Pregnant, Substance-Using Women
Treatment Improvement Protocol (TIP) Series 2

Guidelines for Postpartum Care

1 Encourage continuation of or enrollment in an alcohol and other drug treatment program. The supportive involvement of the patient's significant others in her treatment should be encouraged. This involvement can be extremely important in the treatment of addiction and in positively influencing the environment in which the newborn will be raised.

2 Encourage use of an appropriate family planning method. For further information, refer to the discussion of Preconception Counseling in the introduction to Chapter 1, Alcohol and Other Drug Treatment Guidelines for Pregnant, Substance-Using Women.

3 Permit breastfeeding in methadone-maintained patients. A number of substance-using women express a desire to breastfeed their infants. Breastfeeding is not contraindicated in a methadone-maintained patient if she is known to be free of other drug use and is known to be HIV-seronegative. If the mother is abusing multiple drugs that would expose the infant to diverse agents in varying levels, then breastfeeding may still be contraindicated. Breastfeeding is not recommended if the mother is HIV-infected.

4 Initiate prevention and health maintenance efforts. The woman should be encouraged to start a preventive health maintenance program. This program should provide for immunizations and yearly checkups, including Pap smears and mammograms. For the infant, appropriate pediatric followup and referral to early intervention programs should be arranged.

5 Provide child care and parenting education. Information should be provided on infant feeding, bathing, umbilical cord care, breastfeeding, appropriate approaches for "fussy" infants, and age-appropriate discipline for other siblings.

6 Provide postpartum followup. The health care provider should meet with the woman 2 to 6 weeks after delivery to accomplish the following:

• Review the laboratory data.
• Review the care plan, including parenting education.
• Discuss the delivery and the well-being of the infant.
• Conduct a physical examination.
• Look for current alcohol and other drug use and perform screening.
• Encourage use of an appropriate family planning method.