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Showing posts with label Perinatal Care. Show all posts
Showing posts with label Perinatal Care. Show all posts
Monday, October 6, 2008
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Vacuum-assisted Delivery



Description

A bowl-like apparatus is attached to a baby's head and the air between the baby's head and the apparatus is sucked out to create a vacuum. The apparatus is then pulled to extract the baby. This method is used more frequently than the forceps method. Hard labor, mechanical deliveries using vacuums and forceps, and emergency cesarean sections occur at a considerably high rate: approximately 20% of births. Therefore, advance knowledge of these scenarios can help the patient understand the doctor and make decisions about her baby's birth Compared to forceps delivery, the advantages and disadvantages of vacuum-assisted delivery are as follows.



Advantages

# The vacuum method is easy to use and does not require much experience. It attaches to the baby's head and does not bruise the baby's face.
# If too much pressure is applied, the vacuum detaches. Compared with forceps delivery, the risk of applying excessive force on the baby's head is low.
# It can be performed even when the baby is on his or her side.


Disadvantages

# Because the force that holds the baby's head is weaker than that used by forceps, this method may require several attempts. There is also a higher risk of a failed mechanical delivery with this method.
# The vacuum is difficult to attach if the baby's head is swollen from a long labor.
# Excessive force can damage the baby's skin and cause hair to fall out, hypodermal bleeding, and rupture of the periosteum vessel. If there is a severe edema on the baby's head, these side effects can occur without much force; therefore, this method should not be used, or be used only under extreme caution.
# Unlike an adult's head, a baby's head is soft and the bone on top of the baby's head is not closed. Although a suction device is rarely placed on this area, doing so can cause brain damage.
# Because a suction device cannot be attached to a baby's face, this method cannot be used when a baby is face down in the birth canal.


Vacuum Assisted Delivery: A Brief Summary of Key Principles


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Uterus



Description

# The uterus changes radically during pregnancy and puerperium.



# Size and Weight Decrease

# Immediately after childbirth, the uterus contracts, becoming round and hard.
# Two weeks after childbirth, the uterus recedes back into the pelvis (involution).
# The weight of the uterus immediately after childbirth is 35 oz. (1000 gm). It shrinks to 17.5 oz. (500 gm) after 1 week, 10.5 oz. (300 gm) after 2 weeks, and approximately 2-2.5 oz. (60-70 gm) after 6 weeks.
# The uterine neck, which opens to 10 cm, recovers to near normal, but it is thicker and the endocervix is looser.


Endocervix

# The endometrium recovers in 3 weeks. In 6 weeks, the spot where the placenta was attached heals and normal endometrium tissue grows.
# The placenta separates and easily leaves the body after delivery without scarring, because there is a soft decidual membrane between the uterus and placenta.
# If a woman has undergone curettage for abortion, even once, this leaves many scars on the endometrium and can be a hindrance to the next pregnancy.


Lochia

# Lochia is the secretion from the uterus after childbirth.
# The outside of the decidual membrane, the placenta side, detaches, and the inside, the uterus side, regenerates. Lochia is secretion mixed with blood from the detaching decidual membrane and postpartum uterus.
# As the healing continues and bleeds less, the amount of lochia and the amount of blood in the lochia decreases. Little blood will be present in the lochia after a week, and after 2-3 weeks the lochia turns into a yellowish gray color.

PreOp® Patient Education: Hysterectomy Removal Uterus 1


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Uterine Atonic Bleeding



Description

Uterine atonic bleeding is massive bleeding during puerperium (the period from the end of the last stage of labor and the return of the uterus to its normal size after delivery: about 3-6 weeks in duration), and happens because of uterine contraction failure immediately after the placenta is delivered. It rarely occurs a day later.



Cause

# Excessive expansion of uterus: Uterine inflation from a multiple pregnancy, hydramnion, or a fetus with gigantism.
# Thin uterine muscle: Uterine contractions are weak because of thin uterine muscle.
# Fatigue of uterine muscle: Woman had a difficult labor from strong contractions or prolonged use of contraction drugs.
# Physical constitution: Thorough preparations must be made if there has been a history of excessive uterine bleeding in past pregnancies, anemia, or other debilitating conditions.
# Oxytocia: Uterine contractions can become weak after a speedy delivery
# General anesthesia: Certain general anesthetics weaken uterine contractions when used in excess.


