Seminar on Physiology of Puerperium

8/10/2019 Seminar on Physiology of Puerperium

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SEMINAR ON PHYSIOLOGY OF

PUERPERIUM, LACTATION

AND LACTATION MANGEMENT

SUBMITTED TO:-

Mrs. SOMIBALA

SUBMITTED BY:-

VARSHA SHARMA

MSC NURSING FIRST YEAR

RUFAIDA COLLAGE OF NURSING



PUERPERIUM

Puerperium, the period of adjustment after childbirth during which the mother’s reproductive

system returns to its normal prepregnant state. It generally lasts six to eight weeks and ends with

the first ovulation and the return of normal menstruation.

Puerperal changes begin almost immediately after delivery, triggered by a sharp drop in the levels of

estragon and progesterone produced by the placenta during pregnancy. The uterus shrinks back to

its normal size and resumes its pre-birth position by the sixth week. During this process, called

involution, the excess muscle mass of the pregnant uterus is reduced, and the lining of the uterus

(endometrium) is re-established, usually by the third week. While the uterus returns to its normal

condition, the breasts begin lactation.

INVOLUTION: Is the process whereby the genital organs revert back approximately to the state

where before pregnancy. The women is termed as puerperal.

Puerperium begins as soon as the placenta is expelled and lasts for approximately 6 weeks when the

uteri become regressed almost to the non-pregnant size. The period is arbitrarily divided into-

1. Immediate-within 24 hours.

2. Early-up to 7 days.

3. Remote-upto 6 weeks.

Similarly change occurs following abortion but takes a shorter period for the involution to complete.

INVOLUTION OF THE UTERUS:-

UTERUS: Immediately following delivery the uterus becomes firm and retracts with alternate

hardening and softening. The uterus measures about 20*12*7.5cms.and weight about 1000gm.at

the end of 6 weeks, its measurement is almost similar to that of the non pregnant state and weight

about 60gm.the placenta site contracts rapidly presenting a raised surface with measures about

1.5cm.lower uterine segment immediately following delivery, the lower segment becomes a thin,

flabby, collapsed structure. It takes a weeks to revert back to the normal shape and size of the

isthmuseither part between the bodies of the uterus or internal us of the cervix.

CERRVIX:-The cervix contracts slowely,the external os admits two fingers for a few days but by the

end of first week, narrows down to admit the tip of a finger only. The contour of the cervix takes a

longer time to regain (6weeks) and the external OS never reverts back to the nulliparus state.

PHYSIOLOGICAL CONSIDERATION:-

The physiological process of involution is most marked in the body of the uterus.

Changes occur in following component -

a) Muscles

b) Blood vessel

c) Endometrium.



Muscles -

There is marked hypertrophy and hyperplasia of muscle fibres during pregnancy

and the individual muscle fibre enlarges to the extent of 10 times in length and

5 times in breadth. During puerperium, the number of muscle fibres is not decreased but there is

substantial reduction of the myometrial call size. Withdraw of steroid hormones, oestrogen and

progesterone, may lead to increase in the activity of the uterine collagens and the release of

proteolytic enzyme. Autolysis of the protoplasm occur by the proteolytic enzyme with liberation of

peptones which entre the blood stream. These are excreted through the kidneys as urea and

creatinine .This explain the increase excretion of the products in the puerperal urine. The connective

tissue undergoes the same type of degeneration. The condition which favours involution are -

1.efficiancy of the enzymatic action and 2.Relative anoxia induced by effective contraction and

retraction of the uterus.

Blood vessels -

The changes of the blood vessels are pronounced at the placental site. The arteries

are constricted by contraction of its way and thickening of the intima followed bythrombosis. New blood vessels grow inside the thrombi.

