Welcome to the training on Postpartum Health: Screening and Intervention provided by the Texas Health and Human Services Commission (HHSC) and the Texas Department of State Health Services (DSHS).
Goal
The goal of this module is to equip Texas Health Steps providers and other health-care professionals to identify and address factors that affect maternal health and safety in the first year after childbirth.
Target Audience
Texas Health Steps providers and other interested health-care professionals.
Specific Learning Objectives
After completing the activities of this module, you will be able to:
- Summarize the leading causes of postpartum maternal mortality and morbidity in Texas.
- Specify the postpartum health risks and conditions that are associated with maternal mortality and morbidity.
- Integrate screening, treatment, and counseling that promote maternal health and safety in the first year after childbirth.
- Integrate preconception and interconception services, such as contraception counseling, that can improve maternal health and future pregnancy outcomes.
NOTE: For purposes of this module, the term “women” also includes adolescent girls of reproductive age.
Please note this module expires on 10/24/2022.
This module was released on 10/24/2019.
Accreditation Statement
Continuing Medical Education
The Texas Department of State Health Services, Continuing Education Service is accredited by the Texas Medical Association to provide continuing medical education for physicians.
The Texas Department of State Health Services, Continuing Education Service designates this enduring material for a maximum of 1.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education
The Texas Department of State Health Services, Continuing Education Service is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. The Texas Department of State Health Services, Continuing Education Service has awarded 1.25 contact hour(s) of Continuing Nursing Education.
Social Workers
The Texas Department of State Health Services, Continuing Education Service under sponsor number CS3065 has been approved by the Texas State Board of Social Worker Examiners to offer continuing education contact hours to social workers. The approved status of The Texas Department of State Health Services, Continuing Education Service expires annually on December 31. The Texas Department of State Health Services, Continuing Education Service has awarded 1.25 contact hour(s) of Continuing Social Work Education.
Certificate of Attendance
The Texas Department of State Health Services, Continuing Education Service has designated 1.25 hour(s) for attendance.
Certified Community Health Worker
The Texas Department of State Health Services, Promotor(a)/Community Health Worker Training and Certification Program has certified this course for 1.25 contact hour(s) of continuing education for Certified Community Health Workers and Community Health Worker Instructors.
Disclosures
One of the requirements of continuing education is disclosure of the following information to the learner:
- Notice of requirements for successful completion of continuing education activity. To receive continuing education credit the learner must successfully complete the following activities:
- Create a Texas Health Steps account.
- Complete on-line registration process.
- Thoroughly read the content of the module.
- Complete the on-line examination.
- Complete the evaluation.
- Commercial Support.
The THSTEPS Web-based Continuing Education Series has received no commercial support. - Disclosure of Relevant Financial Relationships.
The THSTEPS Continuing Education Planning Committee and the authors of these modules have no relevant financial relationships to disclose. - Non-Endorsement Statement.
Accredited status does not imply endorsement of any commercial products or services by the Department of State Health Services, Continuing Education Service; Texas Medical Association; or American Nurse Credentialing Center. - Off-Label Use.
Using a disclosure review process, the THSTEPS Continuing Education Planning Committee has examined documents and has concluded that the authors of these modules have not included content that discusses off-label use (use of products for a purpose other than that for which they were approved by the Food and Drug Administration).
The following are policies and definitions of terms related to continuing education disclosure:
The intent of disclosure is to allow Department of State Health Services (DSHS) Continuing Education Service the opportunity to resolve any potential conflicts of interest to assure balance, independence, objectivity and scientific rigor in all of its Continuing Education activities.
All faculty, planners, speakers and authors of Department of State Health Services (DSHS) Continuing Education Service sponsored activities are expected to disclose to the Department of State Health Services (DSHS) Continuing Education Service any relevant financial, relationships with any commercial or personal interest that produces health care goods or services concerned with the content of an educational presentation. Faculty, planners, speakers and authors must also disclose where there are any other potentially biasing relationships of a professional or personal nature.
Glossary of Terms
Conflict of Interest: Circumstances create a conflict of interest when an individual has an opportunity to affect Continuing Education content about products or services of a commercial interest with which she/he has a financial relationship or where there are any other potentially biasing relationships of a professional or personal nature.
Commercial Interest: Any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.