Early Discovery

# The uterus fills with blood when uterine contractions are weak, and the blood stretches the uterine muscle, making contractions even weaker. Pressing on the uterus or an internal examination will detect the condition of contractions and blood in the uterus. Any blood in the uterus must be removed, because it can cause inflammation.
# Many women will not bear down or allow their abdomens to be touched after a natural birth or cesarean section because it hurts. But mothers should bear it, because uterine atonic bleeding is unmanageable after they are moved to a room.
# It is good to have somebody with the mother after delivery. The guardian should alert the medical staff of any abnormal symptoms such as severe bleeding, dizziness, and fainting.


Treatment

# Massage the uterus and inject uterine contraction drugs to control bleeding and recover contractility.
# If atonia uteri cannot be reversed, a peritoneotomy (abdominal section) can be performed to cut, tie, or momentarily press the arteria hypogastrica uterine artery and ovarian artery, which are big blood vessels supplying blood to the uterus.
# If the above methods are not successful, the difficult decision to remove a woman's womb must be made to save her life.


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Tests During Delivery



Description

The following tests and examinations are necessary for insuring the safety and health of mother and child.



Uterine contractions

# Uterine contractions can be measured by the mother's subjective expressions or by directly palpating the abdomen to get a sense of the contractions and laxity.
# The interval, frequency, and intensity of the contractions, and the baby's heartbeat can be measured with a metrodynamometer. Equipment on the belly may be uncomfortable for the mother, but it is the most accurate way to monitor the baby.


Abdominal examination

# By palpating the mother's abdomen, the position of the baby can be determined.


Pelvic examination

An internal examination is an important element in managing childbirth. It examines the inside of the vagina and pelvis. When performing a pelvis examination, a finger is usually inserted in the vagina, but it can also be done through the anus.

What an internal examination will check for:
# How soft, short, and open the uterine opening is.
# How far the baby's head has descended into the birth canal.
# Whether the pelvis and vagina are narrow or wide.
# Whether the baby is facing up, down, or sideways; how hard the baby's head is; how swollen the baby's head is from labor.
# When there is vaginal bleeding (i.e., "colporrhagia"), examinations must be prohibited. If colporrhagia is severe, then an internal examination can be performed only after preparations for a cesarean section are made. Of course, vaginal bleeding must be distinguished from normal prenatal discharge with blood.


Amniotic fluid

# A quarter of all mothers begin labor when their water breaks. Delivery usually begins within 24 hours after the water breaks. If the baby is still in the uterus after 24 hours, then the chance of an infection developing in the uterus is high.
# After observing amniotic fluid from the uterine opening with a colposcope, the secretion is tested by using acidity (pH) test paper.
# The presence of meconium in the amniotic fluid and unpleasant smell provide important clues regarding the baby's condition.


Anal Examination

# Some doctors avoid using the vagina for pelvic examinations and, instead, use the anus to check the condition of the uterine opening (i.e., cervix).
# Examinations differ depending on the doctor's skill, but an anal examination is generally less accurate than a vagina examination. One advantage of the anal examination is that there is less chance for infection.
# When there is a high risk of infection or many internal examinations are expected, an anal examination can be used to determine how open the cervix is, and how far the baby's head has descended.


Vital Signs

# Vital signs measure changes in pulse, body heat, breathing, and blood pressure.
# With the tension and stress of childbirth, the mother can have a faster pulse; however, if the pulse continues to grow faster, it could be a sign of dehydration or exhaustion. Body temperature is measured every hour if the water has broke or there are reasons to suspect a rise in body heat.
# The mother's breathing can change depending on the birth process. When the body is under stress, hyperventilation occurs and breathing becomes deeper and faster. Failure to use breathing techniques appropriately during labor can cause hyperventilation, accompanied by complaints of dizziness and aches in the extremities. Covering the mouth and nose with a paper bag or both hands and breathing in and out alleviates hyperventilation.
# The reasons for low/high blood pressure must be determined. High blood pressure can be caused by pain and anxiety, while low blood pressure can be caused by local anesthesia, medication, or bleeding.


