Puerperium

Puerperium is the postnatal period beginning immediately after the birth of a child and extending for about six weeks. During this period the body tissues, in particular the genital and the pelvic organs, return to the condition in to pre-pregnancy state of the women. This post delivery period of change continues till about 6 weeks (42 days) from delivery to normal, traditionally the concept of 40 days (or ‘sava mahina’) of post-partum confinement was and often still is, the rule in most Indian homes. It gives you time to recover and rest.

Immediate Puerperium

The first 24 hours after birth (immediate Puerperium) is a critical stage. This is the time when your uterus has to contract well, in order to stop the bleeding from the site of placental attachment. It is also the initiation of breastfeeding and bonding. Occasionally, this is the time that most life threatening complications of delivery manifest. These include postpartum excessive bleeding, collapse of the circulation, cardiac failure, etc. These are not common, but even with normal vaginal birth; there is a risk of death of about 1 in 10,000 women. This risk may be more in women with pre-existing medical conditions like anaemia, hypertension or heart diseases. It is also more with operative deliveries. Hence you will be advised to stay in hospital for at least 24 hours following childbirth.

Early Puerperium

This refers to the 2nd to 7th day post-delivery where major changes start in your genital tract. This is probably also the time of maximum adjustment when you come to terms with your new role as ‘mother’. You will also be going home with your baby in this period. There are many relatively minor, yet significant bodily changes you should be aware of. These include:

Lochia / Vaginal discharge

This term refers to the discharge from the vagina, coming mainly from shedding of the inner lining of the uterus. For the first 4 days, there is fresh bleeding, like a heavy menstrual flow. You may need to use 2 pads at a time, changing 3 – 4 times a day. However, if you find it very heavy, or large clots keep coming out, you must inform your doctor. Usually by the 5th day the flow becomes much less, and may now be more of a blood stained yellowish-brown discharge. You may still require sanitary protection, about 2 – 3 pads a day. This discharge usually stops by the end of the second week after which it becomes a plain white discharge. Good hygiene and care of episiotomy will prevent infection. Any foul smell in the discharge should be reported to your doctor.

Urination

The first day you must pass urine at least 2 – 3 hourly, despite pain in the stitches. This is because the bladder may become overfull without your notice, which can cause problems, especially infections later. During the first week, you may notice that you seem to be passing a lot of urine. This is because your body is removing some of the excess water and salt that was retained in pregnancy.

Stools

You may not have a good bowel motion for the first 2 days following delivery, for various reasons. One is that you have not eaten much during labour, you are exhausted and sleepy. Secondly you may be having pain in the stitches of the episiotomy. It is important to take a high fiber diet and plenty of liquids to prevent hard stools. You may need a mild laxative for a few days.

Breasts

The first day you will have only a watery, yellowish discharge, not looking like ‘real’ milk coming from the breasts. This is called colostrum and it is rich in many nutritive factors that are needed by your baby. You must feed your baby at this time. By the third day, the milk flow increases a lot, due to hormonal changes in your body. Regular feeding is important to prevent engorgement.

Care of Episiotomy

If you have had stitches on your perineum there are a few things you need to do, particularly in the first week, to make yourself comfortable and keep healthy.

• Cleaning the area at least twice a day, with local dilute antiseptic solution like Savlon or Dettol. This is a must after passing stools, and washing with water should be done after passing urine. Remember, always wash from front to back, never the other way, to prevent infection.
• Local application of antiseptic creams such as Soframycin, Metrogyl gel, Betadine E – com may be useful to prevent infection. This is usually done twice daily, after bath and before going to sleep at night.
• Pain relieving methods such as hot water washes or hot water bag may be useful.
• Another way of getting pain relief is local application of ointment such as 2% xylocaine, which acts as a local pain-reliever.
• Infrared lamp to apply day heat to the area of stitches may be given to you in hospital.
• Oral medications such as antibiotics to prevent infection, or pain killer tablets (paracetamol, ibuprofen, etc.) should only be taken as advised by your doctor.
• Most doctor use stitches, which dissolve on their own and / or fall off after a few days. Ask your doctor if you need to come back to show the stitches.

Resuming Activities

As discussed earlier, it takes up to 6 weeks for your body to recover from the changes of pregnancy. So, be patient with yourself. Different women have different abilities to deal with their health changes. However, in most cases, after a normal vaginal delivery, you will be able to resume your daily personal care activities within a day, and your household routine within a week, don’t overexert yourself – This is the time you need to devote to yourself and your baby. Take help of others available to make your life easier. After a complicated childbirth or after a caesarean delivery your recovery may take twice as much time.

