Baby Feeding Safety Guidelines to Follow and if Not Followsed Wgat Could Occue

Number 736 (Replaces Committee Opinion Number 666, June 2016. Reaffirmed 2021)

Presidential Task Force on Redefining the Postpartum Visit

Committee on Obstetric Practice

The Academy of Breastfeeding Medicine, the American College of Nurse-Midwives, the National Association of Nurse Practitioners in Women'due south Wellness, the Club for Academic Specialists in General Obstetrics and Gynecology, and the Club for Maternal–Fetal Medicine endorse this document. This Committee Opinion was developed by the American College of Obstetricians and Gynecologists' Presidential Task Force on Redefining the Postpartum Visit and the Committee on Obstetric Practice in collaboration with task force members Alison Stuebe, Physician, MSc; Tamika Auguste, MD; and Martha Gulati, Doc, MS.

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Abstract: The weeks following birth are a disquisitional menses for a adult female and her infant, setting the stage for long-term health and well-beingness. To optimize the health of women and infants, postpartum care should become an ongoing procedure, rather than a single encounter, with services and back up tailored to each woman's individual needs. It is recommended that all women have contact with their obstetrician–gynecologists or other obstetric care providers inside the beginning 3 weeks postpartum. This initial assessment should exist followed up with ongoing care as needed, concluding with a comprehensive postpartum visit no later than 12 weeks later on nativity. The comprehensive postpartum visit should include a total assessment of concrete, social, and psychological well-existence, including the following domains: mood and emotional well-existence; infant care and feeding; sexuality, contraception, and birth spacing; sleep and fatigue; concrete recovery from birth; chronic disease management; and health maintenance. Women with chronic medical conditions such as hypertensive disorders, obesity, diabetes, thyroid disorders, renal affliction, and mood disorders should be counseled regarding the importance of timely follow-upwardly with their obstetrician–gynecologists or principal care providers for ongoing coordination of care. During the postpartum menses, the woman and her obstetrician–gynecologist or other obstetric care provider should identify the health intendance provider who will assume primary responsibility for her ongoing care in her primary medical home. Optimizing care and support for postpartum families will require policy changes. Changes in the scope of postpartum intendance should be facilitated past reimbursement policies that back up postpartum care as an ongoing process, rather than an isolated visit. Obstetrician–gynecologists and other obstetric intendance providers should be in the forefront of policy efforts to enable all women to recover from nativity and nurture their infants. This Commission Opinion has been revised to reinforce the importance of the "fourth trimester" and to propose a new epitome for postpartum intendance.

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Recommendations and Conclusions

The American College of Obstetricians and Gynecologists makes the following recommendations and conclusions:

• To optimize the health of women and infants, postpartum intendance should become an ongoing process, rather than a single come across, with services and support tailored to each woman'south private needs.

• Anticipatory guidance should begin during pregnancy with development of a postpartum care program that addresses the transition to parenthood and well-adult female care.

• Prenatal discussions should include the woman'due south reproductive life plans, including desire for and timing of any futurity pregnancies. A woman's future pregnancy intentions provide a context for shared decision-making regarding contraceptive options.

• All women should ideally have contact with a maternal intendance provider within the first three weeks postpartum. This initial cess should be followed up with ongoing care equally needed, terminal with a comprehensive postpartum visit no subsequently than 12 weeks later on birth.

• The timing of the comprehensive postpartum visit should be individualized and woman centered.

• The comprehensive postpartum visit should include a full assessment of concrete, social, and psychological well-being.

• Women with pregnancies complicated by preterm birth, gestational diabetes, or hypertensive disorders of pregnancy should exist counseled that these disorders are associated with a higher lifetime risk of maternal cardiometabolic affliction.

• Women with chronic medical weather, such every bit hypertensive disorders, obesity, diabetes, thyroid disorders, renal disease, mood disorders, and substance use disorders, should exist counseled regarding the importance of timely follow-up with their obstetrician–gynecologists or chief care providers for ongoing coordination of intendance.