Financial Relationships: Those relationships in which the individual benefits by receiving a salary, royalty, intellectual property rights, consulting fee, honoraria, ownership interest (e.g., stocks, stock options or other ownership interest, excluding diversified mutual funds), or other financial benefit. Financial benefits are usually associated with roles such as employment, management position, independent contractor (including contracted research), consulting, teaching, membership on advisory committees or review panels, board membership, and other activities for which remuneration is received or expected. Relevant financial relationships would include those within the past 12 months of the person involved in the activity and a spouse or partner. Relevant financial relationships of your spouse or partner are those of which you are aware at the time of this disclosure.
Off Label: Using products for a purpose other that that for which it was approved by the Food and Drug Administration (FDA).
Browser Requirements
Texas Health Steps courses are best viewed using a current browser. If you are using an out-of-date browser or a version of Internet Explorer less than 11, lesson progress and interactive features may not function properly.
AIM Safety Bundles from the Council on Patient Safety in Women’s Health Care.
American College of Obstetricians and Gynecologists. (2019). Practice Bulletin 212: Pregnancy and Heart Disease. [Abstract].
ACOG news release, May 3, 2019
American College of Obstetricians and Gynecologists. (2018). Postpartum Health Care Toolkit.
American College of Obstetricians and Gynecologists. Patient Education FAQs, including Annual Well-Woman Exam, Your Postpartum Care Team, Postpartum Birth Control, Alcohol and Pregnancy, Tobacco and Pregnancy, and Using Long-Acting Reversible Contraception Right After Childbirth.
Before, Between & Beyond Pregnancy: Reproductive Life Plan
California and Stanford University, Improving Health Care Response to Cardiovascular Disease in Pregnancy and Postpartum Toolkit. (The toolkit is available free to download after completing a brief survey).
Council on Patient Safety in Women’s Health Care
Postpartum Depression screening and screening tools:
- Texas Health and Human Services, the Texas Clinician’s Postpartum Depression Toolkit
- Texas Health Steps Postpartum Depression Screening (PPD) Screening Tool
- Edinburgh Postnatal Depression Scale (EPDS)
- Postpartum Depression Screening Scale (PPDS)
- Patient Health Questionnaire (PHQ-9)
Gestational diabetes educational tool for postpartum women with gestational diabetes to complete; download from Plaid.
Healthy Texas Women program offers women's health and family planning services at no cost to eligible women with low income. Access the provider portal for information about patient eligibility and benefits.
Healthy Texas Women website: Health topic fact sheets.
Postpartum Support International
Power to Decide: The Campaign to Prevent Unplanned Pregnancy
Texas Collaborative for Healthy Mothers and Babies (TCHMB)
Maternal Early Warning System (MEWS)
Texas Department of State Health Services’ Maternal and Child Health web page
Texas Diabetes Council Toolkit: Free educational materials for patients and professionals
Chamberlain, L. & Levenson, R. (2013). Addressing Intimate Partner Violence Reproductive and Sexual Coercion: A Guide for Obstetric, Gynecologic, Reproductive Health Care Settings, Third Edition. Produced by Futures Without Violence, formerly the Family Violence Prevention Fund.
National Domestic Violence Hotline: 800-799-SAFE (7233)
Rape Abuse & Incest National Network (RAINN) Hotline: 800-656-HOPE (4673)
Futures Without Violence (previously known as Family Violence Prevention Fund)
National Center on Domestic Violence, Trauma & Mental Health. (2015). Women Who Experience Intimate Partner Violence and Prenatal and/or Postpartum Depression: Prevalence and Interventions.
National Coalition Against Domestic Violence
National Network to End Domestic Violence
National Resource Center on Domestic Violence
Office on Violence Against Women (U.S. Department of Justice)
American College of Obstetricians and Gynecologists. (2016). Tobacco and nicotine cessation toolkit.
American College of Obstetricians and Gynecologists. (2014). FAQ: It’s time to quit smoking.
Larzelere, M. M., & Williams, D. E. (2012). Promoting smoking cessation. American Academy of Family Physicians.
Centers for Disease Control and Prevention. (2017). Quit smoking.
Maryland Tobacco Resources Center. (n.d.). Brief intervention and 5 A’s.
AIM Obstetric Care for Women with Opioid Use Disorder Bundle
American Diabetes Association for lifestyle modification
International Lactation Consultant Association for professional lactation assistance (http://www.ilca.org/
La Leche League International for breastfeeding support
March of Dimes. Postpartum care.