Laboratory Test

# Urine test: Checks for possible complications with the mother's hydration level, nutriture, and blood pressure.
# Blood test: Check for anemia; identifying the blood type helps prepare for any emergencies that could occur during labor.


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Stomach



Description

Some mothers are surprised to discover that their stomachs are still large after giving birth. The stomach will get smaller, but this takes time.



Changes with the Peritoneum and Abdominal Wall

# For a few days after delivery, the uterine muscles contract and wrinkle the peritoneum, which is wrapped around the uterus. It is severely relaxed compared to how it was before pregnancy and needs a lot of time to recover. The abdominal wall is very relaxed after giving birth because of the rupture of elastic fiber in the skin and an enlarged uterus. It takes weeks to recover, but exercise helps.
# Except for the striae gravida?rum, the abdominal wall will recover to its prepregnancy state, but this differs from person to person. Sometimes the muscles remain loose.


Belly

# Although most women report that their bellies have shrunk a great deal 6 weeks after birth, it takes a few months, 6 months on average, for the belly to return to normal; sometimes it does not recover.
# Wearing a maternity band (stomach band) helps if moving is uncomfortable after childbirth, but it will not make the belly shrink and revert to its prepregnancy appearance.


Postpartum Exercise

# Appropriate exercise will accelerate recovery during postpartum, returning strength to the muscles, make the belly shrink faster, and help lose the weight gained during pregnancy.
# Mothers who had a normal birth can start abdominal exercises immediately, and mothers who had cesarean sections can begin 1-2 weeks later, as long as there is no pain and the exercises are reasonable.



Afterpains

# After delivery, uterine contractions become weak and occasional. The pains/contractions are called afterpains.
# The pain becomes worse with each birth; breast-feeding causes the uterus to contract and also causes afterpains.
# Most of the pain disappears after 3-4 days; if afterpains are severe, painkillers can be taken for several days.



Stages of Labor

Stages of Labor

Description

Labor describes the uterus' efforts (contractions) to push the fetus out of the birth canal.

Stages

Childbirth labor is continuous, but can be divided into 4 distinct stages.




# Stage 1
During this stage, the woman should prepare herself to push the baby out from the uterus and into the world. This stage can be divided into 2 parts, the latent phase when the uterus opens to 3 cm, and active phase, during which rapid cervical dilation occurs and the uterus opens completely to 10 cm.

# Stage 2
During this stage, the uterus has opened completely and expelled the fetus through the birth canal.

# Stage 3
The placenta is delivered during this stage.

# Stage 4 This stage describes the hour after the placenta is delivered; it is an important time, because there could be bleeding. Duration time

# The duration of each stage depends on the person and, especially, the amount of previous childbirth experience. Stage 1 and 2 are short for experienced mothers, because the uterus will open quickly and the ligaments connecting the pelvis and its substructure have been previously stretched.
# If the woman is in labor, without any type of induction and having a natural birth, then the average durations for normal deliveries are as follow.





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Sitz Bath



Description

All new mothers should know the benefits of a sitz (hip) bath.
1. It prevents inflammation around the perineotomy region and reduces pain around the wound.
2. Helps the birth canal heal and heals slight tissue damage and inflammation.
3. Cleans the perineal region dirtied by excretion and bleeding and improves blood circulation.
4. Helps prevent and treat constipation and hemorrhoids.



How To Take a Sitz Bath

- After boiling some water and cooling it to 100-104?F (38-40?C), submerge the wounded area for 15-20 minutes.
- The water does not have to be completely germ-free and sterile.
- Sometimes salt and other medicines are added, but this has no significance and actually increases the chances for germs. Unless a doctor has prescribed a disinfectant, it is preferable not to use these.
- It is important to dry off after a sitz bath.
- It is ideal to bathe 15-20 minutes, 3-5 times a day, for 1-2 weeks after leaving the hospital. Longer baths are not necessarily better for wounds and can be harmful to the tissue.


