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Puerperium (Postpartum) Guide
Taking care of
newborn mother
Congratulations
on the birth of your baby.
We wish you all the best in this exciting new stage of your
life with your new baby. Babies are the most beautiful gifts from
GOD. May your small one grow strong and happy under your
care and love.
The moment a child is born, the mother is also born. It is
important for mother to spend time everyday caring for herself
both physically and emotionally. The time just after a baby is
born, the postpartum period begins which is something absolutely
new. The postpartum period brings many physical and emotional
changes.
This guide will help in understanding the changes in your body
and about your postpartum care. It is not meant as a substitute
for professional medical care. If you have questions or concerns,
be sure to talk with your doctor.
Regards.
==============================
Table of contents
l
Postpartum
l
Perineal
period defined
care after vaginal delivery
l
Cesarean
Birth (C-section) recovery
l
Uterus
l
Lochia
(vaginal discharge)
l
Menstruation
l
Bladder
care after delivery
l
Swelling
l
Bowels
l
Breast
l
Diet
and hemorrhoids
care
and nutrition
l
Activity
and exercise
l
Postpartum
l
Resuming
medical care
sex
l
Postpartum
blues and depression
l
Resuming
to work
l
Important
warning signs
==============================
Postpartum period defined
It is the period beginning immediately after you deliver your baby until your
reproductive organs return to their pre-pregnancy state is called the postpartum
(puerperium) period. It begins as soon as your baby is born and usually lasts
about six weeks.
Perineal care after vaginal delivery
The perineum is the area between your vagina and rectum. Vaginal and
episiotomy stitches will dissolve during the healing process and do not need
to be removed.
lUse
a peri-wash bottle to clean the perineal area.
lYou
may gently wash the area with soap and a soft washcloth as you shower
or bathe.
lUse
cushions and elevate your feet while sitting.
lYou
should, however, limit your activity, particularly lifting, for at least two to
three weeks
Consult your doctor promptly if you notice any of these signs:
lIncreasing
pain.
lRedness.
lA
foul odor in the perineal area.
lFever.
Cesarean Birth (C-section) recovery
lKeep
the incision (wound) clean and dry.
lLook
at your incision daily with a hand mirror. Report to your doctor if you
notice any redness, swelling, separation, drainage or foul odor from or around
your incision.
lDon’t
lift anything heavier for the first six weeks.
lAvoid
sitting for long periods with your knees bent or crossed.
lWalking
for short periods is fine with rests in between.
03
Uterus
Immediately after your baby is born, your uterus becomes firm and large. If your
abdomen still looks pregnant after delivery, this is normal and will gradually go
away. Six weeks later, the uterus should have returned to its normal size.
Some mothers, especially second-time mothers, feel painful after-birth
contractions when breastfeeding. These contractions, caused by hormones
released when you breastfeed, usually disappear in five to seven days. In the
meantime, if you experience such contraction, try the following steps to ease
pain:
lGently
lKeep
lDo
massage your abdomen.
your bladder empty.
deep-breathing and relaxation exercises.
Lochia (vaginal discharge)
Some vaginal discharge or “lochia” will usually be present for two to three
weeks, perhaps longer.
lInitially
it will be red with small clots.
lBy
eight days after the baby is born, the discharge may be pink or browntinged.
lIt
is normal for the flow to increase whenever you increase your level of
activity, even if it is simply getting out of bed.
lConsult
your doctor if you pass clots larger or if you notice a foul odor in your
vaginal discharge.
lYou
may take showers or (after vaginal deliveries) baths, but no special
vaginal care is necessary.
Menstruation
After giving birth, women start menstruating again on varying schedules. It may
take a few months for your cycles to become regular again. Nursing mothers
often find it takes 18 weeks or longer to resume menstruation after giving birth.
Note: You can become pregnant before your menstrual periods resume, and
you can become pregnant even if you are breastfeeding.
04
Bladder care after delivery
lIt
may take a few days for your bladder to return to normal.
lIt
is normal to feel some tingling or slight discomfort when you urinate, but if
you feel burning or worsening pain, consult your doctor.
Swelling
You may take warm baths and elevate your feet to make yourself more
comfortable. Within a week, this swelling should be gone.
