The Post-Natal Phase
“The most precious jewel a woman can wear are the arms of her child around her neck.”
The postnatal period begins from birth and ends when the baby is six weeks of age. It is a very special phase where every woman undergoes the transition into motherhood. During pregnancy it can be very difficult to comprehend what being a mother would be like. However, once the baby is born, women have to undeniably face major changes in their lives. The changes women undergo do not just include the physical changes that occur from the birth, but social and psychological changes as well.
Each woman’s experience is different. However, it is understandable for a woman to take time emotionally and personally, to digest the feeling of ‘becoming a mother’. A woman’s experience as a new mother is shaped by her past experiences. These experiences include the nature of her baby, prior experience with babies and the amount of support available to her.
Immediate attention: The birth of a healthy baby brings with it the feeling of relief and happiness. However, in the case of premature or ill babies, babies born with congenital malforations, or even death, the woman might suffer fro post-patrum blues or stress, and hence would require immense emotional support.
Rest and Ambulation: Early ambulation after delivery is encouraged, as it is beneficial. After a good resting period, the patient becomes fresh and can breastfeed the baby or move out of bed to use the toilet.
Advantages of an early Ambulation are :
Provides a sense of well-being
Bladder complications and constipation issues are less
Facilitates uterine drainage and hastens involution of the uterus
Lessens puerperal venous thrombosis and embolism. Following an uncomplicated delivery, climbing stairs, lifting objects, daily household work and cooking can be resumed.
Early discharge from the hospital is an almost universal procedure. If adequate supervision by trained health visitor’s is provided, there is no harm in early discharge. Most women are discharged fit and healthy after 2 days of spontaneous vaginal delivery, with proper education and instructions. A late discharge may be provided to few women who require prolonged hospitalization, due to morbidities (infections of urinary tract or the perineal wound, pain or breastfeeding problems).
The patient can resume a normal diet of her choice. If the mother is lactating, high calories, adequate protein & fat, plenty of fluids, minerals and vitamins are to be given. However, in non-lactating mothers, the normal non-pregnancy diet is fine.
The problem of constipation is much less, because of early ambulation and liberalization of the dietary intake. A diet containing sufficient fiber and fluids is helps regulate bowel movement. If necessary, a mild laxative such as the Isabgol husk (2 teaspoons) can be given during bed time.
Sleep: he new mother requires adequate rest, both physical and mental. She should be kept away from worries and undue fatigue. A good sleep is the outcome of physical and emotional support. If there is any discomfort, such as after-pains or painful piles or engorged breasts, they should be dealt with adequate analgesics (Ibuprofen).
Breast Care: The nipple should be washed with sterile water prior to each feeding session. It should be cleaned and kept dry post feeding. A nursing brassiere provides the perfect support.
Nipple Soreness: can be avoided through frequent & short feedings, rather than prolonged one’s, keeping the nipples clear and dry. Candida infection can also be another cause.
Maternal-infant bonding (rooming-in): It starts from first few moments after birth. This is manifested by fondling, kissing, cuddling and gazing at the infant. The baby should be kept in her bed or in a cot besides her bed. This not only establishes the mother-child relationship, but the mother is conversant with the art of baby care so that she can take full care of the baby while at home. Baby-friendly hospital initiatives promote parent-infant bonding, baby rooming with the mother, and breastfeeding.
The objectives of postpartum exercises are
- To improve the muscle tone, which are stretched during pregnancy and labor; especially the abdominal and perineal muscles.
- To educate on the correct posture to be attained, when the patient is getting up from her bed. This also includes the correct principle of lifting and working positions during day-to-day activities.
Procedure: Initially, she is taught breathing exercises and leg movements, while lying in bed.
Gradually, she is instructed to tone up the abdominal and perineal muscles and to correct the postural defects. These can be well-taught by a trained physiotherapist.
These exercises should be continued for at least a period of 3 months. The common exercises prescribed are:
(a) To tone up the pelvic floor muscles. The patient is asked to contract the pelvic muscles in a manner that withholds the act of defecation or urination, and then relax. The process is to be repeated as often as possible each day.
(b) To tone up the abdominal muscles. The patient is to lie in a dorsal position, with the knees bent and the feet flat on the bed. The abdominal muscles are contracted and relaxed alternately, and the process is to be repeated several times a day.
(c) To tone up the back muscles. The patient is to lie on her face, with her arms by her side. The head and the shoulders are slowly moved up and down. The procedure is to be repeated 3-4 times a day, and is gradually increased each day.
Physical Activities: should be resumed without delay. Sexual activity may be resumed (after 6 weeks) when the perineum is comfortable and the bleeding has stopped.