Cold Fomentation

- If edema is severe around the perineal region, an ice pack can reduce the swelling and pain by calming the neuroterminal region and contracting the blood vessels.
- A perineotomy leaves a scar and preventing inflammation is a major objective, however, reducing blood circulation for a long time is not desirable.



Sunday, October 5, 2008
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Sexual Activity after Childbirth



Description

# Sexual activity (coitus) may resume when bleeding has subsided.
# Bleeding and infection are remote 14-21 days after childbirth.
# Usually libido is decreased significantly in the postpartum period.
# Early resumption of intercourse may be unpleasant because of incomplete healing of the episiotomy and laceration, and incomplete uterine involution.



# The best rule to follow is common sense: Six weeks (same as postpartum work disability time) may be the best time for abstinence.
# Because breast-feeding suppresses the production of estrogen, vaginal atrophy and dryness might occur.
# Breast-feeding women might need vaginal lubrication with lubricant.

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Resumption of Menstruation



Description

If the woman is not breast-feeding, menstruation returns within 6 weeks of delivery. After 3 months, 70-90% of women menstruate; 6 months later, almost all have resumed menstruation (average time for resumption is 8 weeks). This timeline varies widely if the mother is breast-feeding. Some new mothers begin menstruating after 4 weeks, and this is hard to distinguish from bleeding (hemorrhaging).



Abnormal Bleeding

# If there is irregular bleeding, chances are that it is abnormal uterine bleeding rather than menstruation.
# If the bleeding is modest and does not continue, there is no need for immediate treatment.
# If the bleeding is heavy, receive an examination and ultrasound to check the condition of the uterus.


Ovulation

# Two thirds of first menstruations after delivery are anovular menstruations (ovulation did not occur). Risk of pregnancy before menstruation is not high.
# When the woman is not breast-feeding, ovulation can occur 35-40 days after delivery, but on average it takes 2.5 months and 6 months for women who continue to breast-feed.
# The further away the first menstruation is from the delivery date, the better the chances for ovulation.
# When there is ovulatory menstruation, the ovaries have recovered and the mother can become pregnant again.


Effects of breast-feeding

# Many women who do not breast-feed during puerperium recover their ovary function, ovulate, and are capable of being pregnant roughly 6 weeks after delivery.
# Although the frequency of breast-feeding is a factor, 15% of mothers who do breast-feed menstruate 6 weeks later, one third menstruate within 3 months, and others can take more than a year and a half.
# Menstruation returns more slowly among mothers who breast-feed because the increase in hormones from breast-feeding causes the ovaries to recover late. The breast secretion hormones are concentrated and, like with infertile women, the ovaries do not respond well to ovary stimulus hormones from the pituitary gland.


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Puerperal Fever



Also known as

Childbed fever

Description

# Infection after childbirth is generally puerperal fever, and rise in body temperature is an important symptom. A puerperal fever is first seen as an infection of the reproductive organs. Puerperal fever was once considered a very dangerous illness: it was one of the 3 leading causes of death among women giving birth. The mortality risk due to Puerperal fever has been reduced by the development of antibiotics, but there are still dangers like surgery and blood poisoning.



# Definition

# The condition in which for 10 days after delivery, body temperature is measured orally 4 times daily, and body temperature twice exceeds 100 degrees Fahrenheit. If a fever reaches 102°F, or continues for 3 days, the likelihood of infection is high (excluding the 24 hours after delivery).


Diagnosis

# If infection of the reproductive organs is ruled out, there are no symptoms of a cold or pneumonia, and there is no suspicion of reproductive organ infection, then it is not considered a puerperal infection.
# Mastitis (inflammation of the breast), thrombophlebitis outside the pelvis, and inflammation of the abdominal wall after cesarean section are not reproductive organ infections. Nor are these infections considered to be puerperal fever.
# Often when a mother has puerperal fever, she suffers from flu-like symptoms and appears ill. Women with fever from total exhaustion or mastitis, on the other hand, are able to maintain an overall healthy condition.

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Puerperium



Description

# Puerperium is the period from termination of pregnancy to the involution of the uterus, traditionally 6 weeks.



# Involution of reproductive organ

Uterus:
# Just after birth: Slightly below umbilicus, weighs about 1000 gm.
# Day 2: Uterus begins to shrink.
# 2 weeks: Uterus descends into pelvic cavity; weighs 300 gm.
# 6 weeks: Uterus returns to normal nonpregnant state; weighs 50-70 gm.