Bowels and hemorrhoids
Physical inactivity and perineal soreness may cause constipation and gas.
Try these simple tips to prevent or relieve constipation:
lDrink
lEat
plenty of fluids, six to eight glasses of water a day.
fruits, leafy green vegetables; and whole-grain bread and cereals.
lTake
stool softeners and/or laxatives as recommended by your doctor.
lEstablish
lBegin
a regular time to go to the bathroom.
taking walks.
Consult your doctor if you have not had a bowel movement within four days of
giving birth.
Note: If you have rectal stitches, do NOT use an enema without consulting with
your doctor first.
Hemorrhoids (painful, swollen veins in the anus) commonly occur and may
become tender after a vaginal birth. To relieve hemorrhoidal discomfort:
lUse
ice packs to reduce swelling.
lAvoid
lIn
prolonged periods of sitting or standing.
your diet increase your intake of fluids and fibers to prevent constipation
Breast Care
Two to five days after delivery, it is normal for your breasts to get bigger and
tender. Wearing a well-fined, supportive bra (with no underwire) day and night
may be more comfortable as your body adjusts to these changes. Your breasts
may leak milk for several weeks, so wear breast pads (Cotton is best) until the
leaking stops.
05
Engorgement
Engorgement is a process in which breast tissue swells and hardens. It last
about 48 hours and causes varying degrees of discomfort. Some women
feel only mild swelling and tenderness, while others have more pronounced
soreness as their breasts become firm and the skin stretches and becomes
tight and shiny.
If your breasts continue to be uncomfortable, try the following:
lAvoid
lLie
using heat or hot water, as this may increase swelling.
on you back.
lApply
ice packs made of crushed ice in plastic bags that will mold to your
breasts. Be sure to have one layer of cloth (such as a towel) between your
skin and the ice pack. Apply for 20 minutes, one to each side. Alternate them
20 minutes on and 20 minutes off until you are comfortable.
Breastfeeding
For a few days after your baby is born, your breasts will secrete thin yellow
fluid called colostrum. Composed of water, fat and protein, that helps your
newborn’s immune system. Nursing your baby on demand or at least every
three to four hours, acts as a good stimulus for milk production.
lWash
lKeep
your hands thoroughly before each feeding.
your breasts and nipples clean, but avoid harsh soap and drying lotions.
Nipple Care
After several feedings, your nipples may become tender with the first few sucks
as the baby latches on. This discomfort should be bearable and improve within
the first few weeks of nursing.
If your nipples become very sore, cracked or blistered, the baby is probably not
latching on correctly.
lAvoid
using soap on nipples. Wash with warm water only.
lExpose
lApply
your breasts to air and keep them as dry as possible.
small amount of colostrum or breast milk on sore nipples.
06
Mastitis
Mastitis, an infection within the breast, may occur at any time while you are
nursing. Symptoms of mastitis include:
lFever
higher than 100.4 F (38 C)
lIncreased
lFlu-like
lA
fatigue.
symptoms.
red, tender area in the breast.
lRed
streaks extending toward your armpit.
If you experience any of these symptoms, consult your doctor immediately. Be
sure to continue nursing or pumping your breasts.
Diet and nutrition
You should eat three regular good meals daily and drink plenty of water in
between. If you are breastfeeding, your diet should include extra calories of
protein and calcium. Caffeinated drinks should be limited to one to two servings
per day.
Activity and Exercise
Exercise helps to restore muscle tone needed to protect your bones and joints.
It will also help you lose weight gained during pregnancy. You can start these
simple strengthening exercises as soon as you feel comfortable. Lie on your
tummy with a pillow under your hips to relieve back strain, and relax your
abdominals. Don’t let your back sag.
lTighten and release
the perineal muscles to tone muscles that were stretched
during the birth process. Repeat 10 times at least twice daily.
lLie
on your back with your arms at your sides. Raise your head so that
your chin touches your chest. Slowly lower your head. (Raising your head
strengthens abdominal muscles) Repeat 10 times, four times daily.
Walking is usually a good exercise for new mothers. You can begin other
exercises, such as those illustrated on the following page, in 10 to 14 days if
you feel strong enough. Yoga or stretching exercises are fine if they are not
too strenuous. Most doctors recommend waiting six weeks before gradually
resuming strenuous exercise.
