 8
- Intrauterine devices placed immediately postpartum result in higher utilization at 6 months compared to delayed outpatient placement. 7
Psychosocial Assessment and Support
Mental Health Screening
- All women require biopsychosocial assessment including screening for postpartum depression during the postpartum period. 1, 6
- Screen for intimate partner violence, substance use, and assess adequacy of social support systems. 2, 6
- Behavioral educational interventions and physical activity are protective against postpartum mood disorders. 7
High-Risk Situations
Document and address risk factors including: 2
- Untreated parental substance use
- History of child abuse or neglect
- Mental illness in the home
- Lack of social support (particularly single first-time mothers)
- No fixed home address
- History of domestic violence
- Adolescent mother
- Barriers to accessing follow-up care
When risk factors are present, ensure a safety plan involving social services or child protective services is established before discharge. 2
Medical Home Establishment
Continuity of Care
- Verify that both mother and infant have identified a physician-directed source of continuing health care (medical home) with clear instructions on how to reach providers for questions or emergencies. 1, 2, 3
- Provide written contact information including after-hours emergency numbers. 2, 3
- Ensure parents understand the plan for routine preventive care, immunizations, and periodic evaluations. 1, 2