Principles of postnatal care

Dr Isameldin Elamin MD DOWH MBBSAssistant Professor Obstetrics & Gynaecology

Puerperium: Post natal period

• Definition of puerperium : • The period of time after completion of the delivery

during which the woman’s body returns to the pre- pregnancy state.

• 6 weeks in duration. • By 6 weeks after delivery, most of the changes of

pregnancy, labor, and delivery have resolved and the body has reverted to the non-pregnant state.

Systemic changes: Cardiovascular system

• Blood volume returns to non-pregnant levels by around the 10th day after delivery.

• Cardiac output increases immediately after delivery, then slowly declines to reach normal levels by 2-6 weeks.

• Hematologic changes– Hemoglobin concentration increases during the first few days- so

blood becomes thicker.– Levels of some blood clotting factors (like fibrinogen) increase

during the first few days after delivery.– This is why there is more chance of deep vein thrombosis during

this period.

Common manifestations of post natal period• Low grade fever can be common during the first 24

hours after delivery.• She can get repeated abdominal pains due to

contractions and shrinking of the uterus. This is more common while she is breastfeeding her baby.

• Sweating is more common due to the exhaustion after labour and delivery.

• Lochia-– It is the blood stained discharge coming out of the uterus

through the vagina in the first few days. This is part of the healing process.

– A large amount of red blood initially flows from the uterus as the contraction phase rapidly occurs.

– The colour of this discharge changes gradually from red – yellowish- finally becoming whitish.

Post Natal Care

Definition: Care of newborn and mother after delivery during the post natal period.

Objectives:• To prevent complications of postnatal period.• To provide care for rapid restoration of the

mother to optimum health.• To check adequacy of breast feeding.• To provide family planning services.• To provide basic health education to mother and

family.

How to manage the mother during normal post natal period ?

1. Observe her closely in the delivery room for 2 hours after completion of delivery for:• Pulse, BP, Respiration and Temperature.• Amount of bleeding coming out of the vagina.• If uterus is well contracted or not.

2. Check 1-2 weeks after delivery for :• Vaginal bleeding should be minimal by now.• Healing of episiotomy wound.

Management of Puerperium..

3. Bowel movements - encourage to avoid constipation by advising high fiber diet, lot of fluids and early ambulation.

4. Advise on proper hygiene, including daily baths.5. Advise on care of episiotomy and any lacerations.6. Care of breast:

– Stress on early and regular breast feeding.– Good breast support using proper undergarments.– Proper hygiene during breast feeding.

Possible complications in the postnatal period

• Puerperal sepsis – is infection of the genital tract with in 3 weeks after delivery.

• Thrombophlebitis – is infection of leg veins frequently associated with varicose veins .

• Deep vein thrombosis.• Secondary hemorrhage –bleeding from the vagina

anytime from 24 hours to 6 weeks after delivery.

• Urinary Tract Infection.• Mastitis- inflammation, infection of the breast.

Restoration of mother and baby to optimum health• Postnatal examination

– Check the baby twice a day during first 3 days ,then once a day till umbilical cord drops off . At the end of 6 weeks check up for involution (shrinking) of uterus. Further visits every month during first 6 months there after once in 2 – 3 months till end of 1 year . In rural areas 3-6 visits should be made .

• Correction of anemia – give Iron and Folic Acid supplements.

• Nutrition – advise a well balanced diet.

• Postnatal exercises- demonstration and guidance.

• Psychological factors- look for postpartum depression or psychosis.

Basic health education

• Hygiene – personal and environmental.• Immunization.• Feeding for mother and infant.• Birth registration.• Importance of health check up.• Regular post natal exercises.

I. Guidelines to mothers for postnatal exercises

Postnatal exercise is as important as antenatal exercise. Its duration need not be long but it should be done twice or thrice a day. Repeat each set of movements about ten times in every session.

Keep your breath smooth, work gradually according to your capability.

A physiotherapist may make modifications to the exercise according to your physical conditions.

Note: This leaflet is only a partial introduction to postnatal exercise. You are advised to join a postnatal exercise class organized by physiotherapy department.

II. Purposes of postnatal exercises.

Strengthen pelvic floor muscle to prevent incontinence.

Prevent low back pain.

Speed up the restoration of body shape.

Stimulate blood circulation and enhance appetite.

Maintain vitality and self-confidence which helps keep a happy mind.

III. When should you start postnatal exercises after delivery? Two days after normal delivery, you can get off the bed to walk around and do

postnatal exercise. If you had a caesarean section, you should not begin until advice is sought from a physiotherapist or a doctor.