Endometrium -

Following delivery, the major part of the decidua is cast off with the expulsion of

the placenta and the membranes, more at the placental site. The endometrium left

behind varies in thickness from 2-5 mm. The superficial part containing the

degenerated decidua, blood cells and bits of fatal membranes becomes necrotic

and is cast off in lochia. Regeneration occurs from the epithelium of the uterine

gland mouths and interglandular stromal cells. Regeneration of the epithelium is

completed by 10th day and the entire endometrium is restored by the day 16,

except the placental site it takes about 6 weeks.

Clinical assessment of involution -

The rate of involution of the uterus can be assessed clinically by noting the height

of the fundus of the uterus in relation to the symphysis pubis. The measurement

should be taken carefully at fixed time every day, preferably by the same observer.

Bladder must be emptied beforehand and preferably the bowel too, as the full

bladder and the loaded bowel may raise the level of the fundus of the uterus.

The uterus is to be centralised and with a measuring tape, the fundal height is

measured above the symphysis pubis. Following delivery, the fundus lies about

13.5 cm above the symphysis pubis. During the first 24 hour, the level remains

constant, thereafter there is a steady decrease in height by 1.25 cm in 24 hours,

so that by the end of second week the uterus becomes a pelvic organ.

ABSTRACT:- VanRees, D., Bernstine, R. L. and Crawford, W. (1981), Involution of the postpartum

uterus: An ultrasonic study. J. Clin. Ultrasound, 9: 55 –57.

The involution of the uterus was studied between 1 and 40 days postpartum utilizing serial

ultrasonic scans. All pregnancies and postpartum periods were uncomplicated. The decrease in

uterine size was related to a diminution in uterine length. No difference was observed between

nullipara and primipara or breast- or bottle-feeding mothers.



INVOLUTION OF OTHER PELVIC STRUCTURES:

VAGINA:-

Involution of the Vagina

The vagina involutes more slowly than the uterus. Immediately after the delivery, it is swollen,toneless and appears bruised and red. The normal rugosity (wrinkles) of the vaginal walls reappear

at about the 3rd week of the postpartum period. But the size and elasticity of the tissues never

regain the pre-pregnancy state. Broad ligaments and round ligaments require considerable time to

recover from the stretching and laxation.

Pelvic floor and pelvic fascia take a long time to involute from the stretching effect during

parturition.

LOCHIA:-

Lochia is the vaginal discharge after giving birth (puerperium) containing blood, mucus, and uterine

tissue. Lochia discharge typically continues for 4 to 6 weeks after childbirth. It originates from the

uterine body, cervix and vagina. It is sterile for the first 2 –3 days, but not so by the third or fourth

day.

ODOUR AND REACTION:-It has got a peculiar offensive fishy smell. Its reaction is alkaline tending to

become acid towards the end. It progresses through three stages:-

1. Lochia rubra (RED) is the first discharge, red in colour because of the large amount of blood

it contains. It typically lasts no longer than 3 to 5 days after birth.

2. Lochia serosa is the term for lochia that has thinned and turned brownish or pink in colour. It

contains serous exudate, erythrocytes, leukocytes, and cervicalmucus. This stage continues

until around the tenth day after delivery. Lochia serosa which persists to some weeks after

birth can indicate late postpartum haemorrhaging, and should be reported to a physician.

3.

Lochia Alba (or purulent) is the name for lochia once it has turned whitish or yellowish-

white. It typically lasts from the second through the third to sixth weeks after delivery. It

contains fewer red blood cells and is mainly made up of leukocytes, epithelial cells,

cholesterol, fat, and mucus.

AMOUNT- The average amount of discharge for the 5-6 days, it’s estimated to be 250 ml.

NORMAL DURATION: Normal duration may extend up to 3 weeks. The red lochia may persists

for longer duration especially in women who get up from the bed for the first time in later

period. The discharge may be scanty, especially following premature labour or may be excessive

in twin delivery or hydramnios.

CLINICAL IMPORTANCE:-

The character of the lochia discharge gives useful information about the abnormal puerperal state.

The valve pads are to be inspected daily to get information.

ODOUR: If malodorous indicates infection .retained plug or cotton piece inside the vagina should

be kept in mind.