Placental site involution takes 6 weeks.

Abdominal wall:
# Because of rupture of elastic fibers in the skin during pregnancy, abdominal walls remains\ soft and flabby after childbirth.
# Exercise helps speed recovery of abdominal walls.

Urinary tract:
# After birth: over-distention and incomplete emptying occurs.
# Complete recovery takes 2-8 weeks.
# About 7% of women develop stress incontinence after delivery; Kegel exercises are helpful.


Care: immediately after childbirth

# Bleeding: Vaginal bleeding should be monitored closely.
# Care of perineum:
# Mother should be advised to clean the perineum from front to back after bowel movements.
# Hot sitz bath can reduce discomfort of perineal area and enhance recovery.
# Early ambulation:
# Women can get out of bed several hours after childbirth: An attendant should monitor the first ambulation.
# Early ambulation reduces bladder complications and constipation.


Care: puerperal period

After pains:
# Uterine contractions after birth cause pain.
# After pains are more common in multiparous women and when the baby suckles.
# After pains decrease after 3 days after childbirth.

Lochia:
# Lochia is red, due to mixture of blood and tissue, for the first few days.
# After 3-4 days, lochia gradually becomes pale in color.
# After 10 days lochia, becomes yellowish-white in color.

Temperature:
# Physiologic " milk fever" can occur on 3rd or 4th day.
# Any fever after childbirth should be monitored. It can indicate an infection.

Bleeding:
# Any bleeding exceeding 2 times the amount of menstrual blood should be monitored.

Weight loss:
# Initially after birth, 10-13 lbs is lost due to uterine evacuation and 4.5-6.5 lbs is lost due to diuresis.
# Most women approach their prepregnancy weight within 6 months.
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Postpartum Exercise



Description

# Postpartum exercise has the following effects: It helps the woman return to her prepregnancy weight or condition.
# It tightens stretched abdominal muscles.
# Allows the mother to devote some time for herself.



# Starting Postpartum Exercise

# Exercises can begin 24-48 hours after delivery, if there are no complications with delivery.
# After a cesarean section or permanent sterilization, exercise should be put off for at least a month.
# Exercise should be postponed if there is a severe laceration from perineotomy, bleeding, or other complications.


Cautions

# Stop exercising right away if bleeding occurs during exercise or exercising is uncomfortable.
# Wear comfortable and loose clothes for postpartum exercises. Start in bed first; after 6 weeks, move to the floor.
# Initially, do each exercise 4-6 times twice a day and increase thereafter.


Methods

Stretching: Tightens loosened abdominal muscles and buttock muscles. 1.Lie down on the floor, place pillows under back and buttocks, and stretch arms above the head.
2.From head to toe, stretch the body as much as possible.
3.In the process, tighten the buttocks muscles and pull in the abdominal muscles.
4.Repeat after relaxing.


Knee Rotations: Tones the waist.

1.Lie down on the floor, bend knees, and spread arms at shoulder height sideways.
2.Do not move shoulders; keep them straight, and rotate knees to the right.
3.Return knee to original position and rotate left. Repeat.


Knee-Chest Exercise: Strengthens lower back muscles.

1.Lie down with feet touching the floor and knees up.
2.With both hands pull a knee toward chest. Alternate knees.




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Postpartum Depression



Definition

Postpartum depression occurs in 8-15% of postpartum women, 3-6 months after childbirth. Depressed mothers have less social interaction with children. It is a condition similar to major and minor depression and necessitates medical treatment.



Causes

* Biochemical changes due to childbirth.
* Strong association with previous psychological problems.
* History of depression: 30% recurrence rate.



