Readiness
Every woman
- Engages with her provider during prenatal care to develop a comprehensive personalized postpartum care plan that includes designation of a postpartum medical home, where the woman can access care and support during the period between birth and the comprehensive postpartum visit.
- Receives woman-centered counseling and anticipatory guidance regarding medical recommendations for breastfeeding in order to make an informed feeding decision.
- Receives woman-centered counseling regarding medical recommendations for birth spacing and the range of available contraceptive options.
- Identifies a postpartum care team, inclusive of friends and family, to provide medical, material, and social support in the weeks following birth.
Every provider
- Ensures that each woman has a documented postpartum care plan and care team identified in the prenatal period.
- Develops and maintains a working knowledge of evidence-based evaluation and management strategies of common issues facing the mother-infant dyad.
Every clinical setting
- Develops and optimizes models of woman-centered postpartum care and education, utilizing adult-learning principles when possible and embracing the diversity of family structures, cultural traditions, and parenting practices.
- Develops systems to connect families with community resources for medical follow up and social and material support.
- Optimizes counseling models, clinical protocols, and reimbursement options to enable timely access to desired contraception.
- Develops systems to ensure timely, relevant communication between inpatient and outpatient providers.
- Develops protocols for screening and treatment for postpartum concerns, including depression and substance abuse disorders, and establishes relationships with local specialists for co-management or referral.
Readiness Resources
- ACOG Committee Opinion 658: Optimizing Support for Breastfeeding as Part of Obstetric Practice (ACOG)
- ACOG Committee Opinion 736: Optimizing Postpartum Care (ACOG)
- ACOG Committee Opinion 670: Immediate Postpartum Long-Acting Reversible Contraception (ACOG)
- Breastfeeding, Family Physicians Supporting Position Paper (AAFP)
- Evidence-Based Clinical Practice Guidelines (AWHONN)
- Maternal Mental Health: Perinatal Depression and Anxiety Patient Safety Bundle (Council on Patient Safety)
- POST-BIRTH Warning Signs Course (AWHONN)
- Postpartum Discharge Education Program (AWHONN)
- Practice and Policy Considerations for Child Welfare, Collaborating Medical, and Service Providers (SAMHSA)
- United States Medical Eligibility Criteria (US MEC) for Contraceptive Use (CDC)
Recognition & Prevention
Every woman
- Is respected as the expert in her own needs, and is empowered to trust her instincts and access care as early and frequently as needed in the weeks following birth.
- Reviews her postpartum care plan with her provider prior to discharge from maternity care, revising as needed. The care plan should include a list of warning signs and responses for life-threatening postpartum complications, a list of lactation support resources, a “first call” phone number for her postpartum medical home, including a contact for breastfeeding issues, and the time and date of postpartum visits.
- Attends a comprehensive postpartum visit, scheduled at an interval tailored to the needs of the mother-infant dyad.
Every clinical setting
- Determines guidelines for patient education, discharge from inpatient maternity care, and indications for early postpartum visits.
- Coordinates ongoing care between inpatient and outpatient settings and between the maternal and infant providers to facilitate the health and wellbeing of the dyad. This includes coordination for issues related to breastfeeding.
- Screens for and treats common morbidities, including mental health issues, smoking, and substance use, as well as concerns such as unstable housing and food insecurity.
- Ensures that each woman has identified a source of ongoing primary health care.
Readiness Resources
- ACOG Committee Opinion 630: Screening for Perinatal Depression (ACOG)
- Depression and Postpartum Depression: Resource Overview (ACOG)
- Evidence-Based Clinical Practice Guidelines (AWHONN)
- Maternal Depression Screening: Medicaid and EPSDT Coverage (AAP)
- Maternal Mental Health: Perinatal Depression and Anxiety Patient Safety Bundle (Council on Patient Safety)
- NIDA Drug Screening Tool (NIH)
- PMH Care Pathways: Postpartum Care and the Transition to Well Woman Care (CCNC)
- POST-BIRTH Warning Signs Course (AWHONN)
- Postpartum Discharge Education Program (AWHONN)
Response
Every clinical setting
- Implements treatment protocols and either provides desired care or facilitates timely referral to an appropriate resource. Whenever feasible, a warm hand-off is provided, via a face-to-face introduction to the specialist to whom the patient is being referred.
- Maintains an up-to-date inventory of community resources to assist with unmet needs, such as 24-hour hotlines, food banks, diaper banks, lactation support groups, and home visiting programs.
- Develops strategies to reach women who do not attend the comprehensive postpartum visit.
Every identified need
- Is assessed for its acuity using a tiered response.
– If life-threatening, the identifying provider facilitates transportation to an appropriate facility for immediate care.
– If non-acute, the need is addressed by the woman and her provider in a woman-centered, shared-decision making discussion, honoring each woman’s self-sufficiency and autonomy.
Readiness Resources
- A Guide for Enrolling Patients and Clients in Text4baby (Text4baby)
- Academy of Breastfeeding Clinical Protocols (Academy of Breastfeeding)
- Evidence-Based Clinical Practice Guidelines (AWHONN)
- Informed Medical Decisions Foundation
- Partnership for Maternal & Child Health of Northern New Jersey
- POST-BIRTH Warning Signs Course (AWHONN)
- Postpartum Support International
- Postpartum Depression Screening: MCPAP for Moms (MCPAP for Moms)
- The 5As: Evidence-Based Tobacco Cessation Counseling for Pregnant and Postpartum Women (You Quit Two Quit)
- Tobacco, Alcohol, and Substance Abuse Resources and Tools (ACOG)
Reporting & Systems Learning
Every health system
- Convenes inpatient and outpatient providers to share successful strategies and identify opportunities for improvement.
- Identifies and monitors postpartum quality measures, such as postpartum emergency room utilization and readmission rates.
- Works toward quality metrics that compare postpartum outcomes with prenatal intentions, such as receipt of intended contraception or attainment of desired breastfeeding duration.
- Conducts quality improvement projects to reduce preventable postpartum morbidity.
- Collaborates with the community to maintain a clearinghouse for resources that address the needs of women during the postpartum period.
- Ensures that reimbursement policies do not disincentivize postpartum visits.
Reporting Resources
- Breast Milk Feeding, Contraceptive Care, and Postpartum Care Measures (NQF)
- HEDIS Depression Measures Specified for Electronic Clinical Data Systems (NQCA)
- HEDIS Prenatal and Postpartum Care Measure Specification (NCQA)
- Thinking (Re)Productively: Performance measures for contraceptive care: what are we actually trying to measure? (ARHP)
© 2017 American College of Obstetricians and Gynecologists. Permission is hereby granted for duplication and distribution of the bundle document, in its entirety and without modification, for solely non-commercial activities that are for educational, quality improvement, and patient safety purposes. All other uses require written permission from ACOG.
Standardization of health care processes and reduced variation has been shown to improve outcomes and quality of care. The Council on Patient Safety in Women’s Health Care disseminates patient safety bundles to help facilitate the standardization process. This bundle reflects emerging clinical, scientific, and patient safety advances as of the date issued and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed. Although the components of a particular bundle may be adapted to local resources, standardization within an institution is strongly encouraged.
The Council on Patient Safety in Women’s Health Care is a broad consortium of organizations across the spectrum of women’s health for the promotion of safe health care for every woman.