COLUR:Persistence of red colour beyond the normal limit signifies sub involution or retained bits

of bits of concepts.

DURATION: Duration of the lochia alba beyond 3 weeks suggest local genital lesions.

GENERAL PHYSIOLOGICAL CHANGES:-

PULSE:-for a few hours after the normal delivery, the pulse rate is likely to be raised which settle

down to normal during the second day .however, the pulse rate often rises with after-pain

excitement.

TEMPERATURE: -The temperature should not be above 37.2degree C (99degree F)with in the first

24 hrs. There may be slight reactionary rise following delivery by 0.5degree but comes to the normal

within 12 hrs .On the 3rd day there is slight increase in the temperature due to the breast

engorgement which should not last for more than 24 hrs .however, genitor –urinary tract infection

should be excluded if there is raise of temperature.

URINARY TRACT: -It may be slightly uncomfortable to urinate for a few days after your baby’s

birth. Pain or burning when you urinate, or the urge to urinate frequently, may indicate a bladder

infection. Bladder capacity increases the bladder may be distanced without urge to pass urine.

Common urinary problems are: overdistention, incomplete emptying and prence of residual urine

.dilated ureters and renal pelvis return to normal size within 8 weeks. There is pronounces diuresis

on the second or third day of perpurium.

GESTRO-INTESTINAL TRACT:-Increases thirst in early perpurium is due to loss of fluid in during

labour, in the lochia diurasis and perspiration constipation is a common problem .

WEIGHT LOSS :- In addition to the weight loss (5-6kg) as a consequence of the expulsion of the fetes,

placentae, liquor and blood loss. A further loss of about 2kg occur during purperium chiefly caused

by diurasis.The weight loss may continue up to 6 months of delivery.

FLUID LOSS:-There is a net fluid loss of at least 2 litters during the first week and an addition 1.5litres

during next 5 weeks .The amount of loss depends on the amount retained during pregnancy,

dehydration during labour and blood loss during delivery the loss of salt and water are larger in

women with pre elampsia and eclampsia.

BLOOD VALUES:- Decrees in blood volume due to blood loss and dehydration. Blood volume returns

to the non-pregnant level by the second week. Cardiac output increases soon after delivery to about

80%above the prelabour values but slowly return to normal within one week.

RBC volume and haematocrit values return to normal by 8bweeks.Postpartum after the hydraemia

disapper.Lecocytes to the extent of 25,000per cu mm occur following delivery probably in response

to stress of labour. Platelet count decreases soon after the separation of placenta but secondary

elevation occurs with increase in platelet count adhesiveness between 4-10 days. Fibrinogen level

high up to the second week of puerperium. A hypercoagulatin state persists up to 48hrs postpartum

and fibrinolytic activity is enhanced in first 4 day. The secondary increase in fibrinogen, factor viii and

the platelet in first week increase the risk for thrombosis the increase in fibrinolytic activity after

delivery acts as a protective mechanism.



MENSTRUATION AND OVULATION:-Onset of first menstruation period following delivery is very

variable and depends on lactation. If women does not breast feed her baby, the mensuration returns

by 6th week following delivery in about 40%and 12th week in 80%of cases.

In non-lactatingmothers, ovulation may occur as early as 4 weeks. And in lactating mothers about

10weeks after delivery.In lactating mother women who is exclusively breastfeeding thecontraceptive protection is about 98%upto 6 months postpartum. Lactation provide natural method

of contraception.so consell the patent to use contraceptive method from 3rd week for non lactating

mother or from 3 month for lactating mother.

SCHEME OF MACHANISM OF AMENORRHOEA AND ANOVULATION IN

LACTATING MOTHERS:-

BRESTFEEDING – SUCKING* * FREQUENCY

*INTENSITY

*DURATION

INCRESES PROLACTIN LEVEL

INHIBITS OVARIAN RESPONSE GNRH SECRETION.

