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Wednesday, 8 February 2017

Puerperium and Postnatal Care | Definition of Puerperium

After the ordeal of the delivery, the mother is exhausted mentally and physically and therefore she is best left undisturbed for a minimum of 2 to 4 hours after which she can be allowed to put the baby to breast. The mother should be encouraged to walk and made to sit up in bed a day after the delivery whether by natural way or caesarean section. This will  considerably improve the pelvic circulation and tone up the muscles. She must be instructed to take deep breathing exercises of 10-15 breaths at a time a day to improve her lung circulation and move her foot and leg well to prevent clotting of blood in her veins (thromboembolism).




DIET

On the day of the delivery, the mother can have light diet like any nutritive drink and 2 slices of bread since she will be exhausted and tired. The next day, she can have rice porridge and bread with milk, butter, jam, fruit juice etc. On the third day, she can get back to her normal diet. The first 2 days after delivery, due to  exhaustion and lack of diet, the breast milk is very scanty and only the yellow liquid called colostrum comes, which is very good for the baby. I am in favour of binding the abdomen immediately after delivery - either normal or caesarean, since patients do not develop a "tummy" It is very advantageous to bind the abdomen after delivery. It helps to maintain one's figure. The mother should also wear a proper brassiere to prevent the sagging of the breast. She must wear the appropriate size, sot that it is neither too lose nor very tight.

As far as feeding of the baby goes, the mother has to be extremely alert, because milk suffocation can occur or the breast tissue itself can press the face and suffocate the child to death. Therefore, the mother should sit up and have a back rest and after cleaning the breasts, should feed the baby for 1/2 an hour, that is for 15 minutes at each breast, every 3 hours or demand feed, that is whenever the baby cries for milk. After feeding, the balance milk should be expressed out so as to prevent milk engorgement, which may later lead to breast abscess. I have seen many cases of breast abscess due to the ignorance of the simple measure of draining the breast off the remaining milk. After feeding on each breast, the child should be burped, i.e. the gas in the tummy should be let off by rocking the child gently or holding the child in the upright position. This helps the excess gas swallowed by the child to come out prevent milk regurgitation and a colicky stomach. After feeding, the child should not be put to bed immediately, but held for 10 minutes in the hand. Then the baby should be put to bed with the head a little raised. The mother should be extremely alert while feeding the child at night.

Cleanliness of the private parts is extremely important since, otherwise, it may lead to puerperal infections. Washing the private parts with sterile water (boiled & cooled) and adding some antiseptic is extremely important. Sanitary pads should be worn instead of just any cloth. In case of episiotomy, antibiotic ointment should be applied after wet wash. Improper care will lead to puerperal infection and tubal block, which will later lead to secondary infertility.

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