Produced by Marilyn Smith – The # 1 midwife
Hello mamas- to -be. I hope you are all doing great. If you need to know how to have a great postpartum experience you have come to the right place. I am a mother of four and a nurse midwife of 36 years so I can tell you about postpartum.
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Postpartum care is so essential in whether or not you succeed in your recovery from child birth. Every mother desires a smooth transition. My postpartum experiences were all successful. My experience with post partum was one of so much business. There is so much to do.
Some of the things I had to deal with were a crying baby, demand for attention by younger siblings, husband claiming I am not giving him enough attention, support from family members, painful body, staying on schedule meals, learning to breastfeed, sore perineum, abdominal cramping and vaginal discomfort. I thank God that I made it with strategic planning and implementation. You can do it too.
Now I Have My Baby, What is My Next Phase?
Hold on Mama! You are not out of harms way just yet. The next phase of your journey we call the Postpartum phase which focuses on the management and continued care of you and your baby for the next six weeks up to the mother’s postpartum check-up with her health care provider. I am going to reveal to you the secrets to having the best postpartum ever, by providing valuable, practical tips for your success.
Your Postpartum Period is Crucial to Your Successful Transition
My experience with this; was that it was very relieving to know that me and the baby were safe so far; as my biggest dread which was labor. Many persons I think take this phase lightly. We usually believe the labor is the worst; but did you know the postpartum can be just as crucial or even worse than the labor and delivery? So many things can go wrong .
Following childbirth, as a new mother, you may experiences profound physical and emotional changes. You may stay in the hospital or birthing center a very short time, as little as 24-48 hours after delivery.
The physical and emotional care a woman receives during the postpartum period can influence her for the remainder of her life. It is my hope that yours is a great adventure.
RELAX AND TAKE IT SLOW!
Mamas during the postpartum period you are is at risk for such problems as:
- Infection– Because your womb is not fully healed; you may have pre-existing infections, or vaginal tears, C-Section
- Hemorrhage- At this stage; you can also experience heavy bleeding from the birth processes, vaginal or C- Section
- pregnancy-induced hypertension. Some women develop elevations in blood pressure as a result of their pregnancy.
- Blood clot formation- the legs can develop blood clots as a result of blood stasis. Usually one leg is progressively swollen.
- The opening up of incisions- Episiotomy wounds. These are wounds that were intentionally created to accommodate the vaginal birth
- Breast problems
- and postpartum depression. A mental condition that can happen within the six week period of birth.
The best way to take on this period is to take it slow and relax. Taking one day at a time is beneficial for everyone. Make sure you have good family support because you will need to spend a lot of time with baby. Be prepared to spend quality time with baby, cuddling, learning what works and what does not work. This is an exciting time for you and baby. Stay strong in the Lord and in the power of His might. This too shall pass.
DID YOU KNOW POSTPARTUM CARE BEGINS IN THE HOSPITAL?
The initial phase of the postpartum period encompasses the first one to two hours after delivery. It takes place most often in the birthing room or in a recovery room. Once this initial phase is over, the woman has passed through the most dangerous part of childbirth.
Assessments of pain, the condition of the uterus, vaginal discharge, the condition of the perineum, and the presence/absence of bladder distension (followed by appropriate interventions) are part of the initial postpartum evaluation, and should be done every 15 minutes for the first hour, then generally every 30 minutes for the second hour, and every four to eight hours thereafter depending on facility policy.
Here are some of the things you may experience after you baby is born:
The degree of pain and discomfort from incisions, lacerations, and uterine cramping (afterbirth pains) is assessed by hospital staff.
The woman may also complain of muscle pain after a prolonged labor. If the level of pain warrants it, analgesic medications are given, usually orally.
Women who have undergone cesarean births may have more pain than women who have given birth vaginally, and may need injectable analgesics.
If complains of pain in her calf, she should be evaluated for thrombophlebitis. Also, if a woman complains of a headache, her blood pressure should be checked to rule out the presence of pregnancy-induced hypertension.
