Postpartum Evaluation Name * First Name Last Name Phone (###) ### #### Email * Postpartum Recovery Evaluation Full Uterine Cleanse Complete In Progress To Be Assessed At a Later Date Further Assessment Necessary Uterus organs and ligaments have returned to normal size and position Complete In Progress To Be Assessed At a Later Date Further Assessment Necessary Neighboring organs (colon, bladder, intestines) have returned to normal position and function Complete In Progress To Be Assessed At a Later Date Further Assessment Necessary Stretched vulva, perineum and vaginal canal skin tissue must regain tone and shape and heal from tears, sutures, scar tissue Complete In Progress To Be Assessed At a Later Date Further Assessment Necessary Water Retention or Swelling must disperse Complete In Progress To Be Assessed At a Later Date Further Assessment Necessary Pelvic or spinal bone injuries should be assessed and addressed Complete In Progress To Be Assessed At a Later Date Further Assessment Necessary Blood and fluid loss during labor and delivery should be replenished Complete In Progress To Be Assessed At a Later Date Further Assessment Necessary Return to intimacy should be painless Complete In Progress To Be Assessed At a Later Date Further Assessment Necessary Menstrual return should consist of 3 consecutive months of standard healthy cycles - 4 day menses, pain free, red color, no side-effects, 28-30 day cycles Complete In Progress To Be Assessed At a Later Date Further Assessment Necessary The birth experience, labor and delivery should be emotionally processed Complete In Progress To Be Assessed At a Later Date Further Assessment Necessary The matrescence transition into motherhood should be acknowledged and supported Complete In Progress To Be Assessed At a Later Date Further Assessment Necessary Imbalances Uterine Fatigue Yes - Current Imbalance In the past but not now No Dampness Yes - Current Imbalance In the past but not now No Stagnation Yes - Current Imbalance In the past but not now No Blood Deficiency Yes - Current Imbalance In the past but not now No Dryness Yes - Current Imbalance In the past but not now No Excess Heat Yes - Current Imbalance In the past but not now No Weak Digestion Yes - Current Imbalance In the past but not now No Inadequate Rest Yes No Possibly Incomplete Recovery Yes No Possibly Postpartum Steam Therapy Plan Steam plan Yes - Steaming is safe at this time No - Steaming should not take place Contraindication Type Uterine Bleeding Contraindication Pregnancy Contraindication Medical Contraindication Excess Heat Contraindication Contraindication Recommendation There is soft containdication to discuss further Only an herbal bath is recommended at this time Wait to steam See referral First Aid Care Go on bedrest immediately to slow down bleeding See local acupuncturist to slow or stop bleeding (ask about yunnan baiyao or gui pi pian or moxa) If still bleeding by period day 5 go to an acupuncturist to stop bleeding First aid herbal remedies See first aid herbal remedies for home remedies and herbs to keep in the medicine cabinet at home. Please read this article about first aid to stop bleeding and important safety signs to watch out for: https://steamychick.institute/firstaid Practitioner Notes Steam Sensitivities Uterine Bleeding Sensitivity Medical Sensitivity Heat Sensitivity Age Sensitivity First Timer Stage 1 Early Postpartum Steam Plan (1-40 Days) - Focus: Uterine Cleanse 0-10 Days Stage Postpartum Uterine Cleanse Steam Plan Cleansing Herbs Yes No Disinfecting Herbs Yes No Hemostatic Herbs Yes No Cooling Herbs Yes No Rotate Herbs Every Other Day Yes No No Heater Setup Yes No Yes Heater Setup Yes No 5 Min Steam Session Duration Yes No 10 Min Steam Session Duration Yes No 30 Min Steam Session Duration Yes No One Session Per Day Yes No Two Sessions Per Day Yes No Three Sessions Per Day Yes No Hourly (or as needed) Yes No Steam Daily Yes No Cloak Yes No No Cloak Yes No Notes 11-20 Days Stage Postpartum Uterine Cleanse Steam Plan Cleansing Herbs Yes No Disinfecting Herbs Yes No Gentle Herbs Yes No Cooling Herbs Yes No Rotate Herbs Every Other Day Yes No No Heater Setup Yes No Yes Heater Setup Yes No 5 Min Steam Session Duration Yes No 10 Min Steam Session Duration Yes No 30 Min Steam Session Duration Yes No One Session Per Day Yes No Two Sessions Per Day Yes No Three Sessions Per Day Yes No Hourly (or as