Postpartum Care
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Schedule Frequent Postpartum Visits |
Schedule extra visits to: o Assess
the woman and her substance use issues o Determine
if the basic needs of the woman are being met, e.g., food, safe place to
stay, support o Determine
if the woman is being abused by her partner (pregnancy and postpartum are
increased risk times for woman abuse) o Assess
the care the infant is receiving: hygiene, nutrition, comfort, etc. o Assist
the woman in contacting child protective services if she needs more support,
or if child neglect or abuse suspected o Discuss
contraception needs o Immunizations
(see infectious
disease section) |
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Postpartum Mood and Anxiety Disorders |
o Increased
risk of postpartum depression (PPD) if the woman
experienced depression during pregnancy, at another time in her life or after
a previous pregnancy o Monitor
the woman to determine if she is developing a postpartum mood and anxiety
disorder: appetite and sleep changes, depressed mood, panic attacks, thoughts
of harming self or infant, increased calls about infant concerns, decreased
coping skills, etc. o Check
throughout the first year; PPD can develop
immediately or months after birth o SSRIs linked to increased risk (1%) of persistent
pulmonary hypertension of the newborn; some SSRIs
associated with congenital malformations (see literature for updates)* and
self-limited neonatal adaptation syndrome e.g., jitteriness, respiratory
distress, weak cry, seizures – benefit-risk decision should be made on
individual case basis* o Use
lowest dose of SSRI in pregnancy; consider starting
an antidepressant immediately after birth if there is an increased risk of PPD o Consider
referral to a psychiatrist or PPD support group |
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*References |
o Wooltorton E. Presistent
pulmonary hypertension of the newborn and maternal use of SSRIs.
CMAJ 2006; 174(11): 1555-1556 o Einarson TR, Einarson A. Newer antidepressants in pregnancy and rates
of major malformations: a meta-analysis of prospective comparative studies. Pharmacoepidemiology & Drug safety 2005; 14(12):823-7 o Louik C, Lin AE, et al. First-Trimester
use of selective serotonin – reuptake inhibitors and the risk of birth
defects. NEJM 2007; 356(26): 2675-2683 |