MD Notes

creation date: 2026-10-19 21:34
tags: Assessments

Postpartum Assessment

Background

Following delivery, the patient is admitted to postpartum and rounded on until they are assessed to be fit for discharge.

A maternal postpartum appointment should be scheduled at 6 weeks postpartum. This is typically done with the obstetrician or family physician who followed the pregnancy prenatally.

In-Patient Assessment

Subjective

Components to inquire about:

  • Pain and whether it is well controlled (with oral vs. IV)
  • Bleeding, and if so, presence of clots
  • Voiding, if not, when was catheter removed
  • Flatulence (note: constipation may be present but gas insures bowels are functioning)
  • Ambulation, with/without pain
  • Tolerating diet

Objective

Exam includes:

  • Incision sites
  • Abdominal distension/rigidity
  • Extremities for swelling/DVT

Plan

  • Feeding instructions: q3h minimum, may notice uterine cramps with good latch
  • Continue prenatal vitamins x6 wk
  • Vaginal bleeding is normal for 2-6 wks
  • Stitches fall out on own
  • Nothing in vagina x6 wk

Follow up appointment at 6 wks

Postpartum Appointment (6 week)

History

Inquire/confirm about the following:

  • Type of delivery, complications including instrumentation use or hemorrhage
  • Perineal/surgical healing
  • Follow up with prenatal complications (eg. BP)
  • Postpartum course (eg. bleeding pattern, sleep, energy levels)
  • Bladder and bowel function
  • Sexual activity and contraception plan to prevent unwanted pregnancy
  • Mood
  • HPV testing (last pap)

Mental health:

  • Assess for postpartum depression
  • Self-care (sleep, diet, exercise)
  • Intimate partner violence screen

Physical Exam

While not routinely done, some physical examination may be indicated based on any complaints:

  • Abdomen (tenderness, incision if c-section)
  • Breast (lumps, tenderness, nipples, discharge)
  • External genitalia/perineum (check stitches if tear/epis)
  • Vagina/cervix if also requiring HPV testing
  • Thyroid (size)

Plan & Counselling

Sexual activity

  • Delay sex until 6 wk; ovulation may occur 25 days postpartum
  • Counselling: reduced libido common after birth
  • Contraception:
    • Immediate postpartum: IUD if c-section (note: risk of expulsion); progestin-only contraceptives (pill, ring, inj., implant)
      • CHCs contraindicated: estrogen increases risk of VTE and may affect milk production
    • 6 wk+: IUD insertion, can consider CHC if no risk factor for VTE

Note – lactational amenorrhea: 1st six months only if breastfeeding ever 3 hours, difficult to get exactly right

Bowel changes
Lower GI motility due to decrease from pregnancy (late until postpartum) and side effect from pain med, sore perineum, and stretched muscles.

  • Osmotic laxative indicated if no BM in 3 days

Fecal incontinence common if damage to pelvic floor muscles.

Other (at 6 weeks)

  • Go ahead for sex/strenuous exercise
  • Use contraception
  • Repeat OGTT if had GDM
  • Continued BP monitoring if GHTN

Debrief may include:

  • Breastfeeding concerns
  • Future pregnancies
  • Birth experience (esp. if difficult)

References

Tools / Guidelines

Additional Reading