Postpartum Support International
University of North Carolina, School of Medicine, Center for Maternal and Infant Health. Offers several booklets about postpartum health, including the bilingual booklet, Taking Care of You: Your Postpartum Health and Visit booklet (English and Spanish).
- American College of Obstetricians and Gynecologists. (2019). Practice Bulletin 212: Pregnancy and Heart Disease. [Abstract].
- ACOG news release, May 3, 2019
- American College of Obstetricians and Gynecologists. (2018). Committee Opinion No. 736:Optimizing Postpartum Care.
- American College of Obstetricians and Gynecologists. (2018). Postpartum Health Care Toolkit.
- American College of Obstetricians and Gynecologists. (2015, reaffirmed 2017). Committee Opinion No. 629:Clinical Guidelines and Standardization of Practice to Improve Outcomes.
- American College of Obstetricians and Gynecologists. (2016). Committee Opinion No. 654:Reproductive Life Planning to Reduce Unintended Pregnancy.
- American College of Obstetricians and Gynecologists. (2013). Hypertension in pregnancy.
- American College of Obstetricians and Gynecologists. (2012). Committee Opinion No. 518:Intimate partner violence. Obstetrics and Gynecology, 119:412–7.
- Bramham, K., Nelson-Piercy, C., Brown, M. J., & Chappell, L. C. (2013). Postpartum management of hypertension. BMJ, 346:f894.
- Castorino, K., & Jovanovič, L. (2013). The postpartum management of women with gestational diabetes using a continuum model for health care. Clinical Obstetrics and Gynecology, 56(4):853-9.
- Centers for Disease Control and Prevention. (2019). Pregnancy-Related Deaths.
- Centers for Disease Control and Prevention. (2018). Report from Nine Maternal Mortality Review Committees.
- Kassebaum, N. J., Bertozzi-Villa, A., Coggeshall, M. S., Shackelford, K. A., Steiner, C., Heuton, K. R., . . . Lozano, R. (2013). Global, regional, and national levels and causes of maternal mortality during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. The Lancet, 384(9947),956.
- Kreatsoulas, C., & Anand, S. S. (2010). The impact of social determinants on cardiovascular disease. The Canadian Journal of Cardiology, 26(Suppl C): 8C–13C.
- Lassi, Z., Majeed, A., Rashid, S., Yakoob, M. Y., & Bhutta, Z. A. (2013). The interconnections between maternal and newborn health: evidence and implications for policy. The Journal of Maternal-Fetal & Neonatal Medicine, 26:sup1, 3-53.
- March of Dimes. (2018). Position Statement: Maternal Mortality and Severe Maternal Morbidity.
- Maryland Tobacco Resources Center. (n.d.). Brief intervention and 5 A’s.
- National Center on Domestic Violence, Trauma & Mental Health. (2015). Women Who Experience Intimate Partner Violence and Prenatal and/or Postpartum Depression: Prevalence and Interventions.
- Shelton, S. (2015). Postpartum Care of Women Affected by Diabetes: A Review of Current Trends. Plaid: People Living with and Inspired by Diabetes.
- Texas Department of State Health Services, (2018) Maternal Mortality and Morbidity Task Force and Department of State Health Services Joint Biennial Report.
- Texas Department of State Health Services, & Texas Health and Human Services Commission. (2019). Maternal Mortality and Morbidity in Texas.
- Texas Health Steps, Online Provider Education. (2019). Promoting Maternal Health in Texas: A Call to Action. (podcast).
- U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality. (2013). Atlas of Integrated Behavioral Health Care Quality Measures. AHRQ Publication No. 13-IP002-EF.
- U.S. Department of Health and Human Services. (2019). Texas Adolescent Reproductive Health Facts.
- Ying, W., Catov, J., & Ouyang, P. (2018). Hypertensive Disorders of Pregnancy and Future Maternal Cardiovascular Risk. Journal of the American Heart Association, 7(17), e009382.
The medical definitions in this module were obtained or adapted from the American Heart Association; Mayo Clinic; National Heart, Lung, and Blood Institute; Texas Maternal Mortality and Morbidity Task Force; The Canadian Journal of Cardiology, Tufts University, and the World Health Organization.