necessary) Yes No Steam Daily Yes No Cloak Yes No No Cloak Yes No Notes 21-30 Days Stage Postpartum Uterine Cleanse Steam Plan Cleansing Herbs Yes No Disinfecting Herbs Yes No Hemostatic Herbs Yes No Cooling Herbs Yes No Rotate Herbs Every Other Day Yes No No Heater Setup Yes No Yes Heater Setup Yes No 5 Min Steam Session Duration Yes No 10 Min Steam Session Duration Yes No 30 Min Steam Session Duration Yes No One Session Per Day Yes No Two Sessions Per Day Yes No Three Sessions Per Day Yes No Hourly (or as necessary) Yes No Steam Daily Yes No Yes Cloak Yes No No Cloak Yes No Notes 31-40 Days Stage Postpartum Uterine Cleanse Steam Plan Cleansing Herbs Yes - Current Imbalance In the past but not now No Disinfecting Herbs Yes - Current Imbalance In the past but not now No Gentle Herbs Yes - Current Imbalance In the past but not now No Cooling Herbs Yes - Current Imbalance In the past but not now No Rotate Herbs Every Other Day Yes - Current Imbalance In the past but not now No No Heater Setup Yes - Current Imbalance In the past but not now No Yes Heater Setup Yes - Current Imbalance In the past but not now No 5 Min Steam Session Duration Yes - Current Imbalance In the past but not now No 10 Min Steam Session Duration Yes - Current Imbalance In the past but not now No 30 Min Steam Session Duration Yes - Current Imbalance In the past but not now No One Session Per Day Yes - Current Imbalance In the past but not now No Two Sessions Per Day Yes - Current Imbalance In the past but not now No Three Sessions Per Day Yes - Current Imbalance In the past but not now No Hourly (or as necessary) Yes - Current Imbalance In the past but not now No Steam Daily Yes - Current Imbalance In the past but not now No Yes Cloak Yes - Current Imbalance In the past but not now No No Cloak Yes - Current Imbalance In the past but not now No Notes Cesarean Guidelines Wait 6 Weeks Post-Cesarean to Start Yes No Disinfecting Herbs Yes No Hemostatic Herbs Yes No Cooling Herbs Yes No Rotate Herbs Every Other Day Yes No No Heater Setup (10 min) Yes No Heater Setup (30 min) Yes No One Session Per Day Yes No Two Sessions Per Day Yes No Cloak - If Desired Yes No No Cloak Yes No Monthly (Optional with the Moon) Yes No Weekly (Optional with the Moon) Yes No 30 Days in a Row Yes No 90 Days in a Row Yes No Stage 2 Middle Postpartum Steam Plan (1-12 Months) Hemostatic Herbs Yes No Cooling Herbs Yes No Disinfecting Herbs Yes No Cleansing Herbs Yes No Rotate Herbs Every Other Day Yes No No Heater Setup Yes No Heater Setup Yes No 5 Min Steam Session Duration Yes No 10 Min Steam Session Duration Yes No 30 Min Steam Session Duration Yes No One Session Per Day Yes No Two Sessions Per Day Yes No Three Sessions Per Day Yes No 3 Days in a Row Yes No Weekly (Optional: With Moon Phases) Yes No Monthly (Optional: With Moon Phases) Yes No 30 Days in a Row Yes No 90 Days in a Row Yes No Daily Until Issue Resolves Yes No Pre-Sex Yes No Add Additional Sessions As Desired Yes No Cloak Yes No No Cloak Yes No Notes Stage 3 Late Postpartum Steam Plan (1-2 years) - Focus: Circulation Hemostatic Herbs Yes No Cooling Herbs Yes No Disinfecting Herbs Yes No Cleansing Herbs Yes No Rotate Herbs Every Other Day Yes No No Heater Setup Yes No Heater Setup Yes No 5 Min Steam Session Duration Yes No 10 Min Steam Session Duration Yes No 30 Min Steam Session Duration Yes No One Session Per Day Yes No Two Sessions Per Day Yes No Three Sessions Per Day Yes No 3 Days in a Row Yes No Weekly (Optional: With Moon Phases) Yes No Monthly (Optional: With Moon Phases) Yes No 30 Days in a Row Yes No 90 Days in a Row Yes No Daily Until Issue Resolves Yes No Pre-Sex Yes No Add Additional Sessions As Desired Yes No Basic Uterine Cleanse (3x before and after menses) Yes No Intermediate Uterine Cleanse (5x before and after menses) Yes No Advanced Uterine Cleanse (3x before/after menses plus every other day) Yes No Advanced Uterine Cleanse PLUS (Daily Except During Active Menses) Yes No Once After Period Yes No MC Day 20 Yes No MC Day 19/20/21 Yes No Cloak Yes No No Cloak Yes No Notes Referrals Acupuncturist Medical Doctor Midwife Doula Therapist or Healer Pelvic Floor Physical Therapist Abdominal Massage Practitioner Sex Therapist Scar Tissue Remediation Expert Nutritionist Referral Notes and Contact Information Practitioner Notes Steam Records Follow Up Appointment Recommended Yes Not at this time Date of Next Appointment Good Job!
