Postpartum care--what's new?

The postpartum period is a time of significant emotional, social, and physical change for most women. This review focuses on recent evidence supported by systematic reviews and randomized, controlled trials to guide the care of postpartum women who are otherwise healthy.

Mental health outcomes are improved with postpartum support in at-risk women. Postpartum depression can be treated either pharmacologically or with counseling; however, exercise and omega-3 fatty acids are emerging as potentially effective alternatives. Intrauterine devices are safe and effective methods of contraception in the postpartum period. There has yet to be an effective, postpartum, smoking-cessation program developed, although intensive motivational counseling shows some promising early results. Bladder dysfunction continues to be a significant problem for women even at 10 years postpartum. Pelvic floor muscle exercises can help prevent and treat incontinence at 12 months, but longer-term follow-up studies are needed. Prevalence studies suggest that bowel dysfunction is common in the postpartum period, but randomized, controlled trials are limited to treatment in women with third-degree perineal damage.

Although some recommendations can be made for evidence-based postpartum care, many important questions related to the postpartum period have not been examined by rigorous methodologies.