TO FSH SUPPRESSES THE RELEASE OF LH

NO LH SURGE

LESS FOLLICULAR GROWTH

HYPO-OESTROGENIC STATE ANOVULATION

NO MENSURATION



LACTATION

The secretion from the breast called colostrums which starts during pregnancy becomes more

abundant during the period.

Composition of colostrums: Deep yellow serous fluid, alkaline in reaction. It has got a higher specificgravity, high protein, vit A, sodium and chloride content but has got lower carbohydrate, fat and

potassium than the breast milk. It contains antibody (IgA).

ADVANTAGES: - 1. Provide immunity to the Baby.

2. Laxative action on the baby due to the large fat globules.

PHYSIOLOGY OF LACTATION:

DIVIDED INTO FOUR PHASES:-

PREPRTATION OF THE BREASTS(MAMMOGENESIS)

SYNTHESIS AND SECRETION FROM THE BREAST ALVEOLI (LACTOGENISIS).

EJECTION OF THE MILK (GALAKTOKINESIS).

MAINTENANCE OF LACTATION (GALATOPOIESIS).



MAMMOGENIS: - pregnancy is associate with a remarkable growth of both the ductal and lobular

alveolar system .intact nerve supply is not essential for the growth of the mammary glands during

pregnancy.

LACTOGENISIS: - milk secretion starts actually on day 3rd or 4th postpartum day. This time breast

become engorged. Tense and feel warm in spite of high prolactin level in pregnancy milk secretion is

abeyance. Steroids-estragon and progesterone is circulating so it makes unresponsive to the

prolactin when after pregnancy estragon and progesterone level decreases and prolactincomes intothe action and secretion of milk occurs.

GALACTOKINASIS: - Discharge of the milk from the mammary gland not only depends on the sucking

of the baby but also on the contractile mechanism of which expresses the milk from the alveoli into

the ducts. Oxytocin is a major gelectokinetic hormone.

Discharge of milk from the mammary glands of breast depends upon the suction exerted by the baby

during suckling. Contractile mechanism also helps by expressing the milk from alveoli into the ducts.



During suckling,a conditioned nervous reflex is set up. The impulses start from the nipples to

Supraoptic nucleus in brain and thence along the hypothalamus-pituitary axis to posterior pituitary.

It appears to be so complicated and essentially when the love of baby is there, all this is simply a

loving privilege of Moms!

Oxytocin is secreted from posterior pituitary which exerts several effects on the uterus and breast. Inbreasts, there iscontraction of the epithelial cells of alveoli and ducts containing the milk .

This is the "milk ejection" or "milk let down"reflex that forces the milk down into the

lactiferous ducts. From lactiferous ducts milk is expressed either by the mother by hand or sucked

out by the baby.

A sensation of rise in pressure in the breast is felt by the mother at the beginning of suckling. It is

called"draught". This effect can be produced artificially by the injection of Oxytocin hormone.

The milk ejection reflex is inhibited by several factors like pain in breasts or body,

breast engorgement, psychological upsets. In addition this ejection reflex might be weak for

several days following breast feeding and it results in breast engorgement.

GALACTOPOISE:

The hormoneProlactinappears to be the single most important factor for maintenance of

lactation.Sucking is also essential for maintenance of lactation. Sucking is essential for the

removal of milk from the glands in breast but also for the release of Prolactin.

Secretion of milk is a continuous processunless suppressed by congestion or emotional

disturbances. Milk pressure reduces the rate of breast milk production. So periodic breast feeding

is necessary to relieve the pressure that in turn maintains the secretion of milk inside the breast.

MILK PRODUCTION:-Healthy mother produce about 500-800ml milk a day to feed her baby.

Inadequate milk production (lactationfailure) it may be due to the infrequent sucking or due to

endogenous suppression of prolactin .pain anxiety .unrestricted feeding at short interval (2-3hrs)

Drugs to improve milk production: - metocloperamide10 mg thrice a day increase milk volume by

increasing prolactin level.

