CE/CME
Postpartum Health: Screening and Intervention
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).
Credit Hours: 1.50 CE
This course is currently being revised and is temporarily unavailable. Please check back soon.
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 pregnancy and childbirth.
Target Audience
Primary care providers, including obstetricians/gynecologists, family practitioners, certified nurse midwives, advanced practice nurse practitioners, physician assistants and other health professionals who provide services to infants and/or mothers in the first year after pregnancy and childbirth.
Specific Learning Objectives
After completing the activities of this module, you will be able to:
- Summarize the leading causes of 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 pregnancy and childbirth.
- Integrate preconception and interpregnancy services, such as contraception counseling, that can improve maternal health and future pregnancy outcomes.
NOTE: The terms “girl” and “woman,” along with their plurals and pronouns, are used throughout this module, although the creators intend inclusivity and wish to avoid bias based on gender identity. Two companion modules, Preconception Health: Screening and Intervention and Prenatal Health: Screening and Intervention address issues related to the preconception period and pregnancy.
Please note this module expires on 8/16/2025.
This module was released on 8/16/2022.
Featured
- American College of Obstetricians and Gynecologists. (2019). Practice Bulletin 212: Pregnancy and Heart Disease.
- American College of Obstetricians and Gynecologists. (2019). 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. (2016). Committee Opinion No. 654:Reproductive Life Planning to Reduce Unintended Pregnancy.
- American Heart Association. (2021). Adverse Pregnancy Outcomes and Cardiovascular Disease Risk: Unique Opportunities for Cardiovascular Disease Prevention in Women: A Scientific Statement From the American Heart Association. Circulation, 143:18.
- American Medical Association. (2019). AMA adopts new policies at 2019 Annual Meeting. (Press release)
- Berry, D. C., Boggess, K., & Johnson, Q. B. (2016). Management of Pregnant Women with Type 2 Diabetes Mellitus and the Consequences of Fetal Programming in Their Offspring. Current Diabetes Reports 16:36.
- Buschur, E. O. & Polsky, S. (2021). Type 1 Diabetes: Management in Women From Preconception to Postpartum. The Journal of Clinical Endocrinology & Metabolism, 106(4).
- 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. (2022). Current Cigarette Smoking Among Adults in the United States.
- Centers for Disease Control and Prevention. (2021). CDC Statement on Pregnancy Health Advisory.
- Centers for Disease Control and Prevention. (2021). Social Determinants of Health: Know What Affects Health.
- Centers for Disease Control and Prevention. (2020). Health Effects of Secondhand Smoke.
- Centers for Disease Control and Prevention. (2019). Pregnancy-Related Deaths.
- Centers for Disease Control and Prevention. (2018). Report from Nine Maternal Mortality Review Committees.
- Chen, J., Cox, S., Kuklina, E. V., Ferre, C., Barfield, W., & Li, R. (2021). Assessment of Incidence and Factors Associated With Severe Maternal Morbidity After Delivery Discharge Among Women in the US. JAMA Network Open, 4(2):e2036148.
- 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:supplement 1, 3-53.
- Maryland Tobacco Resources Center. (n.d.). Brief intervention and 5 A’s.
- Metz, T. D., Collier, C., & Hollier, L. M. (2020). Maternal Mortality From Coronavirus Disease 2019 (COVID-19) in the United States. Obstetrics & Gynecology, 136(2):313-316.
- National Center on Domestic Violence, Trauma & Mental Health. (2015). Women Who Experience Intimate Partner Violence and Prenatal and/or Postpartum Depression: Prevalence and Interventions.
- Ortique, C. (2018). Preventing Maternal Mortality and Morbidity in Texas:
- Every Mom Matters. Presentation by Carla Ortique, M.D., Vice-Chair, Maternal Mortality and Morbidity Task Force.
- Power to Decide. (2022). Texas Data.
- Rollè, L., Giardina, G., Caldarera, A. M., Gerino, E., & Brustia, P. (2018). When Intimate Partner Violence Meets Same Sex Couples: A Review of Same Sex Intimate Partner Violence. Frontiers in Psychology, 9.
- Shelton, S. Fj. (2015). Postpartum Care of Women Affected by Diabetes: A Review of Current Trends. The PLAID Journal, 1(2): 40-46.
- Texas Department of State Health Services. (2020). Texas Maternal Mortality and Morbidity Review Committee and Department of State Health Services Joint Biennial Report.
- 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).
- The Commonwealth Fund. (2021). Policies for Reducing Maternal Morbidity and Mortality and Enhancing Equity in Maternal Health: A Review of the Evidence.
- 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. (2021). The Surgeon General’s Call to Action to Improve Maternal Health.
- Whitfield, D. L., Coulter, R. W. S., Langenderfer-Magruder, L., & Jacobson, D. Experiences of Intimate Partner Violence Among Lesbian, Gay, Bisexual, and Transgender College Students: The Intersection of Gender, Race, and Sexual Orientation. Journal of Interpersonal Violence, 36(11-12):NP6040-NP6064. (Abstract)
- World Health Organization. (n.d.). Social determinants of health.
