The Postpartum Period
Written by : Dr.M.D.Mazumdar, MD
The postpartum period is a very delicate period in a woman's life. At this time, she is exhausted from the childbirth, has suffered pain and blood loss and is prone to develop postpartum infections.
The main aim of the proper management of the postpartum period are:
- To help the mother regain proper health.
- To provide proper nursing care.
- To help her to care for her baby.
- To encourage breastfeeding.
- To provide contraceptive advice.
The patient should be encouraged to be active as early as she possibly can after the childbirth. This helps to drain out lochia and encourages uterine involution. Bladder complications and constipation is reduced. It also prevents the development of venous thrombosis.
However, caring for a newborn baby is a strenuous job and she should be advised to do only as much as she can - she should be careful not to tire herself. She should to tailor her activities around the baby's needs.
Care of the Perineum
Only sterile vaginal pads should be used. The perineum should be cleansed with sterile water and patted dry after passing urine or stool. In case there are episiotomy stitches, they should be dressed by a nurse with swabs soaked in savlon or other antiseptic solution. The stitches need to be checked daily for infection.
Pulse, BP and temperature should be recorded daily. The involution rate of the uterus should be measured daily after emptying the bladder. Character of the lochia is noted. Any signs of postpartum infection like foul smelling lochia or excessive bleeding should be immediately brought to the attention of the doctor.
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Care of the Breasts
The nipples should be cleaned and dried with sterile cotton or lint before and after every feed. A nursng brassiere should be worn to help support the breasts which are quite large and heavy at this time. If any dry crusts form on the nipples, they should be massaged away with warm olive oil.
Retention of urine
Some women may complain of being unable to pass urine after childbirth. This inability to pass urine usually occurs due to lax abdominal and bladder walls, spasm of the bladder sphincter secondary to pain from an episiotomy wound or lacerations and bruising of the urethra during delivery. Being at bed rest for long periods of time with decreased movements of the body also contribute to the inability to pass urine.
Treatment consists of prescribing a smooth muscle relaxant like buscopan to relax the urethral sphincter (the outlet for urine), a pain reliever like ibuprofen and advising the woman to be more active. If necessary, the bladder may have to be catheterized for a day or two.
Sometimes, some women suffer from lower abdominal colicky pains due to irregular uterine spasms. They occur mainly during breastfeeding as the oxytocin released during feeding causes the uterine muscles to contract. If the uterus is empty of any blood clots or retained placental bits (as diagnosed by ultrasonogram), supportive treatment in the form of pain relieving medicines and counseling is all that is required.
The woman who has recently delivered a baby needs a full diet with adequate calories. An extra 700 calories over her pregnancy diet should be added daily. If the woman is breastfeeding, adequate proteins, fats, minerals and vitamins ashould be given. Extra liquids must be taken to compensate for the loss of water in breastfeeding.
Antibiotics must be prescribed if an episiotomy has been done or the vaginal tissues manipulated excessively. Ergometrine can be given to help in contracting the uterus better. Laxatives may be given if the patient suffers from constipation (very common at this stage). Supplements of calcium, iron and Vit B-complex tablets may be given.
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