Management of normal puerperium

Immediately following delivery, the patient should be closely observed. She may be given

a drink of her choice or something to eat, if she is hungry.

Principles -

- To give all out attention in to restore the health status of the mother.

- To prevent infection.

- To take care of the breasts, including promotion of lactation and nursing of the child.

- To motivate the mother for contraception.



General management -

Rest and ambulance - It is indeed difficult to categories an uniform period of rest. After a good resting period,

the patient becomes fresh and can breast feed the baby or moves out of bed to go to the

toilet. Early ambulation is encouraged. Advantages of early ambulation are:- Provide a sense of well-being.

- Bladder complications and constipation are reduced.

- Facilitates uterine drainage.

- Hastens involution of uterus.

- Lessens puerperal venous thrombosis and embolism.

Hospital stay -

Early discharge from the hospital is an almost universal procedure. If adequate supervision

by trained health visitors is provided, there is no harm in early discharge.

Diet - The patient should be on normal diet of her choice. If the patient is lactating, high calories,

adequate protein, fat, plenty of fluids, minerals and vitamins are to be given.

Care of the bladder -

The patient is encouraged to pass urine following delivery as soon as convenient. If the patient

fails to pass urine, catheterisation should be done. Catheterisation is also indicated in case of

incomplete emptying of bladder.

ABSTRACT:-2

Saadia, Z., Roshdy, S., Sagir, F. and Abidin, S. (2013), Dietary practices of Saudi womenduring puerperium. Journal of Obstetrics and Gynaecology Research, 39: 799 –805.

Poor maternal health sometimes can be a consequence of practicing different myths during puerperium. This cross-sectional study describes the practice of different myths regarding diet among

Saudi women.Using method of comprised women attending the postnatal clinic at the Mother andChild Hospital in Buraidah from January to December 2011.hence shows that Almost 65.9% ofwomen were using a combination of herbs such as ginger (zingiber officinale), hilba (fenugreek) and black seeds (nigella sativa). The multinomial logistic regression of herbs on age, education,occupation, parity and mode of delivery was statistically significant (χ 2 [48] = 214.645, P < 0.001).

Hilba was more commonly used by women with instrumental delivery. It was common for women to

avoid different fruits and vegetables (33.89%). Eggs were avoided by 16.5% of women and 11%avoided cold drinks. The multinomial logistic regression of diet on age, education, occupation, parityand mode of delivery was statistically significant (χ

2 [72] = 389.861, P < 0.001). Individuals below

college level education were more likely to avoid fruits, vegetables and cold drinks in their diet. It

proves that Health education programs are needed to improve knowledge about dietary malpracticesduring puerperium. This may help eliminate myths regarding avoidance of certain dietary

components.

Care of the bowel -

The problem of constipation is much less because of early ambulation and liberalisation of the

dietary intake. A diet containing sufficient roughage and fluids is enough to move the bowel.

If necessary, mild laxative such as Igol (isogon husk) two teaspoons may be given at bed time.



ABSTRACT:-3

John M. Thorp,Peggy A. Norton,Urinary incontinence in pregnancy and the puerperium: A

prospective study American Journal of Obstetrics & Gynecology,Volume 181, Issue 2, Pages 266 –

273, August 1999

Objective: Pregnancy and childbirth are commonly thought to be associated with the development

of urinary incontinence and lower urinary tract symptoms. The purpose of this study was to assess

the relationship, if any, between pregnancy and the development of lower urinary tract symptoms.