A woman who received epidural anesthesia during delivery may develop a “spinal headache.” A spinal headache is due to the loss of cerebrospinal fluid from the subarachnoid space that may occur during the administration of the spinal anesthesia.
should be treated by the anesthesiologist or nurse-anesthetist. Treatment for this type of headache typically includes keeping the patient flat in bed, encouraging increased fluid intake, and administering pain medication
3.Breast engorgement and Plugged ducts
This characterized by low-grade fever and the absence of systemic symptoms. It is usually bilateral; the breasts feel warm to the touch and appear shiny. Pain from breast engorgement can be minimized for the breastfeeding mother by mild analgesics, the application of warm packs, and frequent nursing.
For the mother who is not breastfeeding, this pain can be minimized by mild analgesics and the application of cold packs. A nursing mother may find that the use of a lanolin-based preparation or a nipple shield (although controversial) provides relief for sore or cracked nipples. Changing positions for the nursing baby also can help in reducing irritation and minimizing stress on sore spots.
A plugged duct can also cause breast pain. Breast pain caused by a plugged duct is distinguished from breast engorgement by the fact that it is usually confined to one breast and the breast is not warm to the touch. This pain may be relieved by heat packs, gentle massage of the breast toward the nipple, and changing positions for nursing the baby.
The condition of the uterus is assessed by evaluating the height and consistency of the fundus (the part of the uterus that can be palpated abdominally). Immediately after delivery, uterine contractions begin triggering involution.
Involution is the process whereby the uterus and other reproductive organs return to their state prior to pregnancy. To properly palpate the uterus, the woman is positioned flat on her back (supine). The health care provider places one hand at the base of the uterus above the symphysis pubis (the interpubic joint of the pelvis) in a cupping manner (to support the lower uterine ligaments). Then, she presses in and downward with the other hand at the umbilicus until she makes contact with a hard, globular mass.
If the uterus is not firm, light massaging usually results in tightening. Massaging of the uterus should not be so vigorous as to cause the mother pain. A mother who has had a cesarean delivery should be medicated, if possible, prior to assessment of the fundus, and the health care provider should use the minimal amount of pressure necessary to locate your fundus.
The height of the fundus after the first hour following delivery is at the umbilicus or above it. Every day your fundal height decreases by approximately the width of one finger. You may be wondering if this is painful. It usually is not.
The fundal height may be palpated off of midline because of a distended bladder. If possible, you should be encouraged to empty your bladder prior to assessment of the fundus. A full bladder can prevent uterine involution and also develop a urinary tract infection. So passing urine after delivery is essential to preventing bladder distention and infection.
Many women wonder how long it will take for their belly to go down. But don’t worry, it’ll be fine. Hormonal changes lead your uterus to contract after your baby is born, reducing it back to its pre-pregnancy size. Your uterus will return to its normal size in six to eight weeks.
A woman sometimes receives the medication oxytocin (Pitocin) after the delivery of the placenta. Oxytocin causes the uterus to contract and can decrease the amount of postpartum bleeding. Your health care provider should assess the condition of the uterus frequently and may need to massage the uterus gently to encourage its clamping down on itself, especially when oxytocin has not been given.
If the uterus does not firm to gentle massage, then a clot may be present inside. Gentle pressure on the uterus following massage, and while simultaneously supporting the base of the uterus, may expel the clot. At this time you are at risk for heavy bleeding which sometimes is called hemorrhage. If you notice that you are filling a pad less than an hour, you can let your nurse or doctor know this so that they can check to see if the bleeding is too heavy.
If massaging the uterus does not result in a firming of the fundus, then your physician or nurse-midwife should be contacted immediately as this could lead to excessive blood loss.
What About Using a Belly Wrap Post Delivery?
Now I have never really needed a belly wrap after my pregnancies, many women are actually using them because of their effectiveness. In fact,
Jay Goldberg, MD, an obstetrician/gynecologist in Beverly Hills, Calif., agrees. “We have been prescribing abdominal binders for a long time. They have been used for tummy tucks and back problems, but with obstetrics these wraps help women recovering from a vaginal delivery or a C-section with their posture, abdominal support, and self-confidence.” He claims that the minor compression not only helps to reduce belly fat, but promotes comfort.
