What Is Postpartum Care?
The postpartum period is the six weeks following the birth of a baby when the mother's body recovers to its pre-pregnancy state. The weeks following delivery are crucial for her and her baby's long-term health and well-being. Therefore, postpartum care should become a continuous practice to improve the health of mothers and infants. A mother can expect some physical changes and symptoms after childbirth, but they are usually minor and transient. Severe health problems are uncommon.
What Are the Various Components of Postpartum Care?
Instead of a single six-week postpartum visit, the American College of Obstetrics and Gynecology (ACOG) advises 12 weeks of care.
The components of postpartum care are as follows-
1. Vaginal Pain- Minor vaginal tears occur during childbirth and heal in a few weeks, whereas extensive tears may take longer. Women can ease pain by using over-the-counter pain relievers like Ibuprofen or Acetaminophen, sitting on a cushioned ring, or cooling the area with an ice pack. Women should be informed about the indicators of infection, such as fever, and encouraged to seek medical help if they have persistent, severe pain.
2. Breastfeeding- Breastfeeding is good for both the mother and the baby. Breastfeeding mothers have a lesser risk of breast cancer, ovarian cancer, and type 2 diabetes. Doctors should check for any issues with infants' latch, swallow, nipple type and condition, and hold. The World Health Organization (WHO) suggests breastfeeding every three to four hours for four to six months. Breastfeeding lowers the chances of GI tract infections, pediatric malignancies, and atopic eczema in newborns.
3. Breast Engorgement- Women may notice full, hard, and tender breasts following birth. Engorgement can be avoided by nursing both breasts often. To ease the pain, women are encouraged to use warm washcloths or warm showers or place cold washcloths between feedings. The women who are not planning to breastfeed should utilize cold packs, strong support of the breasts, analgesics when needed, and mechanical milk extraction.
4. Vaginal Bleeding or Discharge- Postpartum vaginal bleeding or discharge has the following stages-
a. Lochia Rubra- Heavy bloody discharge for initial three to four days.
b. Lochia Serosa- Watery pinkish-brown discharge for the next ten to twelve days.
c. Lochia Alba- Yellowish-white discharge after ten to twelve days.
Retained placenta, uterine atony, rarely invasive placenta, endometritis, or coagulation abnormalities should all be considered in women with significant, chronic postpartum bleeding.
5. Exercise and Nutrition- Women at a higher risk of postpartum weight retention are more likely to get obesity and type 2 diabetes later in life. Women must be encouraged to eat a range of nutritious, balanced foods and gradually return to regular eating patterns. Breastfeeding women must consume an additional 500 calories per day. They must avoid vigorous activities in the early postpartum time and get plenty of rest for the first few weeks. They can gradually introduce low-impact activities like walking and slowly return to previous activities.
6. Sexual Relationship- Lower estrogen levels may decrease libido after delivery. This could take up to a year after delivery, especially in nursing women. Women should wait for their perineal area to heal before resuming sexual activity, and perineal tears can take up to four weeks to six weeks to heal fully.
7. Contraception- Progestin-only contraceptives are the best hormonal contraceptive option for breastfeeding women, according to the American College of Obstetricians and Gynecologists (ACOG). In most cases, intrauterine devices are best inserted six weeks following delivery. Barrier contraception (condoms), intrauterine devices (copper-releasing and hormone-releasing), and progestin-only contraception are options for both breastfeeding and non-breastfeeding women.
8. Bladder and Bowel Function- Voiding should be encouraged and monitored to prevent asymptomatic bladder overfilling. If defecation has not occurred within three days following delivery, women are advised to use mild laxatives such as Docusate, Psyllium, or Bisacodyl. Osmotic laxatives such as Polyethylene Glycol and Lactulose can also be considered.
9. Essential Education Regarding Newborns- Essential infant care instruction, such as umbilical cord care, baby-bathing, breastfeeding, and the necessity of vaccines, should be provided by healthcare professionals.
10. Miscarriage, Neonatal Death, or Stillbirth- It is important to ensure follow-up for mothers who have lost a pregnancy. Emotional support and bereavement therapy are essential. In addition, any laboratory or pathology examinations related to the loss should be reviewed, and counseling about recurring risks and future pregnancy planning.
What Are the Various Health Issues That Arise After Delivery?
After baby delivery, the following issues occur commonly-
Postpartum Depression- Transient postpartum depression (baby blues) is prevalent during the first week after delivery. Women may experience depression, anxiety, mood changes, weeping bouts, irritability, and sleeping difficulties. The postpartum blues usually go away within two weeks.
Incontinence- Stress incontinence develops when the pelvic floor muscles are stretched or injured during labor. Obesity, parity, smoking, prolonged nursing, and forceps during vaginal delivery are all risk factors for urine incontinence. Management includes kegel exercises to strengthen pelvic floor muscles, bladder training, and weight loss.
Hemorrhoids- Constipation or pushing during the second stage of labor can cause hemorrhoids. Increased water and fiber consumption, as well as stool softeners, are the first line of treatment.
Intimate Partner Violence- The HARK (humiliation, afraid, rape, kick) or HITS (hurt, insult, threaten, scream) tools can be used to assess for intimate partner violence.
Health Issues That Arise During Pregnancy-
a. Pregnancy-Induced Hypertension- The risk of hypertension increases after delivery. Within the first seven days after delivery, an appointment for a checkup is recommended. Oral medications such as Nifedipine or Labetalol can be used to treat high blood pressure. If indicators of end-organ failure appear (liver injury or pulmonary edema), immediate hospitalization is recommended. Lifestyle changes, as well as annual blood pressure and body weight checks, are essential.
b. Gestational Diabetes Mellitus (GDM)- Gestational diabetes mellitus puts women at significant risk of acquiring diabetes. According to ACOG, women with gestational diabetes mellitus should have a fasting oral glucose tolerance test four to twelve weeks after delivery to screen for type 2 diabetes.
c. Thyroid Disorders- Hypothyroidism or hyperthyroidism symptoms can affect the mother. Clinical presentation and thyroid function tests are used to diagnose postpartum thyroiditis. Hyperthyroidism is a temporary condition that is rarely treated. If symptoms persist, a beta-blocker may be used. Levothyroxine is used to treat hypothyroidism.
To improve women's and children's health, postpartum care should become a continuous process rather than a one-time event, with resources and support tailored to each woman's specific requirements. Formulating a postpartum care plan that addresses the transition to parenthood and well-woman care should begin during pregnancy. Women who have a preterm birth, gestational diabetes, or hypertensive disorders of pregnancy should be informed that these conditions are linked to an increased lifelong risk of maternal cardiometabolic disease. After the baby is born, the mother's emotional and physical changes recover gradually. Any concerns regarding depression, the baby, or the healing process should be discussed with a doctor.