Management of the postpartum period
Despite the fact that the postpartum period refers to the physiological state, it requires a serious attitude to itself. The state of health of the puerpera, the resistance of the organism to a possible infection, the normal course of the involution of the uterus, and lactogenesis largely depend on a well-organized hygienic regimen in the postpartum period.
In recent decades, the experience gained in obstetric practice has convincingly confirmed the rationality of active management of the normal postpartum period. This means that after 6-8 and at the maximum after 12 hours the puerpera gets up, she serves herself. Such an active tactic contributes to a significant reduction in the frequency of subinvolution and uterus, improved lactation, almost complete absence of postpartum thrombophlebitis.
The following principles of postpartum management are distinguished:
Maintenance of normal state of health of mother and child
Evaluation of the mother's condition, measurement and recording of body temperature, blood pressure, determination of the nature and pulse rate. Pay attention to the mammary glands: determine their shape, possible engorgement, the state of the nipples, the presence of cracks in them; -
Constant monitoring of postpartum discharges (lochia) and uterus involution.
- during the first two hours - every 15 minutes;
- during the third hour - every 30 minutes;
- for the next three hours - every 60 minutes;
- during the further stay in the postpartum department
- once a day.
The height of the standing of the bottom of the uterus above the bosom is measured by a centimeter tape, with the bladder emptied. Its value on the first day is 15-16 cm. Decreasing daily by 2 cm, the uterus bottom is not determined by the 10th day of the normal postpartum period above the genital area. The uterus during palpation, as a rule, is painless, mobile, dense, Regular emptying of the bladder and intestines promotes active involution of the uterus.
More reliable information about involutive processes in the uterus in the postpartum period is obtained with ultrasound. In this case, the length, width, anteroposterior size of the uterus is determined, the uterine cavity is examined, its sizes and contents are evaluated.
The ultrasound picture of the postpartum uterus depends on the method of delivery: performing postpartum exercises.
Support for early breastfeeding
At present, the effectiveness of the early application of the newborn to the mother's breast, that is, in the first 2 hours, is theoretically proved and confirmed by practice:
- it causes positive emotions in the mother, prevents hypogalactia and promotes the better intake of immune components from the mother's blood through the barrier of the breast and milk to the newborn's body;
- contact "skin to skin" and early attachment of the newborn to the breast, a 24-hour joint stay of the mother and newborn, the mother's choice of that position in breastfeeding, which is most comfortable for her and the child, which contributes to a long and successful feeding - this emotional contact and gives the puerpera an opportunity to reveal her maternal feelings;
- protects the newborn from infections.
For today, a flexible feeding schedule is allowed. Such a regime means a reasonable amount of feeding at certain times and stopping night feeding if the child gets used to it. The intervals between feedings increase as the weight of the child increases.
Support for the mother's sense of self-confidence
Providing the mother with accurate and comprehensive information throughout the postpartum period regarding her condition and the condition of the newborn, the acquired skills of quality care and supervision of the child will increase the sense of self-confidence, and will also provide an opportunity to seek help in a timely manner if necessary.
Conducting counseling on family planning and childcare after discharge
The discharge of the puerpera from the hospital is carried out:
- after an objective assessment of the mother's condition: no complaints, stable hemodynamics, no bleeding, no signs of infection. There is no evidence in favor of the need for routine ultrasound of pelvic organs of women in the postpartum period;
- after the mother is taught how to care for the child. In the absence of deviations from the physiological course of the postpartum period, the paternal and newborns are discharged home on the third day;
- after the mother was consulted on infant feeding, postpartum contraception and the main menacing symptoms of the postpartum period.
Menacing symptoms in postpartum women:
- bleeding from the vagina (use 2-3 pads in 30 minutes);
- increased body temperature;
- difficulty breathing;
- abdominal pain;
- pain in the mammary glands and nipples;
- pain in the perineum;
- Purulent (with an unpleasant smell) discharge from the vagina.
Threatening conditions of the child, for which help is needed
- the child sucks badly;
- the child is sluggish or agitated;
- the child has convulsions;
- the child has a breathing disorder;
- the child has hyperthermia or hypothermia;
- the edema, hyperemia or suppuration of the umbilical wound is determined;
- urinary incontinence, pain (difficulty) with urination;
- the child has vomiting or diarrhea.
Medical expert editor
Portnov Alexey Alexandrovich
Education: Kiev National Medical University. A.A. Bogomolets, Specialty - "General Medicine"
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