Evidence-based Labor Management: postpartum care after vaginal delivery (Part 6).

In the setting of postpartum care after vaginal delivery: Rooming in is associated with a higher rate of exclusive breastfeeding rate at hospital discharge, but there is insufficient evidence to support or refute rooming in order to increase breastfeeding at 6 months. Education and support for breastfeeding is a valuable intervention to promote initiation of breastfeeding whether it is offered by a healthcare professional, a non-healthcare professional or a peer. A combined intervention, a professional provider led intervention, having a protocol available for the provider training program, and implementation during both the prenatal and postnatal periods, increased the rate of exclusive breastfeeding for 6 months. There is no single effective treatment for breast engorgement. Breast massage, continuing breastfeeding and pain relief are recommended by national guidelines. NSAID and acetaminophen are better than placebo for relief of pain cause by uterine cramping and perineal trauma; acetaminophen is effective in breastfeeding individuals who underwent episiotomy; local cooling pain relievers, have been shown to reduce perineal pain 24 to 72 hours, compared with no treatment. There is insufficient evidence to assess safety and efficacy of postpartum routine universal thromboprophylaxis after vaginal delivery. Anti-D immune globulin administration is recommended in Rhesus negative individuals who have given birth to a Rhesus positive infant. There is very low-quality evidence that universal CBC is useful in reducing the risk of receiving blood products. In the absence of any postpartum complication, there is insufficient evidence to recommend routine postpartum ultrasound. MMR, varicella, HPV and Tdap should be administered in non-immune individuals in the postpartum period. Smallpox and yellow fever vaccines should be avoided. Individuals undergoing post-placental placement are more likely to use an IUD at six-months than those advised to follow-up for placement during outpatient postpartum care. Implant is safe and effective for immediate postpartum contraception. There is insufficient evidence to support or refute routinely administration of micronutrients supplements in breastfeeding woman. Placentophagia does not provide any benefits, exposes mothers and offspring to infectious risk, and therefore should be discouraged. Due to the low level of evidence, there is insufficient data to assess efficacy of home visits in the postpartum period. There is insufficient evidence to recommend when to resume daily activities and individuals should be counseled to return to pre-pregnancy level of activity/exercise when comfortable. Sexual activity, housework exercise, driving, climbing stairs and lifting weight should be resumed as soon as postpartum individuals want. A behavioral educational intervention reduces depression symptoms and increases breastfeeding duration. Physical activity postpartum is protective against postpartum mood disorders. There is no strong evidence that supports early discharge after vaginal delivery compared to standard discharge (i.e., ≥48hr).