- 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.
Medical Definitions
The medical definitions in this module were obtained or adapted from the American Heart Association; Centers for Disease Control and Prevention, Mayo Clinic; National Heart, Lung, and Blood Institute; Texas Department of State Health Services; The Canadian Journal of Cardiology, Tufts University and World Health Organization.
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 1.50 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Nursing Continuing Professional Development
The Texas Department of State Health Services, Continuing Education Service is accredited as a provider of Nursing Continuing Professional Development by the American Nurses Credentialing Center’s Commission on Accreditation.
Texas Department of State Health Services, Continuing Education Service has awarded 1.50 contact hours of Nursing Continuing Professional Development.
Social Workers
The Texas Department of State Health Services, Continuing Education Service, the continuing education provider, ensures that the education provided is directly related to the practice of social work; and that the individuals presenting the information have the necessary experience and knowledge in the topics presented. The Texas Department of State Health Services, Continuing Education Service has awarded 1.50 hours of credit.
Certificate of Attendance
The Texas Department of State Health Services, Continuing Education Service has designated 1.50 hour(s) for attendance.
General Disclosure
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).
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Health-Care Providers
Alliance for Innovation on Maternal Health (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.
American College of Obstetricians and Gynecologists. (2019). 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. Includes 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 Maternal Quality Care Collaborative. (2017). Improving Health Care Response to Cardiovascular Disease in Pregnancy and Postpartum Toolkit. (The toolkit is free to download, sign-in required.)
Centers for Disease Control and Prevention. (2022). COVID-19 Vaccines While Pregnant or Breastfeeding.
Hear Her. A campaign from the Centers for Disease Control and Prevention to raise awareness of urgent maternal warning signs.
Hear Her Concerns Texas. Texas Department of State Health Services campaign to empower women to know their health risks and warning signs and speak up when they have concerns.
Healthy Texas Women. No-cost health and family planning services for low-income patients. Access the provider portal for information about patient eligibility and benefits.
Healthy Texas Women. Certification form for health-care providers to become a Healthy Texas Women provider.
Healthy Texas Women. Topics and Resources.
LactMed. U.S. National Library of Medicine’s free online resource that provides high-quality guidance on medication safety during lactation.
Maternal Early Warning System (MEWS). Texas Collaborative for Healthy Mothers and Babies.
MEWS Protocol. Protocol to increase early recognition of and effectively escalate and promptly evaluate obstetrical hemorrhage, hypertension or other severe maternal morbidities.
National Maternal Mental Health Hotline. Free, confidential phone or text access to professional counselors at 833-9-HELP4MOMS (833-943-5746).
Postpartum Support International.
Power to Decide: The Campaign to Prevent Unplanned Pregnancy.
Texas AIM. Website offers a COVID-19 Vaccines and Pregnancy Poster and current AIM Maternal Safety Bundles.
Texas Department of Family and Protective Services. Texas Home Visiting program.
Texas Department of State Health Services. (2020). Texas Maternal Mortality and Morbidity Review Committee and Department of State Health Services Joint Biennial Report.
Texas Department of State Health Services’ Maternal and Child Health web page.
Texas Diabetes Council Toolkit. Free educational materials for patients and providers.
Postpartum Depression screening and screening tools:
- Texas Health and Human Services. The Texas Clinician’s Postpartum Depression Toolkit
- Edinburgh Postnatal Depression Scale (EPDS)
- Patient Health Questionnaire (PHQ-9)
- AAP Toolkits. Bright Futures Toolkit: Links to Commonly Used Screening Instruments and Tools (See “Click here for a pdf of the list of links.”)
Intimate Partner Violence
- 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, 800-799-7233 (800-799-SAFE).
- Rape Abuse & Incest National Network Hotline (RAINN), 800-656-4673 (800-656-HOPE).
- Futures Without Violence (Previously known as Family Violence Prevention Fund).
- National Resource Center on Domestic Violence.
- Office on Violence Against Women. U.S. Department of Justice.
Tobacco Use
- American College of Obstetricians and Gynecologists. (2014). FAQ: It’s time to quit smoking.
- Centers for Disease Control and Prevention. (2017). Quit smoking.
- Maryland Tobacco Resource Center. (n.d.). Brief intervention and 5 A’s.
Postpartum Care Resources for Families
- American Diabetes Association.
- International Lactation Consultant Association.
- La Leche League International, Breastfeeding support.
- Postpartum Support International.
- March of Dimes. (n.d.) Taking Care of You: Your Postpartum Health and Visit.
- March of Dimes. (2018). Your Postpartum Checkups.
Social Determinants of Health Resources
- U.S. Department of Health and Human Services. (2021). SDOH & Practice Improvement: Tools to Help Healthcare Organizations Address SDOH.
- Centers for Disease Control and Prevention. (2021). Social Determinants of Health: Know What Affects Health.