Postnatal Exercises

Sexual Activity is best avoided in the early post delivery period. This is because your stitches may be raw or painful, and your genital tract is prone to infection, particularly in the first week. Complete restoration of the lining of the uterus, including the placental site, is not complete. Hence traditionally some advice abstinence till 6 weeks following delivery. However, if you have had an uncomplicated birth, and are not having any problems, you could resume your sexual life earlier. You and your partner may have been deprived of each other, particularly in the last month of pregnancy. Hence, it is not unusual to feel the need to renew your sex – life. Until you feel comfortable for actual penetrative sexual intercourse, other displays of caring and affection can suffice. Hugging, kissing, petting or touching is not forbidden at any time during pregnancy or post-delivery.

Lactational Amenorrhoea

While you are exclusively breastfeeding, the hormonal changes in your body act on the genital tract to suppress ovulation and menstruation. You may not get your periods for a few months. Some women do not start menstruating for up to a year, depending on the pattern and frequency of breastfeeding.

Does this mean you cannot get pregnant? The answer is NO. About 5% of women get pregnant before they start menstruating, post-delivery. Lactational amenorrhoea (absence of periods) does protect you from pregnancy to some extent. However, you can rely completely on Lactational amenorrhoea as a method of preventing pregnancy ONLY IF ALL 3 preconditions listed below are satisfied:

• You are exclusively breastfeeding.
• Not more than 6 months have passed since delivery.
• You have not yet got a period after delivery.

Contraception

If you are relying on lactational amenorrhoea, you may be protected. If not, that brings us to the important question: Are you ready for another pregnancy? You need to give your body time to recover; your baby time to grow up and yourself time to adjust to the new role of ‘mother’. Of course, it is a question of personal choice but a minimum gap of 2 years is recommended between successive pregnancies.

How can you prevent pregnancy during the post-delivery period? There are many methods available.

During the post-partum period, however, certain factors need to be kept in mind, such as

• Whether breastfeeding or not.
• Frequency of sexual intercourse.
• For how long pregnancy prevention is required.
• The final choice is also influenced by your personal needs and experience.

Others

Condoms
Condoms are a good, locally acting method, which are reliable if used correctly and consistently. They have no side effects and are useful for couples with less frequent sexual intercourse.

IUCDs or ‘loops’
These are a very reliable method, requiring one visit to the doctor for insertion, which can be done easily without anaesthesia. They are effective for average 3 – 5 years (depends on the device) and are independent of the sexual act, unlike condoms. This is a very popular method for women with one or more children. In fact, can be used as an option to permanent procedure. The IUCD can be inserted at the first postnatal visit. (6 weeks from childbirth) or later, even if you do not have periods, provided your internal checking is normal.

Oral Contraception Pills
During the period of exclusive breastfeeding the combined Oral Contraception pills (containing Oestrogen + Progesterone) may reduce the breast milk flow. Hence are not popularly recommended. Once weaning is begun, there can be used safely.

Sterilisation
This is a permanent method, which can be opted for after you have completed your family. This is a procedure which can be done easily immediately post-delivery (puerperial sterilization) or at the time of caesarean section. For both these options, you need to discuss the pros and cons with your doctor and spouse before delivery, ideally in one early antenatal period. Some prefer to wait until the youngest child is older, preferably above 1 year old, before doing this permanent procedure. As an interval procedure, 6 weeks or more after delivery, it is usually done by laparoscopy.

First Postnatal Visit
You and your baby have been through a lot. After you go home, and you recover from childbirth, your doctor will need to see you at least once to confirm that your recovery is complete. The first checkup is usually 6 weeks from delivery. It may be earlier, about 3 weeks, if you have needed special care or had any problem in delivery.

At the first visit, your doctor will check

• Your weight.
• Blood pressure.
• Signs of anaemia.
• Your breasts.
• Your episiotomy scar (should be dissolved by now).
• Your uterus (to see if it is shrinking back to normal size).

You may need to do some tests. You need to discuss the following issues with your doctor

• Restoration of your complete health.
• Postnatal exercises.
• Diet and nutrition.
• Your baby’s health.
• Immunization schedule.
• Continuing exclusive breastfeeding
• Contraception.

Source : Portal Content Team