Diagnosis

According to the American Psychiatric Association, a woman suffering from postpartum depression demonstrates at least five of following symptoms:

1. Depressed mood most of the day.
2. Markedly diminished interest or pleasure in all, or almost all, activities.
3. Significant weight loss or weight gain when not dieting, or decrease or increase in appetite.
4. Insomnia or hypersomnia.
5. Psychomotor agitation or retardation.
6. Fatigue or loss of energy.
7. Feelings of worthlessness or excessive or inappropriate guilt.
8. Diminished ability to think or concentrate.
9. Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt



Treatment

Mild to moderate depression can be treated with psychotherapy. Severe, chronic or recurrent depression can be treated with antidepressants and psychotherapy. For patients with suicidal ideation or suicide attempts, hospitalization and psychotherapy are needed.

1. Antidepressant Medications
Once medication is taken and is effective after a six-week trial period, it must be taken regularly for 6 to 12 months. In cases of recurrent depression, long-term maintenance of medication is the most effective way of treating and preventing depression. When discontinuing antidepressants, dosage is gradually decreased. Dosage of antidepressants is adjusted for each individual patient.

* Tricyclic antidepressants (TCAs)
TCAs are early antidepressants from the 1960s. They are as effective as the newer antidepressants, but have less tolerable side effects. The action mechanism of TCAs affects two brain chemicals: norepinephrine and serotonin. TCAs, such as amitriptyline (Elavil), nortriptyline (Pamelor), desipramine (Norpramin), and imipramine (Tofranil) are still commonly prescribed as a second or third line of treatment for depression. The most common side effects are dry mouth and constipation. Bladder problems, change in sex drive, weight gain, blurred vision, dizziness, drowsiness, and rapid heard rate also may occur.

* Monoamine oxidase inhibitors (MAOIs)
MAOIs, such as Phenelzine (Nardil), Tranylcypromine (Parnate), and isocarboxazid (Marplan) have been used for major depression, panic disorder and bipolar disorder (manic depressive disorder) since the 1960s. MAOIs are used as the last resort when other antidepressants are not effective. Dietary restrictions are required because it may have interactions with certain foods, including cheeses, pickles, beverages (wines), and with medications, including decongestants and antidepressants, especially SSRIs. This interaction can increase blood pressure sharply, which can lead to a stroke. Interaction with SSRIs can cause serotonin syndrome.

* Selective serotonin reuptake inhibitors (SSRIs)
SSRIs have fewer side effects, less toxicity, and yield a lower suicide risk than the older antidepressants (TCAs, MAOIs). SSRIs primarily affect one neurotransmitter(serotonin), while old antidepressant TCAs affect both serotonin and norepinephrine in the brain. Fluoxetine(Prozac), sertraline (Zoloft), fluvoxamine (Luvox), paroxetine (Paxil), and citalopram (Celexa) are the most commonly used SSRIs. Side effects may include sexual problems, headache, nausea, nervousness, insomnia and agitation; however, they are usually temporary after a short period of time. Sexual problems can be common in both men and women, but reversible. When SSRIs are combined with other medications that affect serotonin, such as an MAOI, it can lead to serotonin syndrome.

* Other antidepressants
Venlafaxine (Effexor), Nefazadone (Serzone), Mirtazepine (Remeron), bupropion (Wellbutrin), are examples of other antidepressants that may be used to treat postpartum depression.


2. Counseling and psychotherapy
Psychotherapy alone may be an effective treatment for postpartum depression; but psychotherapy, accompanied by antidepressants, is a more effective in treatment.

3. Electroconvulsive therapy (ECT)
ECT is effective for pregnant and postpartum women with depression, especially psychotic depression, who have not responded to antidepressants or who cannot take medications. ECT is relatively safe, not painful, but recommended only when other treatments have failed.

4. Group therapy, light therapy, hormone therapy
Depression After Delivery, Inc. is a national, nonprofit organization that provides support for women with ante and postpartum depression. Women and families coping with mental health issues associated with childbearing, both during pregnancy and post partum, should call 1-800-944-4773 for more information, referral to support groups, telephone support, and more.


Women's Health, Hormones, Sun & Postpartum Depression


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Postpartum Care



Description

# Puerperium, the time when the physical changes caused by pregnancy return to their pregnancy state, lasts until 6 weeks after delivery. Postpartum care is the general care for all conditions that occur during puerperium.
# Postpartum care prevents side effects/aftereffects and helps make the recovery quick and healthy.