07
Exercises
l
Add
one new exercise each day.
l
Begin
by repeating the exercise five times and gradually increase to 10
times.
1.Breathe deeply, expanding
your abdomen. Hiss as you
slowly exhale, then forcibly
draw in your abdominal
muscles.
3.Lying with your arms at your
sides, draw your knees up
slightly, and arch your back.
2.Lying on your back with your
legs slightly apart, place your
arms at right angles to your
body and slowly raise them,
keeping your elbows stiff.
When your hands touch, lower
your arms gradually.
4.Lying with your knees and hips
flexed, tilt your pelvis inward
and tightly contract your
buttocks as you lift your head.
08
5.Lying with your legs straight,
raise your head and left knee
slightly, then reach for (but do
not touch) your left knee with
your right hand. Repeat, using
your right knee and left hand.
7.Leaning on your elbows and
knees, keep forearms and
lower legs together. Hump
your back upwards, strongly
contracting your buttocks and
drawing in your abdomen.
Then relax and breathe deeply.
6.Lying on your back, slowly flex
one knee and one thigh toward
the abdomen; lower your foot
toward your buttock, then
straighten and lower your leg.
09
Postpartum Medical Care
By 6 weeks, your uterus should be back to its normal size and position. Make
an appointment to visit your doctor about 6 weeks after delivery (patients who
have had a Cesarean delivery should be seen at about 2 weeks after delivery).
Your postpartum examination will include weight, blood pressure, a blood
test for anemia, internal and breast examinations, and any other laboratory
tests, such as a Pap test. Your doctor will prescribe treatment or special care
if you need it. The postpartum visit is a good time to talk to your doctor about
anything that concerns you - your health, your weight, exercise, diet, work, and
your feelings about your baby.
Resuming Sex
Note: Pregnancy can occur before your menstrual periods resume.
Most doctors suggest that you refrain from intercourse until your stitches stop
hurting and the birth canal has healed. This usually takes four to six weeks
after delivery. When you resume sexual intercourse, it may be beneficial to use
additional lubrication and go slowly.
Postpartum Blues and Depression
The baby blues
Having a baby brings many dramatic changes in you. You may not have
been expecting it, but mild depression and mood swings are common in new
mothers, in fact, that it has its own name: the baby blues.
The vast majority of new mothers experience at least some symptoms of the
bay blues, including moodiness, sadness, difficulty sleeping, irritability, appetite
changes, and concentration problems. Symptoms of the baby blues typically
show up within a few days of giving birth and last from several days to a couple
of weeks.
The baby blues are a normal part of new motherhood-probably caused by the
hormone changes that occur following birth. If you have them, there is no cause
for undue worry. You’ll feel better once your hormones level out. Aside from
the support of your loved ones and plenty of rest, no treatment is necessary.
Postpartum depression
Unlike the baby blues, postpartum depression is a more serious problem-one
10
that you shouldn’t ignore. However, it’s not always easy to distinguish between
the two. The difference is that with postpartum depression, the symptoms are
more severe (such as suicidal thoughts or an inability to care for your newborn)
and longer lasting.
Signs and Symptoms of Postpartum Depression
lLack
of interest in your baby.
lLack
of energy and motivation.
lNegative
feelings towards your baby.
lWorrying
about hurting your baby.
lChanges
lLack
in appetite or weight.
of concern for yourself.
lSleeping
more or less than usual.
lRecurrent
thoughts of death.
Resuming to work
Consult your doctor before resuming work.
Important warning signs
Consult your doctor immediately if you develop any of these warning signs:
lAbdominal
pain that gets worse instead of better.
lCesarean
incision that separates, becomes hot or red, or develops foulsmelling drainage.
lBright
red or heavy vaginal bleeding, with or without clots that saturates a
pad in less than two hours.
lPassing
clots larger.
lFoul-smelling
lFever
vaginal flow.
or chills with a temperature over 100.4 F.
lOngoing
urinary or perineal discomfort.
lBurning,
frequent or bloody urination.
lSevere
or persistent hemorrhoidal pain.
11
lNo
bowel movement within four days of giving birth.
lCracked
nipples or red, tender areas in a breast that don’t respond to home
treatment.
lPostpartum
depression symptoms.
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