• For a woman who has experienced a miscarriage, stillbirth, or neonatal death, it is essential to ensure follow-upwardly with an obstetrician–gynecologist or other obstetric care provider.

• Optimizing care and back up for postpartum families volition require policy changes. Changes in the telescopic of postpartum intendance should be facilitated by reimbursement policies that support postpartum care every bit an ongoing procedure, rather than an isolated visit.

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Introduction

The weeks following birth are a disquisitional period for a adult female and her baby, setting the stage for long-term wellness and well-being. During this period, a woman is adapting to multiple concrete, social, and psychological changes. She is recovering from childbirth, adjusting to changing hormones, and learning to feed and care for her newborn 1. In add-on to being a time of joy and excitement, this "fourth trimester" tin can nowadays considerable challenges for women, including lack of sleep, fatigue, pain, breastfeeding difficulties, stress, new onset or exacerbation of mental health disorders, lack of sexual desire, and urinary incontinence 2 iii 4. Women also may need to navigate preexisting wellness and social issues, such every bit substance dependence, intimate partner violence, and other concerns. During this time, postpartum intendance often is fragmented amid maternal and pediatric health care providers, and advice across the transition from inpatient to outpatient settings is often inconsistent v. Home visits are provided in some settings; however, currently, most women in the Usa must independently navigate the postpartum transition until the traditional postpartum visit (4–vi weeks after delivery). This lack of attending to maternal health needs is of item concern given that more than one one-half of pregnancy-related deaths occur after the birth of the infant vi. Given the urgent demand to reduce astringent maternal morbidity and mortality, this Committee Opinion has been revised to reinforce the importance of the "4th trimester" and to propose a new prototype for postpartum intendance.

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Redefining Postpartum Care

Following birth, many cultures prescribe a thirty–40-day period of rest and recovery, with the woman and her newborn surrounded and supported by family and community members 7. Many agrestal cultures enshrine postpartum rituals, including traditional foods and support for day-to-day household tasks. These traditions have been sustained past some cultural groups, merely for many women in the United States, the six-week postpartum visit punctuates a flow devoid of formal or informal maternal support. Obstetrician–gynecologists and other women's wellness intendance providers are uniquely qualified to enable each woman to access the clinical and social resource she needs to successfully navigate the transition from pregnancy to parenthood.

To optimize the health of women and infants, postpartum care should go an ongoing procedure, rather than a single encounter, with services and support tailored to each woman'due south individual needs. Indeed, in qualitative studies, women have noted that there is an intense focus on women'south health prenatally but care during the postpartum period is infrequent and late 8. Rather than an arbitrary "vi-week bank check," the American College of Obstetricians and Gynecologists recommends that the timing of the comprehensive postpartum visit exist individualized and woman centered. To ameliorate meet the needs of women in the postpartum period, care would ideally include an initial assessment, either in person or by phone, inside the commencement iii weeks postpartum to accost acute postpartum issues. This initial assessment should be followed up with ongoing intendance as needed, concluding with a comprehensive well-woman visit no afterwards than 12 weeks after birth Figure 1. Insurance coverage policies should be aligned to support this tailored approach to "fourth trimester" care Policy and Postpartum Intendance.

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Increasing engagement

Currently, equally many equally 40% of women exercise not attend a postpartum visit. Underutilization of postpartum care impedes management of chronic health atmospheric condition and admission to effective contraception, which increases the risk of brusk interval pregnancy and preterm nascence. Attendance rates are lower amongst populations with limited resources nine 10, which contributes to health disparities.

Increasing attendance at postpartum visits is a developmental goal for Healthy People 2020. Strategies for increasing attendance include merely are non limited to the following measures: discussing the importance of postpartum care during prenatal visits; using peer counselors, intrapartum support staff, postpartum nurses, and belch planners to encourage postpartum follow-up; scheduling postpartum visits during prenatal intendance or before infirmary discharge; using engineering science (eg, e-mail, text, and apps) to remind women to schedule postpartum follow-upward 11; and increasing admission to paid sick days and paid family get out.

