A woman's body goes through remarkable changes during pregnancy, ending in the physical effort of the birth itself. After the birth she needs a period of recovery so that she can return to feeling strong and healthy. This is especially important since the woman must also care for her newborn during this time. This period of rest and recovery is called the postpartum period. It covers about six weeks during which the body returns to the normal state and the woman adjusts to life with her child. The husband and other family members can help during this time by assuming responsibility for household tasks (see Figure 13.1).
Figure 13.1: Rest During the Postpartum Period
After giving birth the woman needs time (about six weeks) to return to feeling healthy and strong, and to care for her newborn. Family members can help by taking on household tasks.
The first few days immediately after delivery are often called the lying-in period. In many countries, there is a tradition that women rest for anywhere from one week to six months after delivery. This tradition recognises the hard work they have done - and the work they still have ahead. Many women may enjoy and appreciate this time of rest. However, they should also feel free to return to their normal activities when they feel ready.
Childbirth is a deeply emotional experience that often affects a woman's mood and behaviour. Many women have extreme mood changes after their babies are born. They may feel happy and relaxed one minute, and anxious, depressed, or tearful the next. The responsibility of caring for a new baby can feel confining or demanding. Relationships with other loved ones seem to change. For most women, these feelings fade and go away as time passes. What women need most at this time is support, understanding, and help from their friends and families. If a woman is feeling anxious and depressed and these feelings do not go away, she may need special help at a health facility that can provide psychiatric counselling or therapy. This is especially important if she talks seriously of hurting either herself or her baby, or makes an attempt to do so.
Chapter 6 discussed the physical changes a woman's body goes through during pregnancy. These changes are reversed during the first six weeks or so after the baby is born. The first noticeable change, of course, is the loss of weight when the baby and the placenta, plus the bag of water, are delivered. The changes continue until most organs - womb, heart, etc. - have returned to the way they were before the pregnancy.
Immediately after delivery, the womb weighs about two pounds (one kilo). It soon begins to get smaller; by the end of the fourth week it has returned almost to its original size and position in the pelvis. The overstretched soft tissues of the birth canal also return to normal. Breastfeeding helps this process by stimulating the womb to contract. This also helps reduce the amount of fluid (lochia) that comes from the womb during the first couple of weeks after delivery.
Immediately after delivery the lochia is bright red because it contains mostly blood. A clean cloth or cotton pad can be used to absorb the blood. The area can be washed gently to help prevent an infection. Women should be told to avoid tampons, douching, and intercourse at this time as they may increase the risk of infection. Over the next several weeks, the lochia changes to a dark brown colour, then to pale cream. The amount of the discharge becomes smaller over time and then completely stops, usually by the end of the fourth week. At first, it has a heavy smell which is not unpleasant. If the amount of the lochia increases, or has a bad smell, the woman may have an infection. If so, she should go to a clinic for a check-up and treatment immediately. Other signs of infection may include fever; chills; abdominal pain; a red, swollen, painful area in one of the breasts or in the leg; or very painful urination.
RETURN OF MENSTRUATION: If a woman breastfeeds without giving the baby any other milk or formula, her periods may not return for six or more months after delivery. If she is not breastfeeding, menstruation usually begins 4-6 weeks after delivery. Exactly when menstrual periods return may vary from one pregnancy to another. Women should know, however, that it is possible to get pregnant even before menstruation starts again if no family planning method is used.
RESUMPTION OF ACTIVITIES AFTER AN UNCOMPLICATED DELIVERY: Women recover from labour and feel ready for their usual activities at different times. It depends on many things, such as how many other children she has, how much family support is provided, and how the new baby is adapting. There are no firm rules about this, and women should be encouraged to let their own feelings be their guide.
RESUMPTION OF ACTIVITIES AFTER A CAESAREAN SECTION OR SYMPHYSIOTOMY: A woman who has undergone a Caesarean section or symphysiotomy will take longer to recover from the delivery than a woman who did not have any complications. She will need to stay longer in the hospital. After she returns home, she will also need extra help and rest. If any drainage, redness, increased pain, or swelling appears at the site of the incision, she should go immediately to a clinic for evaluation. A woman who has had a symphysiotomy may need to wear a tight band around her abdomen and hips to support her pelvis as it heals.
CARE OF HAEMORRHOIDS: Many women develop haemorrhoids or enlarged blood vessels around the anus late in pregnancy or after delivery. These usually shrink after delivery, but they can cause a lot of discomfort. Eating lots of fresh fruit and vegetables and drinking plenty of liquids will help reduce constipation, which makes the haemorrhoids worse. Medicated creams and suppositories may also be used.
POSTPARTUM EXERCISES: Postpartum exercises can help a woman regain her energy, muscle tone, and feeling of well-being. These exercises may be started when a woman is thoroughly recovered from the delivery, and should be done for about 15-20 minutes a day. The exercises are not difficult and should not be tiring (see Figures 13.2-13.4).