# Immediate care

# After delivery, women may experience bleeding, dizziness, and muscles weakness. Women should move slowly and ask for assistance when going to the bathroom.
# If there are no complications, a woman may eat 2 hours after delivery. Before that time, water or fruit juice is acceptable.


Complications

# Bleeding after delivery, especially internal hemorrhaging, is the most serious complication. The mother's condition must be checked often.
# The first few days after delivery are also a time when the risk of inflammation is high. Therefore, it is important to be vigilant for symptoms of infection and a rise in body temperature.


Fatigue and Exhaustion

# Usually mothers complain about becoming easily fatigued and exhausted during puerperium. This is attributable to the delivery, stress of raising a baby, lack of sleep, and physical recovery.
# Getting sufficient rest and sleep is helpful. It is useful to have a person who can assist in watching the baby after the woman is discharged from the hospital, because nursing a child can delay the mother's recovery.
# If fatigue and exhaustion continue for weeks, then an examination is needed. Thyroid gland dysfunction (subthyroidism, hypothyroidism) is not uncommon after delivery. Fatigue is the main symptom, so it must be distinguished from normal fatigue.


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Postpartum Blues



Description

"Postpartum blues" is a mood disturbance experienced up to 70% of postpartum patients within 3-6 days after delivery.

Causes

# Blues are precipitated by progesterone withdrawal, which occurs with delivery of infant.



# Symptoms

# Anxiety
# Restlessness
# Extreme irritability
# Insomnia
# Weepiness
# Poor concentration
# Usually symptoms only last few hours to a few days and are mild


Psychological Examination

# Examination


Treatment

# These symptoms usually resolve without therapy within 10 to 15 days.
# Supportive treatment.
# The symptoms can develop into postpartum depression or psychosis, a severe condition that requires medical attention. If they do not resolve in 15 days, consult a physician.

How To Cope With Postpartum Blues Or Depression



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Postpartum Activity



Description

There are individual differences, but in the absence of complications, a mother can walk within a few hours of delivery; after a cesarean section, a woman can begin walking after a day.



Early Activity

# Walking as early as possible helps prevent complications such as bladder dysfunction or constipation.
# There is a risk of thrombosis after delivery because blood coagulates easily, but activity will accelerate blood circulation and help prevent thrombosis.


Activity After a Cesarean Section

# Some people lie in bed without moving, fearing that problems will occur with the surgery site, but activity is actually beneficial.
# If abdominal pain prevents walking, rolling and arm and leg exercises are recommended.


Lifting Heavy Objects

# Avoid lifting heavy objects. Tissue supporting the uterus and vagina is already stretched from pregnancy and delivery. Exerting abdominal pressure will stretch the muscles and tendons supporting the pelvis even more.
# Descensus uteri is the condition in which the bladder or uterus sits low or comes out. Physical constitution is a factor, but overstraining during the delivery and inadequate rest during the recovery phase are also causes.


Postpartum Exercise

# Moving the body early and starting to exercise after delivery helps postpartum recovery.
# If a woman becomes dizzy or weak during exercise, she should lie down and move arms and legs to help blood circulation throughout the whole body.


Women's Health, Hormones, Sun & Postpartum Depression


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Physical Changes After Birth



Description

The body's ability to recover after childbirth is remarkable. While some areas will not return to their same original state, wounds do heal and stretched tissue shrinks and becomes tight again.



The Circulatory System

# Pulse: A woman's pulse rate returns to its prepregnancy rate in 1-2 days, and the increased volume of blood returns to normal levels in approximately a week.
# White corpuscles (leukocytes): The number of white blood cells increases during labor and right after delivery, and, consequently, it is sometimes difficult to diagnose inflammations. If there is an inflammation and the white blood cell count is high, attentive care is needed because it may be blood poisoning (septicemia).
# Blood coagulation factor: Fibrinogen is elevated for a week, increasing prothrombin time, which measures the time it takes for blood cells to separate from serum in a narrow tube.


Lochia

# Lochia is the secretion from the uterus after childbirth.
# The amount of lochia secreted differs from person to person, depending on how much of the decidual membrane is left and the condition of the uterus. However breast-feeding does not affect the length and consistency of lochia. Over time, lochia changes.