Optimal postpartum intendance provides an opportunity to promote the overall health and well-being of women, and show suggests that electric current care falls brusk of that goal. In a national survey, less than one half of women attending a postpartum visit reported that they received enough information at the visit about postpartum depression, birth spacing, healthy eating, the importance of exercise, or changes in their sexual response and emotions 12. Of note, anticipatory guidance improves maternal well-being: In a randomized controlled trial, 15 minutes of anticipatory guidance before hospital discharge, followed by a phone call at 2 weeks, reduced symptoms of depression and increased breastfeeding duration through 6 months postpartum amidst African American and Hispanic women thirteen fourteen.

Prenatal Training

To optimize postpartum care, anticipatory guidance should begin during pregnancy with development of a postpartum care programme that addresses the transition to parenthood and well-woman intendance fifteen Table ane. Anticipatory guidance should include word of infant feeding 16 17, "baby blues," postpartum emotional health, and the challenges of parenting and postpartum recovery from birth eighteen. Prenatal discussions too should address plans for long-term management of chronic health conditions, such equally mental health, diabetes, hypertension, and obesity, including identification of a primary wellness care provider who will care for the patient beyond the postpartum flow. Inside this guidance, health care providers should discuss the purpose and value of postpartum clinical care likewise as the types of services and support available.

Reproductive Life Planning

Beginning in prenatal intendance, the patient and her obstetrician–gynecologist or other obstetric care provider should discuss the adult female'south reproductive life plans, including desire for and timing of any futurity pregnancies 19. Women should be advised to avert interpregnancy intervals shorter than 6 months and should be counseled about the risks and benefits of repeat pregnancy sooner than 18 months 20. Short interpregnancy intervals likewise are associated with reduced vaginal nascency afterwards cesarean success for women undergoing trial of labor after cesarean 21.

A woman's future pregnancy intentions provide a context for shared controlling regarding contraceptive options 22. Shared determination-making brings 2 experts to the table: the patient and the wellness care provider. The health intendance provider is an expert in the clinical evidence, and the patient is an expert in her experiences and values 23. As affirmed by the Earth Wellness Organization, when making choices regarding the timing of the next pregnancy, "Individuals and couples should consider health risks and benefits along with other circumstances such as their historic period, fecundity, fertility aspirations, access to health services, child-rearing support, social and economic circumstances, and personal preferences" 24. Given the complex history of sterilization abuse 25 and fertility control among marginalized women, intendance should be taken to ensure that every woman is provided information on the full range of contraceptive options so that she can select the method best suited to her needs 26.

The Postpartum Care Program

Beginning during prenatal care, the adult female and her obstetrician–gynecologist or other obstetric care provider should develop a postpartum care program and intendance squad, inclusive of family and friends who will provide social and material support in the months following nascency, likewise as the medical provider(south), who will exist primarily responsible for care of the adult female and her infant after nascency nineteen. Suggested components of the postpartum intendance squad and care program are listed in Tabular array 1 and Tabular array ii . The intendance plan should place the chief intendance provider and other medical providers (eg, psychiatrist) who will assume care of chronic medical issues after the postpartum period. If the obstetrician–gynecologist serves equally the chief care provider, and so transition to another primary care md is unnecessary.

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Transition From Intrapartum to Postpartum Care

The postpartum care plan should be reviewed and updated after the woman gives birth. Women often are uncertain nearly whom to contact for postpartum concerns 27. In a contempo U.S. survey, one in four postpartum women did not take a phone number for a health care provider to contact for any concerns virtually themselves or their infants 12. Therefore, information technology is suggested that the intendance program include contact information and written instructions regarding the timing of follow-up postpartum care. But as a health intendance provider or health care exercise leads the woman's intendance during pregnancy, a primary obstetrician–gynecologist or other health care provider should assume responsibility for her postpartum care fifteen. This individual or practice is the primary signal of contact for the woman, for other members of the postpartum care team, and for whatsoever maternal health concerns noted by the infant's health care provider. When the woman is discharged from inpatient intendance simply prolonged infant hospitalization remote from the woman's dwelling is predictable, a local obstetrician–gynecologist or other health care provider should be identified as a point of contact and an appropriate hand off should occur. Such a referral should occur even if delivery did non take place at a local infirmary.