5.Vaginal Discharge (Lochia)
The color and amount of vaginal discharge (lochia) is assessed by frequently removing the perineal pad and checking the flow of lochia after delivery. An excessive amount could be a sign of a complication such as clot formation or a retained portion of the placenta.
The vaginal discharge is red for one to three days following delivery and is called lochia rubra. Between days two and 10, the discharge changes to a pink or brownish color and is called lochia serosa.
The last phase occurs when the vaginal discharge turns white. This vaginal discharge is referred to as lochia alba and may occur from 10-14 days postpartum. The spotting can continue for another six weeks. It is common in mothers who breastfeed their babies. A constant trickling of blood or the soaking through of a perineal pad in an hour or less is not normal and should be further evaluated.
6.Your Perineum will be checked
The condition of the perineal area is assessed for an episiotomy or laceration repair. An episiotomy is the surgical procedure whereby the physician or nurse-midwife extends the vaginal outlet immediately prior to delivery of the baby. The incision is repaired with sutures after delivery.
An episiotomy ( an incision intentionally made in the vagina during birth) will be 1-2 inches (2.5-5 cm) in length. By 24 hours postpartum the edges of the episiotomy should be fused together. An episiotomy may be covered over with edematous tissue and not easily visible, so the examination must the done carefully.
If the laceration or episiotomy is infected, it appears red and swollen, and discharges pus. Treatment depends on the severity of the infection and may include:
- sitz baths-After bathing, a warm water with salt, or medicine added to your bath water or bowl of water on toilet for 10-20 minutes, 3 times per day is helpful in relieving pain, reduces swelling, and irritation
- application of an antibiotic cream to the wound
- oral antibiotics
- or opening the wound
- cleansing the site
- resuturing it.
When the perineal area is examined, you will also be checked for the presence of a hematoma (a round area filled with blood) that is caused by the rupturing of small blood vessels on the surface of the perineum. After observing the perineum, the rectal area also is evaluated for hemorrhoids, making note of their size, character, and number.
GETTING THE BEST OF YOUR PERINEAL CARE
The following measures are effective in providing relief of perineal discomfort:
- Application of cold packs to the perineum for the first 24 hours after delivery.
- Application of warm packs to the perineum after the first 24 hours.
- Rinsing of the perineal area with warm water after every void and/or bowel movement. (This is also helpful in preventing infection and in promoting healing.)
- Use of anesthetic sprays and creams. Cleaning the area with Witch Hazel is also soothing.
- Sitting in a sitz bath—a small basin that fits on top of the toilet through which warm water flows—three or four times a day. After discharge a woman may use her bathtub at home for this purpose.
7. Bladder Distention :
In the first 48 hours after delivery it is normal to have an increase in the formation and secretion of urine (postpartum diuresis). A full bladder can cause the uterus to shift upward and not contract effectively. An overdistended bladder can even cause injury to the urinary system.
You should be encouraged to void within her first hour postpartum; and her bladder should be checked after voiding, since urinary retention can be a problem. If the woman had a cesarean section and has a Foley’s catheter in place in her bladder, then the output is checked every hour during the initial postpartum period. The Foley’s catheter is likely to be removed approximately eight hours after surgery. The health care provider needs to assess for voiding after removal of the Foley catheter.
8.Postpartum Care after hospital discharge
Ideal postpartum care would include several home visits by health care providers in the one to two weeks following delivery to assess the status of the mother and her family. This rarely happens in the United States, but follow-up phone calls by health care providers during the first week and a visit by the mother and baby to her physician or nurse-midwife one to two weeks after the birth are desirable.
Several problems that may arise during the postpartum period do not typically develop until after the new mother is discharged from the hospital. These include mastitis, endometritis, and postpartum depression. It is my hope that you experience the best postpartum recovery ever.
