Update Your Discharge Teaching (Part 1)

Total truth: I am missing some Alaska this week. So please bear with me while we look at some pretty glaciers 🙂

I came off a 24 hour shift today and am plain old tired. There were lots of babies and some crazy triage calls…i.e. can you take oxycodone for a migraine in the 3rd trimester? Hmm…my thought was where did you get your oxycodone from?

And then there was a mama who needed a vacuum for a prior birth, but came in during transition, birthed her baby super fast, and needed no vacuum at all. Oh, and it was her biggest baby yet. #rockstar

Those are just littles glimpses of the 24 hour shift.

I’ve been thinking a lot about how to share note templates on the blog. Some people use the same note templates for decades, some people change them up every now and then, and some people use whatever their system offers for templates.

If I have learned anything, templates and smart phrases in charting save you HOURS of time.

But I also think it’s important to make them patient friendly. I remember reading the discharge information given to me after my first birth and then thinking – well, that wasn’t really helpful.

What is helpful then?

I think clear language and the most important information up front is key.

I like to put my follow appointments at the top of the page since those are key for the patient’s outpatient visits.

After that, I like a nice overview of vaginas are amazing but these are the warning signs you should look out for.

Lastly, I like a nice summary of the other important topics and resources that mamas might need or may be helpful during their postpartum recovery. These are the websites I recommend over and over and over. Who says you can’t put websites on discharge education?

Here’s my template I use for discharge teaching. I update it every few months based on new resources (maternal mental health hotlines!!) or other helpful websites I find.

See what you think, adjust as you need, and share freely! Tune in next week for my C/S instructions, hypertensive disorders of pregnancy education, and other diseases that need specific follow up during postpartum periods!

xoxo, Jamie


***FOLLOW UP APPOINTMENTS***

Please plan for the following recommended postpartum appointments with your clinic You will need to call the clinic to book your appointment or book your appointments online.

*Blood pressure checks*

3 days postpartum – BP check: 

Please come to the clinic for a blood pressure check 3 days after delivery. This is typically one or two days after your discharge home.

7-10 days postpartum – BP check:

Please come to the clinic for a blood pressure check 7-10 days after delivery. This is important to ensure that the elevated blood pressures you had during pregnancy/delivery/postpartum have returned to normal.

*Incision check*

2 weeks postpartum – Incision check:

Please come to the clinic for a check of your incision with a clinic nurse two weeks after your delivery in order to ensure appropriate healing and recovery.

*Mood check*

1-2 weeks postpartum – Mood check: 

A mood check is recommended for women with a history of anxiety, depression or postpartum depression/anxiety. Please call the clinic to schedule a mood check at 2 weeks or as needed during your postpartum period. This can also be completed over the phone.

*Routine postpartum visit*

6-8 weeks postpartum:

A postpartum visit is recommended for all women after their birth. Please call the clinic to schedule your visit or request an appointment online. If you are due for a pap smear screening, we can complete this at your appointment. If you would like a Nexplanon or an IUD placed at your appointment, please let us know at the time you book the appointment.

***Other postpartum education:***

After delivery you can expect to have some pelvic and vaginal discomfort, but this should continue to improve as time goes on. We will provide oral pain medications, typically an anti-inflammatory (Ibuprofen) and acetaminophen (Tylenol). It is recommended to take the anti-inflammatory medication three times daily with food or milk, and use the Tylenol as needed in addition. Both are safe in breast feeding.

Vaginas are amazing and heal remarkably well, even with large tears or episiotomies. Generally, healing of the tissue is complete by your 6-week postpartum visit, though it may take months for everything to ‘feel normal’ with sex. If you had a tear, it was repaired using suture (stitches) that dissolve on their own over time and do not need to be removed.

Generally we recommend putting nothing in your vagina for the first 4-6 weeks after delivery.

Lochia (vaginal bleeding after delivery) generally slows and stops within a few weeks after delivery, but it can be normal through six weeks after delivery. It is not unusual for bleeding to stop, then have a brief return or increase 1-2 weeks later. This is called placental site involution and is caused by healing of the area in the uterus where the placenta attached. Generally, bleeding should steadily decrease after delivery but may include clots. Bleeding should not become so heavy as to saturate a pad an hour for 2 hours or more.