Substantial morbidity occurs in the early postpartum period; more than than ane half of pregnancy-related maternal deaths occur after the birth of the babe 6. Blood pressure evaluation is recommended for women with hypertensive disorders of pregnancy no later than 7–10 days postpartum 28, and women with severe hypertension should be seen within 72 hours; other experts have recommended follow-up at 3–five days 29. Such cess is disquisitional given that more than one half of postpartum strokes occur within 10 days of discharge thirty. In-person follow-up also may exist beneficial for women at high adventure of complications, such every bit postpartum depression 31, cesarean or perineal wound infection, lactation difficulties, or chronic conditions such as seizure disorders that crave postpartum medication titration. For women with complex medical issues, multiple visits may be required to facilitate recovery from birth.

Of note, even among women without chance factors, bug such as heavy bleeding, pain, physical exhaustion, and urinary incontinence are common 12. World Wellness Organization guidelines for postnatal intendance include routine postpartum evaluation of all women and infant dyads at three days, 1–2 weeks, and half dozen weeks 32. The National Institute for Health and Intendance Excellence guidelines recommend screening all women for resolution of the "Baby Blues" at 10–14 days after nascence to facilitate early identification of and treatment for postpartum depression xv. Contact in the first few weeks also may enable women to meet their breastfeeding goals: Among women with early on, undesired weaning, 20% had discontinued breastfeeding by half dozen weeks postpartum 33, when traditionally timed visits occurred. To accost these common postpartum concerns, all women should ideally have contact with a maternal care provider within the outset three weeks postpartum.

Cess demand not occur as an office visit, and the usefulness of an in-person cess should be weighed confronting the burden of traveling to and attention an role visit with a neonate. Boosted mechanisms for assessing women's health needs after nascence include dwelling visits 34, phone support 35 36, text messages 37, remote claret pressure level monitoring 38 39, and app-based support 40. Phone back up during the postpartum menstruation appears to reduce depression scores, improve breastfeeding outcomes, and increase patient satisfaction, although the testify is mixed 35 36.

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The Comprehensive Postpartum Visit and Transition to Well-Woman Care

Visit Timing

The comprehensive postpartum visit has typically been scheduled between four weeks and 6 weeks after commitment, a time frame that likely reflects cultural traditions of xl days of convalescence for women and their infants 41. Today, however, 23% of employed women return to work inside 10 days postpartum and an additional 22% return to work between 10 days and twoscore days 42. Therefore, timing of the comprehensive postpartum visit should be individualized and adult female centered, occurring no later than 12 weeks from birth. Timing besides should take into account whatever changes in insurance coverage anticipated later delivery. At all postpartum encounters, obstetrician–gynecologists and other obstetric care providers should consider the need for future follow-up and time additional visits accordingly. However timed, the comprehensive postpartum visit is a medical appointment; it is not an "all-clear" signal. Obstetrician–gynecologists and other obstetric intendance providers should ensure that women, their families, and their employers empathise that completion of the comprehensive postpartum visit does not obviate the need for continued recovery and support through half-dozen weeks postpartum and beyond.

Visit Components

The comprehensive postpartum visit should include a full assessment of physical, social, and psychological well-being, including the following domains Box 1: mood and emotional well-beingness; infant care and feeding; sexuality, contraception, and birth spacing; sleep and fatigue; concrete recovery from birth; chronic disease management; and wellness maintenance.

