Prevention is the best option

Postpartum

Postpart

After pregnancy and just after delivery, a new stage known as the puerperium or postpartum begins. This is a physiological process that includes a series of both physical and psychological changes in mothers and that lasts approximately 6 weeks or 40 days, which is colloquially known as the quarantine period. 

Description

On a physical level, postpartum is characterised by an involuntary and regression process of the body areas and organs that have undergone changes, with the exception of the mammary gland, which at this time is of greater importance for feeding the baby. In addition to physiological changes, there are also changes in mothers on a psychological level, in the family structure and in their social role. 

A period in which so many changes appear can translate into a complex or difficult adaptation, so it is important that the care provided by health professionals is carried out from a biopsychosocial and holistic approach and it is recommended that they be coordinated by a midwife. 

 

Three stages of postpartum

From a clinical point of view, three stages can be distinguished. 

 

First stage: immediate postpartum 

The immediate postpartum period includes the first 24 hours, of which the first two represent a period of close surveillance, due to the increased risk of postpartum haemorrhage. 

Regular monitoring of vital signs, such as temperature, blood pressure, and heart rate, will be carried out in the delivery room. Vaginal bleeding and the size of the uterus will be assessed, which after delivery must gradually recover to its size before pregnancy.

It must be verified that there is no wound or laceration in the vagina that is actively bleeding and, in the event that the woman has requested anaesthesia, the recovery of mobility of her legs must be checked. 

Immediate skin-to-skin contact of the baby with the mother will be initiated, under the appropriate supervision of health professionals, as well as the early start of breastfeeding if the mother wishes. The pertinent care of the newborn will also be carried out without altering the mother-child relationship, whenever circumstances allow. 

During the hospital stay, checks and care must be aimed at promoting the bond between mother and baby, together with the establishment of breastfeeding. During this process, it is important to instruct the mother and her family with regards identifying the warning signs to detect possible complications early. 

It is necessary to offer the mother truthful and simple information so that at the time of discharge she has maximum autonomy regarding the care of her baby. During the hospital stay, active participation of the couple in parenting will also be encouraged.

  

Second stage: early postpartum

The "early", "mediate" or "clinical" postpartum covers from 24 hours to the tenth day of postpartum and is considered the most important involuntary period. During this period, attention should be paid to the following possible complications: Infection of the endometrium, the surgical wound, the episiotomy, urine or the breasts; circulatory problems such as varicose veins, haemorrhoids and difficulties related to breastfeeding: pain, cracks, inflammation and problems with the baby's latch.

The hospital stay can be extended by 2 to 3 days depending on the type of delivery and as long as the evolution of the mother and baby is within normal limits. Once hospital discharge occurs, the midwife of the primary care centre will be in charge of the continuity of care for both the woman and her baby. 

 

Third stage: late postpartum 

Finally, the third phase, which corresponds to the late postpartum period, is between the 11th and the 42nd day after delivery (6 weeks). In this period, the physical changes that occurred during pregnancy in the mother have disappeared, breastfeeding is usually in place and the first menstruation appears in mothers who are not breastfeeding. 

In this period, the physical changes that occurred during pregnancy in the mother have disappeared, breastfeeding is usually in place and the first menstruation appears in mothers who are not breastfeeding. We should also provide information on postpartum support groups and breastfeeding groups.

 

Midwife's tips 

 

Breastfeeding

Breast milk let-down may take 2 to 5 days after birth and the breasts may become swollen, hot, and may hurt. The best remedy is to breastfeed the baby to relieve symptoms and prevent breast engorgement or inflammation of the breasts. Mild discomfort is alleviated with a gentle self-massage towards the nipple, to facilitate emptying of the breast prior to breastfeeding. If the discomfort worsens and / or fever appears, you should consult the midwife or go to the emergency room. 

  

Care in case of an episiotomy or tear

If an episiotomy is performed or the perineum is torn, for the care of the stitches, the area should be washed with water and neutral soap once a day, keep the area dry, use cotton pads without plastic and change them frequently. 