Mastitis is an inflammation of the breast usually caused by streptococcal or staphylococcal infection. It can develop any time a woman is breastfeeding, but usually does not occur before the tenth postpartum day. Symptoms of mastitis often mimic those of the flu and include body aches and a fever of 101 °F (38.6 °C) or more.
Mastitis is treated with a course of antibiotics, and women should begin to feel better within 24 hours of beginning antibiotic treatment. If this does not happen, the woman may need to be hospitalized for intravenous antibiotics.
Other measures that may help the mother feel better include bed rest for at least 24 hours, moist heat on the infected breast every two to three hours (when awake), acetaminophen for pain and fever relief, increased fluid intake, and going without a bra for several days.
Mastitis does not contaminate the breast milk, and the baby should continue to nurse from both breasts. If nursing from the affected breast is too painful, use of a breast pump or manual expression of milk may be needed to prevent engorgement and facilitate continued milk production.
Endometritis is an inflammation of the endometrium, the mucous membrane lining the uterus. It is usually caused by a bacterial infection. Symptoms of this infection include fever, abdominal pain, and foul-smelling vaginal discharge. Physical examination of the patient reveals a tender uterus. Watch out for these signs and symptoms and report them as soon as possible.
Endometritis is treated with a course of antibiotics and other care, including bed rest, acetaminophen for pain and fever relief, and increased fluid intake. Severe cases may require hospitalization.
11. POSTPARTUM DEPRESSION:
Postpartum depression may appear at any time during the first year after a baby’s birth. It ranges in severity from mild, postpartum “blues” that last only a few days shortly after birth, to intense, suicidal, depressive psychosis.
Not only does postpartum depression cause distress for the new mother and her partner, but it can also interfere with the new mother’s ability to bond with her baby and to relate to any other children she may have.
No one wants to experience postpartum depression. I want to encourage you to stay strong in the Lord. Focus on the positive things in life. If you had depression before that really does not mean you will have it again.
12.Effective things you can do to reduce postpartum depression in your life include:
- Exercise regularly- Exercise for 10 minutes a few times during the day. Fitness Blender is a good resource for short, simple workouts that you can do without any equipment.
- Get help if you need it-
- Manage your pain
- Have a positive mindset
- Eat healthy-
PPD cannot be cured by healthy nutrition alone. Getting into the habit of eating nutritious foods, on the other hand, can help you feel better and provide your body with the nutrition it requires. Plan your meals for the week on the weekend, and even prepare healthy snacks ahead of time. Consider entire foods that are easy to take on the run, such as diced carrots with cubed cheese or apple slices and peanut butter.
- Make me time a priority
- Breast-feeding may make you feel trapped on the couch. Work, household chores, or your older children may be making you feel overwhelmed. Rather of dealing with these pressures alone, seek assistance. Take advantage of your mother-in-law’s babysitting offer. Allow your partner or another responsible adult to look after the child for an hour or two.
- Rest, rest, rest
- It’s likely that you’ve been told to “sleep when the baby naps.” This counsel may get irritating after a while, but it is scientifically sound. According to a 2009 study, women who got the least amount of sleep also had the greatest depression symptoms. This was especially true for women who slept for less than four hours between midnight and 6 a.m. or napped for less than 60 minutes during the day.
- Take fish oils
- Breastfeeding is a plus
- According to a 2012 study Breast-feeding, according to Trusted Source, may lower your risk of developing PPD. This ostensible protection could last until the fourth month following delivery. Keep on if breastfeeding is something you enjoy.
- Socialize and socialize!
- The days may blend together, making you feel isolated at times. A study published by the Canadian Journal of Psychiatry shows that talking about your feelings with others can help shift your mood.
- Researchers discovered that new mothers had lower levels of depression after regularly speaking with experienced mothers who had previously experienced PPD. These results extended to four weeks and then eight weeks after delivery.
- Get a support system going
- It’s possible that confiding in a close friend or family member will provide you with relief. If you don’t want to discuss your concerns with your friends and family, there are alternative resources available to help you.
- You can do the following:
- Make an appointment with your obstetrician, midwife, or other healthcare professional.
- Make contact with your pastor or another member of your religion community’s leadership.