Components of Postpartum Care

Mood and emotional well-beingness

• Screen for postpartum depression and feet with a validated instrument^i,2

• Provide guidance regarding local resources for mentoring and support

• Screen for tobacco apply; counsel regarding relapse take a chance in postpartum catamenia³

• Screen for substance use disorder and refer as indicated^four

• Follow-upward on preexisting mental health disorders, refer for or ostend attendance at mental health-related appointments, and titrate medications every bit appropriate for the postpartum catamenia

Infant care and feeding

• Assess comfort and confidence with caring for newborn, including

  • feeding method

  • child intendance strategy if returning to work or school

  • ensuring infant has a pediatric medical home

  • ensuring that all caregivers are immunized⁵

• Assess condolement and confidence with breastfeeding, including

  • breastfeeding-associated pain⁶

  • guidance on logistics of and legal rights to milk expression if returning to work or school^7,eight

  • guidance regarding return to fertility while lactating; pregnancy is unlikely if menses have not returned, infant is less than vi months quondam, and infant is fully or nearly fully breastfeeding with no interval of more than 4–six hours between breastfeeding sessions⁹

  • review theoretical concerns regarding hormonal contraception and breastfeeding, within the context of each woman's desire to breastfeed and her hazard of unplanned pregnancy⁷

• Assess material needs, such as stable housing, utilities, food, and diapers, with referral to resources as needed

Sexuality, contraception, and birth spacing

• Provide guidance regarding sexuality, management of dyspareunia, and resumption of intercourse

• Assess desire for futurity pregnancies and reproductive life plan^x

• Explain the rationale for avoiding an interpregnancy interval of less than vi months and talk over the risks and benefits of repeat pregnancy sooner than xviii months

• Review recommendations for prevention of recurrent pregnancy complications, such equally 17α-hydroxyprogesterone caproate to reduce take a chance of recurrent preterm nascence, or aspirin to reduce risk of preeclampsia

• Select a contraceptive method that reflects patient'south stated needs and preferences, with same-24-hour interval placement of LARC, if desired¹¹

Slumber and fatigue

• Hash out coping options for fatigue and sleep disruption

• Appoint family and friends in assisting with care responsibilities

Concrete recovery from nativity

• Assess presence of perineal or cesarean incision pain; provide guidance regarding normal versus prolonged recovery¹²

• Assess for presence of urinary and fecal continence, with referral to physical therapy or urogynecology as indicated^13,14

• Provide actionable guidance regarding resumption of concrete activeness and attainment of healthy weight¹⁵

Chronic disease management

• Discuss pregnancy complications, if whatsoever, and their implications for hereafter childbearing and long-term maternal health, including ASCVD

• Perform glucose screening for women with GDM: a fasting plasma glucose test or 75 g, 2-60 minutes oral glucose tolerance test¹⁶

• Review medication selection and dose outside of pregnancy, including consideration of whether the patient is breastfeeding, using a reliable resource such equally LactMed

• Refer for follow-up care with master intendance or subspecialist health intendance providers, as indicated

Health maintenance

• Review vaccination history and provide indicated immunizations, including completing series initiated antepartum or postpartum¹⁷

• Perform well-woman screening, including Pap test and pelvic test, equally indicated^xviii

Abbreviations: ASCVD, arteriosclerotic cardiovascular disease; GDM, gestational diabetes mellitus; LARC, long-acting reversible contraceptive.

¹Screening for perinatal depression. Committee Opinion No. 630. American College of Obstetricians and Gynecologists. Obstet Gynecol 2015;125:1268–71 .

^twoEarls MF. Incorporating recognition and management of perinatal and postpartum low into pediatric exercise. Committee on Psychosocial Aspects of Child and Family unit Health American University of Pediatrics. Pediatrics 2010;126:1032–9 .

ⁱⁱⁱAmerican Higher of Obstetricians and Gynecologists. Tobacco and nicotine abeyance toolkit . Washington, DC: American College of Obstetricians and Gynecologists; 2016.

⁴Opioid utilise and opioid use disorder in pregnancy. Committee Opinion No. 711. American College of Obstetricians and Gynecologists. Obstet Gynecol 2017;130:e81–94 .

^vAmerican Academy of Pediatrics. Protect infants against pertussis: cocooning through Tdap vaccination. Washington, DC: AAP. Available at: https://www.aap.org/en-us/Documents/immunization_protect_infants_against_pertussis.pdf . Retrieved Jan 23, 2018.