An episiotomy heals 7-10 days after delivery and the stitches usually fall out on their own. In case of caesarean section, there is no problem with showering, as long as the stitches are dried well. The wound will heal in 5 or 6 days (full healing will take a few more days) and the stitches or staples will be removed between the sixth and the seventh day by the midwife at the health centre.

 

Postpartum bleeding 

Lochia is bleeding that occurs in the postpartum period and lasts 6 to 8 weeks after delivery. It changes colour and decreases in quantity over the days. The smell of this discharge is similar to that of menstrual flow. In the event that a bad odour occurs, it is recommended you visit the health centre or hospital to rule out the existence of an infection. 

 

Healthy habits and exercise

  • It is important to maintain adequate fluid intake and a varied and balanced diet. The postpartum period is not a good time to follow restrictive diets (weight loss). 
  • It is recommended you increase your daily intake of fibre and water to promote intestinal transit. 
  • Rest should also be encouraged whenever possible, taking advantage of the baby's sleep periods and organising visits from family and friends. 
  • A daily 30-minute walk will help decrease swelling in your legs and feet and prevent the risk of circulatory complications, which is greater during this stage. 
  • It is recommended that Kegel exercises are begun, which help to strengthen the pelvic floor muscles, progressively, increasing the frequency and intensity to adapt to the mother's physical state and customising them in each case,
  • It is important to start practising sports gradually and to leave moderate or intense exercise for later.

 

Postpartum depression 

In the postpartum period, feelings of sadness and frequent mood changes (sadness, crying and euphoria) may occur. It is a normal adaptive reaction to changes and is known as maternity blues or postpartum depression. 

It can occur between the 3rd and 5th day after delivery and disappears after approximately 15 days. If this situation lengthens over time or symptoms worsen, the midwife or the nearest qualified professional should be consulted. 

 

Reviews  

The first postpartum review with the midwife is usually carried out around the seventh day after delivery. It is advisable to attend with your partner, in order to assess the adaptation and resolve any doubts or difficulties, and with the baby, to be able to assess breastfeeding.  

After 6 or 8 weeks following delivery, another routine visit is carried out, where the general physical and psychological state of the mother and breastfeeding are assessed. It is a good time to consider contraception, and the condition of the pelvic floor and its musculature should be assessed.  

It is necessary to attend the baby’s monitoring visits with your paediatrician and with the infirmary. 

  

Quarantine

During "quarantine" it is recommended you avoid:

  • immersions in water;
  • the use of tampons.

If the woman wants to have sex, this can be restarted during this period. It is recommended that a condom is used.

The first menstruation appears around 40 days after delivery in mothers who are not breastfeeding. Those who breastfeed their children do not generally resume their menstrual cycle until weaning, although they are not, even so, without risk of pregnancy.

 

Contraceptive methods

It is recommended you find out about contraceptive methods from the midwife of the primary care centre. It must be customised in each case and take into account whether there is breastfeeding or artificial feeding, since this, along with other health history, will help define the most appropriate method. Emergency contraception is a valid option also for this period.

  

Watch out for warning signs

It is necessary to go to the emergency department or consult your midwife upon the occurrence during the postpartum of these warning signs:

  • Fever of 38°C or higher. 
  • Large clots and increased vaginal bleeding.
  • Pain in the lower belly area.
  • Bad smell of lochia (bleeding that occurs during postpartum).
  • Pain, tension and redness in the area of the stitches.
  • Hot, burning discomfort when urinating...
  • Redness, pain and warmth in the breasts that is not relieved after breastfeeding the baby. 
  • Chest pain, with a feeling of shortness of breath.
  • Pain in the calves or thighs (with redness, pain and heat).
  • Severe depression after two weeks.
    
Related professionals
Dr. Antonio
Gil Moreno
Head of Department
Gynaecology
Biomedical Research in Gynaecology
Dra. Lidia
Illán Hernández