- Inquire about any nearby PPD support groups.
- In communities like Postpartum Progress, you can talk to other moms online.
Symptoms of severe postpartum depression or psychosis include:
- Mood swings
- Feeling overwhelmed
- Reduced concentration
- Appetite problems
- Trouble sleeping
Any new mother with signs of postpartum depression should be referred to mental health professionals, support groups, and/or new mother groups. Psychotropic medication is often helpful, as is psychotherapy. About 10% of cases of postpartum depression are caused by postpartum thyroiditis, a temporary inflammation of the thyroid gland that usually clears up spontaneously in one to four months.
Whenever postpartum depression occurs, thyroid function should be tested to rule out hyperthyroidism or hypothyroidism as the cause of symptoms.
13.Six-week Postpartum Check-up
Although this postpartum check-up is traditionally scheduled six weeks after delivery, it may be done any time between four weeks and eight weeks after delivery. It usually includes a breast examination, a pelvic examination, any necessary laboratory tests, and a health education component covering such areas as breastfeeding, birth control, weight reduction, etc.
This checkup is also an opportunity to review the pregnancy and birth experience, to discuss problems and assess for depression, to provide emotional support, to answer questions, and to consider if any further referrals are necessary for the new mother.
14. Health Care Team Roles
During your hospitalization, you will be taken care of by hospital staff. Asking questions will do well for you as you try to understand the hospital’s routine. You are free to ask for your baby it not brought to you early.
You should be given instructions on how to hygienically care for her perineal area; like how to change your perineal pad frequently and to wash her hands afterwards.
The presence of a wet pad against sutures is an excellent medium for the development of an infection that could potentially spread to the uterus.
You should not to use tampons for six weeks after delivery, since tampon use can cause infection or even toxic shock syndrome.
You may be overwhelmed by the degree of discomfort after giving birth, and may be frustrated by your desire to interact with your new baby while at the same time being limited by pain, discomfort, and exhaustion.
The health care team member can help you by providing perineal care for you until you are able to get out of bed, and by administering pain medications as ordered. Never be afraid to ask for pain medication if you need it.
Other important things health care providers will do for you postpartum include:
- Evaluate pulse, respiratory rate, and blood pressure regularly like every four hours.
- Help you take a shower as soon as she is allowed to, while monitoring her for lightheadedness.
- Place a warm blanket over you after delivery if you experiences shaking and chills.
- Provide emotional support to you and family through explanations about childbirth and how it can be a highly emotional and psychologically over-whelming time.
- Promote adequate rest. Rest while your baby is sleeping and make sure to wear comfortable clothing.
- Encourage a generous intake of nutrients and fluids. Your body needs continued nourishment to fully recover.
- Ask you if you had a bowel movement prior to discharge and offer medication to soften stools if desired.
- Monitor your voiding and ensure you are not having difficulty. Catheterization is sometimes required. This is where a tube is placed in your bladder to facilitate passing your urine.
- Assist with ambulation until you are steady on your feet.
- Review laboratory tests for signs of anemia, infection, and electrolyte imbalance.
- Teach you muscle-strengthening exercises.
- Prepare you and the family for discharge through discharge teaching.
- Arrange for a home visit if this is provided for through the facility and/or your insurance.
Put God First
Yes God is concerned about everything you are going through. You are now alone. Trust Him and ask for His help.
Your journey to recovery may or may not be so smooth as expected, but do not give up hope . Continue to be alert and ask for God’s help in your continued healing success. Be patient, and alert. Do not miss any of your appointments. Taking one day at a time is the key to true success. Enjoy the time you spend with the family and friends.
Allow them to be involved in you and the baby’s care. Try not to get bogged down with just you and the baby. Did you know that your significant other also needs your attention? Yes they do, so give them some attention where ever necessary. They can assist in helping you to care for the baby. I would love to hear from you. If you have any questions or comments, feel free to add to the comments box on this site. Thank you so much for stopping by. You are free to comment, like or share about this post. Before we go I would like to ask you a question- What are some of the things you fear about postpartum?
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