⁶Berens P, Eglash A, Malloy M, Steube AM. ABM Clinical Protocol #26: persistent pain with breastfeeding. Breastfeed Med 2016;11:46–53 .

⁷Optimizing support for breastfeeding as function of obstetric exercise. Commission Opinion No. 658. American Higher of Obstetricians and Gynecologists. Obstet Gynecol 2016;127:e86–92 .

⁸Breastfeeding in underserved women: increasing initiation and continuation of breastfeeding. Commission Opinion No. 570. American College of Obstetricians and Gynecologists. Obstet Gynecol 2013;122:423–eight .

^nineCenters for Disease Control and Prevention. Lactational amenorrhea method . In: Usa medical eligibility criteria (U.s. MEC) for contraceptive use. Atlanta (GA): CDC; 2017.

¹⁰Reproductive life planning to reduce unintended pregnancy. Commission Stance No. 654. American Higher of Obstetricians and Gynecologists. Obstet Gynecol 2016;127:e66–9 .

¹¹Immediate postpartum long-acting reversible contraception. Committee Opinion No. 670. American College of Obstetricians and Gynecologists. Obstet Gynecol 2016;128:e32–7 .

¹²MacArthur C, Wintertime HR, Bick DE, Lilford RJ, Lancashire RJ, Knowles H, et al. Redesigning postnatal care: a randomised controlled trial of protocol-based midwifery-led care focused on individual women's concrete and psychological wellness needs. Health Technol Assess 2003;seven:1–98 .

^xiiiPrevention and management of obstetric lacerations at vaginal commitment. Practice Message No. 165. American Higher of Obstetricians and Gynecologists. Obstet Gynecol 2016;128:e1–xv .

^fourteenUrinary incontinence in women. Practice Bulletin No. 155. American College of Obstetricians and Gynecologists. Obstet Gynecol 2015;126:e66–81 .

¹⁵American College of Obstetricians and Gynecologists. Obesity toolkit . Washington, DC: American College of Obstetricians and Gynecologists; 2016.

¹⁶Gestational diabetes mellitus. ACOG Practice Bulletin No. 190. American Higher of Obstetricians and Gynecologists. Obstet Gynecol 2018;131:e49–64 .

¹⁷American College of Obstetricians and Gynecologists. Immunization for women . Washington, DC: American College of Obstetricians and Gynecologists; 2017.

^xviiiConry J, Brown H. Well-Woman Task Force: Components of the Well-Adult female Visit. Obstet Gynecol 2015;126:697–701 .

The comprehensive postpartum visit provides an opportunity for a woman to ask questions virtually her labor, childbirth, and any complications fifteen. Relevant details should be reviewed and documented in the medical record. A traumatic birth experience tin cause postpartum posttraumatic stress disorder, which affects three–16% of women 43. Trauma is in the eye of the beholder, and health care providers should be enlightened that a adult female may experience a birth equally traumatic even if she and her infant are healthy. Complications should exist discussed with respect to risks for time to come pregnancies, such every bit recommendations for 17α-hydroxyprogesterone caproate to reduce risk of recurrent preterm nascency, or aspirin to reduce chance of preeclampsia. Any placental pathology reports should be reviewed and shared with the patient. Recommendations should be made to optimize maternal health during the interpregnancy menstruum 44, such every bit controlling diabetes and attaining optimal weight 45.

Adverse Pregnancy Outcomes and Cardiovascular Risk

There are adventure factors for cardiovascular disease that appear during pregnancy, and these risk factors are emerging equally an important predictor of future arteriosclerotic cardiovascular illness (ASCVD) adventure. Complications such as preterm delivery, gestational diabetes, gestational hypertension, preeclampsia, and eclampsia are associated with greater chance of ASCVD 46. Pregnancy is, therefore, a natural "stress examination" identifying at-take chances women, just because these atmospheric condition ofttimes resolve postpartum, the increased cardiovascular disease hazard is not consistently communicated to women. These adverse pregnancy outcomes are besides non assessed when using current ASCVD take a chance assessment tools. Therefore, women with pregnancies complicated by preterm birth, gestational diabetes, or hypertensive disorders of pregnancy should be counseled that these disorders are associated with a higher lifetime risk of maternal cardiometabolic affliction. These women should undergo ASCVD risk cess 47 48, with particular attending to the effect of social determinants of health on cardiometabolic disease 49. All postpartum women with gestational diabetes should undergo glucose screening with a fasting plasma glucose test or a 75-g, ii-hour oral glucose tolerance test 45. Any history of pregnancy complications should exist documented in the woman's electronic medical tape to facilitate effective transition of care and to inform future screening and treatment.