Lochia's condition

Immediate postpartum period
Uterine contractions are strong and there are no complications; some bleeding occurs.

3-4 days after birth
Instead of blood, a reddish discharge from the womb is secreted for about a week.

1-2 weeks after birth
Although not red, a thick mucous-like discharge is secreted. There is a slight odor that usually lasts for 2-3 weeks but can last for 4-5 weeks.

4-6 weeks after birth
For most women, normal dull, yellowish discharge similar to the discharge before pregnancy.

# To prevent infection of the uterus and vagina through childbirth wounds and lacerations, lochia must be disposed of properly. After urination or a bowel movement, wipe from the front, from the urethra toward the anus, with clean paper. Maternity pads should be changed often.


Saturday, October 4, 2008
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Perineum and Vagina



Description

The body prepares for delivery by releasing hormones from the placenta and making the vagina more elastic and wider. A warm sitz bath helps the vagina to recover from stretching, tissue damage, and lacerations from the fetus. It also reduces pain from the perineal region (i.e., perineum, the space between anus and the vulva), promotes blood circulation, and helps the vagina to heal.



Pudendum and vaginal changes

# Labia: After pregnancy, the outside (labia majora) is less prominent, wider, and opened, making it less obvious; the inside (labium minora) becomes distinct and more prominent.
# Hymen: The hymen, which breaks during first intercourse, exists partially until childbirth. After natural delivery, the hymen tissue is no longer visible and there are only small traces remaining in most women.
# Vagina: A widened vagina will become narrower with time but will still be wider than it was before pregnancy. Before undergoing a natural birth, the vagina has wrinkles; after delivery the wrinkles are less prominent and the vagina becomes smooth.


Contractile force of the vaginal muscle

# The relationship between the stretching of the vagina after childbirth and sex is a concern for couples.
# The contractile force of the vaginal muscle is not the only requirement for good sex, but it is helpful if it is somewhat tight.
# The vaginal muscle does not contract independently, but instead is linked to other muscles in the perineal region, including the rectum, which contract and relax simultaneously.


Exercises for the vaginal muscles

# Like other muscles, the vagina must be exercised to improve contractibility. The rectum, anus, perineal region, pelvis, and diaphragm muscles can be strengthened at the same time to a certain extent.
# Doing Kegel exercises, in which the vaginal muscles are clenched (narrow and tighten anus and vagina and then squeeze upward) for 10 seconds, released 10, and repeated 10 times, can help considerably in restoring the size, shape, and contractibility of the uterus.

PostCare™ Basic Center: Female Perineal Wash


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Perineotomy Region



Description

# Many germs inhabit the surrounding perineotomy region, but childbirth wounds can heal quickly without medical intervention.
# Unless infection and hematoma are present, the perineotomy region (i.e., perineum, the space between anus and the vulva) requires only a sitz (hip) bath to heal.



# Pain

# As the perineotomy region heals, tightening pain will continue for 2-3 days after birth and make walking and sitting uncomfortable. But the pain should ease by the time the stitches are removed.
# In the United States and other countries, an anesthetic spray is administered to reduce pain; in Korea, however, hospitals and physicians administer painkillers.
# The pain itself can be from the perineotomy, but if the pain is severe, complications such as necrotizing fasciitis should be considered.


Inflammation

# If there is inflammation in the surrounding tissue, the stitching may look clean but the surrounding area will be reddish, swollen, warm, and painful to touch.
# This must be treated quickly with an antibiotic, because the inflammation could spread or the wound could open.
# If the wound tears a little and the inflammation disappears, it will heal. However, if a considerable tear exists, it will need antibiotics, sitz baths, and a second stitching once the inflammation has been treated, in order to heal properly.


Scars

# There is almost no scarring if the perineotomy is performed vertically, from the vagina to the anus, because it matches the grain of the tissue.
# The perineotomy incision is made at a 45-degree angle if an anal laceration is a concern. This leaves a little scar tissue that does not usually affect a patient's quality of life.
# Large scars that spread in multiple directions are aesthetically unpleasing and can cause pain during sex. Most scars can be removed or made more aesthetically pleasing with plastic surgery.


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