gynecology and obstetrics
Postpartum Care
Management at Home
The woman and infant may be discharged within 24 to 48 hours postpartum; some obstetric units discharge them as early as 6 hours postpartum if major anesthesia was not used and no complications occurred. Serious problems are rare, but a home visit, office visit, or phone call within 24 to 48 hours helps screen for complications. A routine postpartum visit is usually scheduled at 3 to 8 weeks for women with an uncomplicated vaginal delivery. If delivery was cesarean or if other complications occurred, follow-up may be scheduled sooner. Normal activities may be resumed as soon as the woman feels ready. Sexual activity after vaginal delivery may be resumed as soon as desired and comfortable; however, a laceration or episiotomy repair must be allowed to heal first. Sexual activity after cesarean delivery should be delayed until the surgical wound has healed. Pregnancy must be delayed for 1 month if women were vaccinated against rubella or varicella. Also, subsequent obstetric outcomes are improved by delaying conception for at least 6 months but preferably 18 months after delivery. To minimize the chance of pregnancy, women should start using contraception as soon as they are discharged. If women are not breastfeeding, ovulation usually occurs about 4 to 6 weeks postpartum, 2 weeks before the first menses. However, ovulation can occur earlier; women have conceived as early as 2 weeks postpartum. Women who are breastfeeding tend to ovulate and menstruate later, usually closer to 6 months postpartum, although a few ovulate and menstruate (and become pregnant) as quickly as those who are not breastfeeding. Women should choose a method of contraception based on the specific risks and benefits of various options. Breastfeeding status affects choice of contraceptive. For breastfeeding women, nonhormonal methods are usually preferred; among hormonal methods, progestin-only oral contraceptives, depotmedroxyprogesteroneacetate injections, and progestin implants are preferred because they do not affect milk production.Estrogen-progesteronecontraceptives can interfere with milk production and should not be initiated until milk production is well-established. Combinedestrogen-progestin vaginal rings can be used after 4 weeks postpartum if women are not breastfeeding. A diaphragm should be fitted only after complete involution of the uterus, at 6 to 8 weeks; meanwhile, foams, jellies, and condoms should be used. Intrauterine devices may be placed as soon as immediately after delivery of the placenta, but placement after 4 to 6 weeks postpartum minimizes risk of expulsion. Women who have completed their family may choose permanent contraception, which are surgical procedures that involve resecting or ligating part of the fallopian tubes. The procedures can be done during the postpartum period, at the time of cesarean delivery, or after the postpartum period. These procedures are considered permanent and irreversible. 