Chronic Health Atmospheric condition

Women with chronic medical conditions, such as hypertensive disorders, obesity, diabetes, thyroid disorders, renal disease, mood disorders, and substance use disorders, should be counseled regarding the importance of timely follow-up with their obstetrician–gynecologists or principal care providers for ongoing coordination of intendance. Medications such as antiepileptics and psychotropic agents should be reviewed to ensure that the dosage has been adjusted to reverberate postpartum physiology and that the agents selected are compatible for women who are breastfeeding. The U.Due south. National Library of Medicine'due south LactMed is a free online resource that provides high-quality guidance on medication safety during lactation www.toxnet.nlm.nih.gov/newtoxnet/lactmed.htm.

Pregnancy Loss

For a woman who has experienced a miscarriage, stillbirth, or neonatal death, information technology is essential to ensure follow-up with an obstetrician–gynecologist or other obstetric intendance provider. Key elements of this visit include emotional support and bereavement counseling; referral, if appropriate, to counselors and support groups; review of any laboratory and pathology studies related to the loss; and counseling regarding recurrent risk and futurity pregnancy planning 50.

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Transition to Ongoing Well-Woman Intendance

During the postpartum menstruation, the woman and her obstetrician–gynecologist or other obstetric care provider should modify her postpartum care plan to identify the health care provider who will assume chief responsibility for her ongoing intendance in her principal medical abode. Appropriate referrals to other members of her health care team should as well be made during this transitional menstruation. If the obstetrician–gynecologist or other obstetric care provider is also her primary care provider, no transfer of responsibility is necessary. If responsibility is transferred to another chief care provider, the obstetrician–gynecologist or other obstetric intendance provider is responsible for ensuring that in that location is communication with the primary care provider and so that he or she can understand the implications of any pregnancy complications for the adult female's futurity health and maintain continuity of care.

Written recommendations for follow-up for well-adult female intendance and for any ongoing medical issues should exist documented in the medical record, provided to the patient, and communicated to advisable members of the postpartum care team, including her primary care medical home provider. By providing comprehensive, woman-centered intendance subsequently childbirth, obstetrician–gynecologists and other obstetric intendance providers can enable every woman to optimize her long-term health and well-existence.

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Policy and Postpartum Intendance

Optimizing intendance and back up for postpartum families volition require policy changes. Changes in the scope of postpartum care should be facilitated by reimbursement policies that support postpartum care every bit an ongoing procedure, rather than an isolated visit. More broadly, provisions for paid parental get out are essential to amend the health of women and children and reduce disparities. As i study 51 has noted, "The lack of policies substantially benefitting early on life in the United States constitutes a grave social injustice: those who are already virtually disadvantaged in our society comport the greatest burden." The American College of Obstetricians and Gynecologists endorses paid parental go out equally essential, including maintenance of full benefits and 100% of pay for at least 6 weeks 52. Obstetrician–gynecologists and other obstetric intendance providers should be in the forefront of policy efforts to enable all women to recover from birth and nurture their infants.

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For More Information

The American College of Obstetricians and Gynecologists has identified boosted resources on topics related to this document that may be helpful for ob–gyns, other wellness intendance providers, and patients. Yous may view these resources at https://www.acog.org/More-Info/OptimizingPostpartumCare .

These resources are for information just and are not meant to be comprehensive. Referral to these resources does non imply the American College of Obstetricians and Gynecologists' endorsement of the organization, the system'south website, or the content of the resource. The resources may change without notice.

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Source: https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/05/optimizing-postpartum-care

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