Figure 13.2: Head Lifts
1. Lie on back with arms at sides. Bend knees with feet flat on floor.
2. Raise head a little, breathing out. Then lower head slowly, breathing in.
3. Repeat the exercises 5-10 times.
Figure 13.3: Leg Slides
1. Lie on back with arms at sides. Bend knees a little, with feet flat on floor.
2. Slide foot back toward buttocks, keeping right foot flat on floor and bending knee. Slide leg back down.
3. Repeat 10-15 times for each leg.
Figure 13.4: Pelvic Tilts
1. Stand with feet shoulder-width apart and knees slightly bent.
2. Push hips forward a little, tightening stomach muscles. Hold for a count of 5-10, then repeat 5 times.
There are three serious complications that can develop in the period after delivery: eclampsia (within the first two days or 48 hours after delivery), infection, and haemorrhage (heavy bleeding). Eclampsia, fits caused by high blood pressure, is discussed in Chapter 9. Infection is most often caused by prolonged labour or early rupture of the membranes. It can also be due to poor hygiene during a delivery (for example, if the birth attendant's hands or instruments were not clean), or it can happen after a Caesarean section. The signs of a severe infection are fever, headaches, pain in the lower abdomen, bad-smelling vaginal discharge, and vomiting or diarrhoea (see Figure 13.5). These are dangerous signs, and a woman should go to a clinic or hospital immediately if she has them.
Haemorrhage can happen as late as ten days or more after delivery. If the placenta did not come out completely after delivery, bleeding may continue and become heavy. If the lochia is still bright red two weeks after delivery, she should go to a health facility.
Other complications that can develop after delivery are anaemia and fistulae. Anaemia is discussed in Chapter 9. Fistulae, which are holes that can develop between the vagina and the urinary tract or rectum, are discussed in Chapter 11.
Figure 13.5: Sepsis or Infection in the Postpartum Period
Signs of postpartum sepsis include fever, headaches, pain in the lower abdomen, foul-smelling vaginal discharge, and vomiting or diarrhoea. A woman with these signs should be taken to a clinic or hospital.
Box 13.1: Postpartum Danger Signs
If a woman has any of the following danger signs after she has delivered her baby, she should seek care immediately:
· fainting, fits, or convulsions
· paleness in the gums, eyelids, tongue, or palms
Ideally, a new mother should visit a health facility for her first postpartum visit, or be visited by a health worker at home, within 7-10 days of delivery (see Figure 13.6). This is especially true if she delivered at home. This first visit is important to make sure that the woman and the infant are recovering from the labour and delivery. If all is well, the next visit should be about six weeks after the birth of the baby. Both the mother and infant should have a thorough physical examination, and the infant should be immunised. In addition, this is an excellent opportunity to answer any questions the woman may have about breastfeeding, sexual relations, family planning, immunisations for the baby, sleep, or other topics.
Figure 13.6: Postpartum Care
A mother should visit a health facility, or be visited at home, within 7-10 days after delivery for a postpartum check-up.
There are no firm rules about when to resume sexual intercourse after delivery. In general, sexual intercourse during the first six weeks after delivery should be avoided due to the risk of infection. At the very least, sexual relations should be delayed until all bleeding has stopped. After that, women should resume intercourse as they feel comfortable and interested. Whenever sexual relations are resumed, it is important to use an effective family planning method so that the woman does not become pregnant while the baby is still only a few months old. There are several types of contraceptives suitable for women who are breastfeeding (see Box 13.2).
Box 13.2: Family Planning Methods for Breastfeeding Mothers
Women who are breastfeeding should not use contraceptive methods that contain oestrogen (such as combined oral contraceptives), because oestrogen reduces the amount of breast milk that is produced. Other methods that are appropriate for breastfeeding mothers, which are described in Chapter 17, include:
· lactational amenorrhoea method (LAM)
· barrier methods (condoms, spermicide, or the diaphragm)
After childbirth, women need to eat well in order to regain their strength and recover from the labour and delivery. They should continue to take iron tablets to prevent anaemia, especially since they lost blood during delivery. If a woman is breastfeeding, her diet should include extra food and drink (see Chapter 6). Breastfeeding mothers need to eat even more than they did while pregnant, as breastfeeding places great demands on nutritional reserves. They should also be certain to drink plenty of liquids. If a woman is not breastfeeding, she can eat as she normally would. As during pregnancy, it is perfectly safe for a woman to eat almost anything she eats when she is not pregnant. The only things she should avoid are alcoholic drinks.
Summary: The Postpartum Period
During the six weeks after delivery, the mother experiences a number of physical and emotional changes:
she may feel sad or tearful after the stress of pregnancy and labour
Serious complications can still develop after a woman has given birth. She should be taken to a clinic immediately if she has any of the following signs:
eclampsia, shown by fits or convulsions
During the postpartum period, women should watch their bodies carefully, eat well, and resume normal physical activities when they feel able. They can also do exercises to help regain their strength. They should go for a postpartum check-up within one week of delivery if possible, or be visited at home by a health worker. They should have another checkup about six weeks after delivery, which should include information and counselling on family planning.