Normal Puerperium

Normal Puerperium

Puerperium is the period immediately following labour during which, the reproductive organs return to their pre pregnant stage. Lactation is initiated, and the mother recovers from the physical and emotional experiences of parturition. Puerperium begins as soon as the placenta is expelled and lasts for 6 weeks (42 days). The process whereby the genital organs revert back to their original state is called Involution.

Involution of the uterus:

• Immediately following delivery, the uterus becomes firm and weighs about 1000gm.
• At the end of 6 weeks, its measurement is almost similar to that of the non-pregnant state and weighs about 60gm.
• By the end of second week after delivery, the uterus becomes a pelvic organ.

Lochia:

Lochia are the discharges from the uterus, cervix and vagina for the first fortnight during puerperium. They are alkaline in reaction and contain bloods, debris of deciduas, and liquor amnii, lanugo, vernix caseosa and meconium.

Colour of lochia:

1. Lochia rubra (red) lasts for 1-4 days.
2. Lochia serosa – lasts for 5-9 days. Colour is yellowish or pink or pale browne.
3. Lochia alba- (pale white) lasts for 10-15 days.
4. The character of the lochia gives useful information about the abnormal puerperal state.

Puerperal complications:

1. Postpartum hemorrhage
2. Thrombo embolic manifestations
3. Puerperal infections
4. Postpartum psychosis
5. Lactation failure

Lactation:

• Initiation of breast feeding is more important during the immediate postnatal period. For the first two days, colostrum will be secreted from the breasts, which is a yellow serous fluid rich in protein and immunoglobulins. It provides resistance against infection to the newborn.
• The first feeding is an important experience to the mother and baby. The success of breast-feeding depends on mother’ s learning of a good breast-feeding technique in a happy and positive way.
• Breast-feeding should be given on demands of the baby and normally a healthy baby takes breast feeds 6 to eight times in 24 hours, for not less than 10 minutes each.

Advantages of breast-feeding:

1.      Ideal composition. Helps in easy digestion for the baby.

2.      Breast milk contains a number of protective factors. Breast fed babies are less likely to develop infections like diarrhea and respiratory infections.

3.      Breast milk is readily available, usually sterile.

4.      It is convenient, requiring no preparation and costs nothing.

5.      It protects against allergies like asthma.

6.      It has a laxative action for the baby.

7.      It enhances emotional bonding between the mother and the baby.

8.   Breast-feeding acts as a natural contraceptive. Chance of conception is less during lactation period.

9.      Helps in involution of uterus.

10.  Breast fed babies have a higher IQ and have less chance of developing hypertension, diabetes mellitus, coronary heart disease, liver disease and cancer in later life.

11.  For mother, breast-feeding reduces the risk of breast and ovarian cancer.

12.  Breast-feeding saves money and time and conserves energy. The family and society spend less on milk, health care and illness.

Management of puerperium:

The basic principles of post-natal care include.

• Promotion of physical well-being by good nutrition, adequate fluid intake, comfort, cleanliness, and sufficient exercises to ensure good muscle tone.
• Early ampulation is insisted to prevent deep vein thrombosis.
• Establishment of emotional well-being.
• Promotion of breast-feeding.
• Prevention of complications.

Important Considerations of Postnatal Care

1. Adequate rest and sleep:
2. Watch for the signs and symptoms of infection and excess bleeding.
3. Diet: A balanced diet containing sufficient protein (90 gm) minerals and vitamins should be given. Additional fluid intake is encouraged. Fresh fruits and vegetables should be included in the main meals.
4. Antibiotics and analgesics are given to combat infection and to relieve pain and discomfort.
5. Perinial care with aseptic precautions to prevent puerperal infections
6. Micturition: Difficulty with urination is quite common during the first few days due to trauma. It must be ensured that the bladder emptied completely.
7. Constipation: It is common during puerperium as there is a tendency of the bowels to be sluggish. A diet rich in fibre will overcome the problem.
8. Postnatal exercise: The importances of post-natal exercises are stressed to the mother and are also taught to her to regain the muscle tone, which are stretched during pregnancy and labour.
9. Continuance of supplementary iron therapy.
10. Advise for a gradual return to day-day activities.
11. Advise on breast-feeding and care of newborn including immunisation.
12. Family planning advice and guidance.
13. To have a postnatal check up after 6 weeks.