Please contact the clinic or the Emergency Room after hours for any of the following symptoms:

* Fever (temperature > 100.4F)

* Significant pain not controlled with oral pain medications

* Significant nausea and vomiting with inability to tolerate any food or medication

* Significant redness of the incisions or foul-smelling drainage from the incisions 

* Heavy vaginal bleeding that soaks through one pad per hour for more than 2 hours (spotting is okay, it should not be anything like a heavy period)

* Inability to urinate

***Breastfeeding***

– The American Academy of Pediatricians (AAP) recommends exclusive breastfeeding for your infant (breastmilk only) as the primary source of food for the infant’s first six months of life. The World Health Organization also supports exclusive breastfeeding but encourages mothers and infants to continue breastfeeding up to two years of age or as long as desired by the mother or infant.

– For breastfeeding concerns or questions, a wealth of breastfeeding education is available at www.kellymom.com OR www.firstdroplets.com

– La Leche League (LLL) is a group that provides breastfeeding support and education (www.llli.org). LLL has a local group that meets regularly; group meetings can be found on the website.

***Family planning and contraception***

Even if you are exclusively breast feeding and have not yet had a period, it is possible to get pregnant again shortly after delivery. We recommend waiting at least one year between pregnancies. Close interval pregnancies increase your risk of fetal growth restriction, preterm labor, and preterm delivery. We encourage every couple to have a plan in place for preventing unintended pregnancies and multiple options may be reasonable for you to consider even while breastfeeding. Please continue your prenatal vitamin as long as you are breastfeeding.

If you are planning on having an implantable contraceptive (arm implant, intrauterine device) placed postpartum, please let the front desk know when you schedule your postpartum visit so we can be prepared. Please do not have intercourse until your IUD or implant is placed if this is your desired method.

***Mental Health:***

The time after delivery is an emotional time for all new parents, and feelings of depression, anxiety, or being overwhelmed are common. Moms who have a history of depression or anxiety may face more challenges with mood after delivery, and it is not unusual to need to start or increase medications. Please note that postpartum depression and/or postpartum anxiety can occur anytime in the first 12 months after delivery your baby. If you find that you are struggling with your mood, or have any thoughts about hurting yourself or anyone else, please do not hesitate to contact the clinic or the Emergency Department.

Other resources include:

1. Postpartum Support International – www.postpartum.net

– A gathering within the communities around the city, often weekly, see website for meetings/details/times.

– Meetings also available online.

– National Maternal Mental Health Hotline: 1-833-943-5746. Funded by the U.S. Health Resources and Services Administration (HRSA) and powered by Postpartum Support International, is available 24/7, 365 days a year, in English or Spanish and other languages by request. 

2. For military patients: Military One Source 

– Information at website: www.militaryonesource.mil

– Phone: 1-800-342-9647 or 703-253-7599

***Vaccinations***

– If your prenatal labs demonstrated immunity to rubella (measles) or you have had two MMR vaccines in your lifetime, you do not need a booster for this disease. 

– If you have not had the chickenpox or the varicella vaccine, then you may need a booster for varicella. This can be accomplished in the postpartum period.

– A flu vaccine is recommend for all pregnant and postpartum women once during flu season. Please obtain this vaccine as soon as the vaccine is offered during flu season.

– If you have not received the HPV (human papillomavirus) vaccine and are interested in receiving the vaccine, please let the clinic know at your postpartum visit. The HPV vaccine significantly reduces the incidence of anogenital cancer and genital warts in women and in men. Initial vaccination is recommended at 11-12 years of age but there is an opportunity to vaccinate young women from ages 13 to 26 years of age that have not previously received the vaccine regardless of sexual activity, prior exposure to HPV, or sexual orientation, if they were not vaccinated in the target age of 11–12 years. Lastly, the HPV vaccine can be given to breastfeeding women age 26 years and younger who have not previously been vaccinated.

– The COVID-19 vaccine is recommended for pregnant and breastfeeding women. If you have not been vaccinated you can schedule an appointment to receive the vaccine in the community.


1 year ago on the blog…5 Handy Provider Handouts!

2 years ago on the blog…Friday Five (#22)

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