Study Design: A prospective study of lower urinary tract symptoms was carried out in a cohort of

pregnant women who answered a series of symptom questionnaires and kept a 24-hour bladder

chart on which frequency of urination and volumes voided were recorded throughout pregnancy

and for 8 weeks after birth. Results: A total of 123 women participated in the study. Mean daily

urine output (P = .01) and the mean number of voids per day (P = .01) increased with gestational age

and declined after delivery. Episodes of urinary incontinence peaked in the third trimester and

improved after birth (P = .001). White women had higher mean voided volumes and fewer voiding

episodes than did black women. Ingestion of caffeine was associated with smaller voided volumes

and greater frequency of urination. Conclusion: Pregnancy is associated with an increase in urinary

incontinence. This phenomenon decreases in the puerperium. Pregnancy and childbirth trauma are

important factors in the development of urinary incontinence among women. These findings

warrant further investigation. (Am J Obstet Gynecol 1999;181:266-73.)

Sleep - The patient is in need of rest, both physical and mental. So she should be protected against

worries and undue fatigue. Sleep is ensured providing adequate physical and emotional support.

Care of the vulva and episiotomy -

Shortly after delivery, the vulva and buttocks are washed with soap water down over the anus

and a sterile pad is applied. The patient should look after personal cleanliness of the vulvar

region. The perinea wound should be dressed with spirit and antiseptic power after each act

micturition and defecation or at least twice a day.

Care of the breast -

The nipple should be washed with sterile water before each feeding. It should be cleaned

and kept dry after the feeding is over. Nipple soreness is avoided by frequent short feeding

rather than the prolonged feeding, keeping the nipple clean and dry.

ABSTRACT:4

- Winani S1, Wood S, Coffey P, Chirwa T, Mosha F, Changalucha J Use of a clean delivery kit

and factors associated with cord infection and puerperal sepsis in Mwanza, Tanzania. J

Midwifery Womens Health. 2007 Jan-Feb;52(1):37-43

Our objective was to determine the effectiveness of an intervention that incorporated education

about the "six cleans" with the use of a clean delivery kit in preventing cord infection and puerperalsepsis. A stepped-wedge, cross-sectional study was conducted in 10 surveillance sites across two

http://www.ajog.org/issue/S0002-9378%2805%29X7094-6



http://www.ncbi.nlm.nih.gov/pubmed?term=Winani%20S%5BAuthor%5D&cauthor=true&cauthor_uid=17207749



http://www.ncbi.nlm.nih.gov/pubmed?term=Wood%20S%5BAuthor%5D&cauthor=true&cauthor_uid=17207749



http://www.ncbi.nlm.nih.gov/pubmed?term=Coffey%20P%5BAuthor%5D&cauthor=true&cauthor_uid=17207749



http://www.ncbi.nlm.nih.gov/pubmed?term=Chirwa%20T%5BAuthor%5D&cauthor=true&cauthor_uid=17207749



http://www.ncbi.nlm.nih.gov/pubmed?term=Mosha%20F%5BAuthor%5D&cauthor=true&cauthor_uid=17207749



http://www.ncbi.nlm.nih.gov/pubmed?term=Changalucha%20J%5BAuthor%5D&cauthor=true&cauthor_uid=17207749



http://www.ncbi.nlm.nih.gov/pubmed/17207749















infections followed vaginal delivery compared to Cesarean section 121 (97.6%), 3 (2.5%)

respectively. All strains of Staph were sensitive to Vancomycin, Gentamicin and Ceftriaxone.

C. perfringens were sensitive to Ceftriaxone, Penicillins, Vancomycin and Metronidazole,

while E. cloacae were sensitive to Gentamicin and Ceftriaxone. Conclusion: despite the

limited resources in the developing countries, treatment based on cultures remains the onlysolution to reduce maternal morbidity and mortality rates following puerperal infections.

POSTNATAL CARE:-

Take your medicine as directed:

Call your primary healthcare provider if you think your medicine is not working as expected. Tell him

if you are allergic to any medicine. Keep a current list of the medicines, vitamins, and herbs you take.

Include the amounts, and when, how, and why you take them. Take the list or the pill bottles to

follow-up visits. Carry your medicine list with you in case of an emergency. Throw away old medicine

lists.

NSAIDs:

No steroidal anti-inflammatory (NSAID) medicine may decrease swelling and pain or fever. This

medicine can be bought with or without a doctor's order. This medicine can cause stomach bleeding

or kidney problems in certain people. Always read the medicine label and follow the directions on it

before using this medicine.

Follow-up visits:

Ask your caregiver when to return for a follow-up visit. Often, caregivers will want to see you six

weeks after having your baby. Your caregiver may do a vaginal exam at your visit. Tell your caregiver

if you are having any pain or other symptoms. Keep all appointments. Write down any questions you

may have. This way you will remember to ask these questions during your next visit.

Activity:

After having a baby, you may be very tired. It is very important to get enough rest after having a

baby. For a while after delivery, try to keep all activities short. You may be able to do some exercise

soon after having your baby, such as walking. Kegel exercises may help your vaginal and rectal

muscles heal faster. You can do Kegel exercises by tightening and relaxing the muscles around your

vagina. Kegel exercises help make the muscles stronger, and may prevent gas and urine from leakingout. Talk with your caregiver before you start exercising. If you work outside the home, ask your

caregiver when you can return to your job.

Breast care:

When your milk comes in, your breasts may feel full and hard. If you plan to breastfeed, ask

caregivers to show you how to hold and breastfeed your baby. Ask caregivers for more information

about how to care for your breasts even if you are not breastfeeding. Also ask your caregiver about

breastfeeding while taking medicines.



Constipation:

Do not try to push the bowel movement out if it is too hard. High-fibre foods, extra liquids, and

regular exercise can help you prevent constipation. Examples of high-fibre foods are fruit and bran.

Prune juice and water are good liquids to drink. Regular exercise helps your digestive system work.

You may also be told to take over-the-counter fibre and stool softener medicines. Take these items

as directed.

Haemorrhoids:

Haemorrhoids are swollen veins in or around your rectum. Pregnancy can cause haemorrhoids to

stick out or swell. You may have rectal pain because of the haemorrhoids. Ask your caregiver about

preventing and caring for haemorrhoids.

Perinea care:

Your perineum is the area between your vagina and anus. To help heal your perineum, keepthe area as clean and dry as possible. This will also help prevent infection. You can wash the

area gently with soap and water when you bathe or shower. Ask your caregiver about any

special wound care needed if you had an episiotomy. An episiotomy is an incision (cut) in

your perineum.

Your caregiver may suggest using sits baths to help decrease your pain. During a sits bath,

you will sit in a bathtub filled with warm or cold water. A cold sits bath may decrease your

pain right away. To make a cold-water sits bath, sit in slightly warm water and add ice cubes

to the water. Stay in the sits bath for 20-30 minutes, or aslong as your caregiver suggests.

Ask your caregiver for more information about sitz baths and other ways to decrease your

pain.

Vaginal discharge: You will have a vaginal discharge, called lochia, after your delivery. The lochia is bright red the first

day or two after delivery. By the third or fourth day, the amount decreases, and it turns a red

browncolour. About 7 to 14 days after having your baby, you may have a heavier flow of blood.

Sometimes the colour of the lochia changes to a yellow-white colour and may have an odor (smell).

You may need to wear a pad and change it many times each day. You may be able to use tampons if

you can insert them without any problems. Caregivers may advise you not to use tampons at night

time to lessen the risk of infection. It is normal to have lochia up to eight weeks after your baby is

born.

Monthly periods:Your period may start again within 7 to 12 weeks after your baby is born. If you are breastfeeding, it

may take longer for your period to start again. You can still get pregnant again even though you do

not have your monthly period. Talk with your caregiver about a birth control method that will be

good for you if you do not want to get pregnant.

Mood changes:Many new mothers have some kind of mood changes after delivering their baby. Some of these

changes occur because of lack of sleep, hormone changes, and caring for a new baby. Some mood

changes can be more serious, such as severe (very bad) postpartum depression (deep sadness). Talk

with your caregiver if you feel unable to care for yourself or your baby after delivery.

Seminar on Physiology of Puerperium

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