Management of puerperium

Caring for the woman, her newborn baby and her family after a normal delivery creates a happy, exciting and rewarding experience. It is a time when the midwife exercises her ability of observation and sensitivity to provide excellent nursing care. The puerperal woman is no more treated as ignorant, idle, ill woman, confined to bed. Today the puerperal woman is regarded to be healthy, intelligent, who is anxious to see, touch and care for her baby. The first ten days is regarded as the “lying- in-period” when close observation and adequate care should be given to the patient.

Care during puerperium must aim at:

· Promote physical well being of client by

· correcting anaemia, providing comfort, cleanliness and promoting sufficient physical activity to ensure good muscle tone and involution of the pelvic organs.

· Establish emotional well being, quietness, freedom from worry and exicitment and proper phychological approach.

· prevent infection

· promote breast feeding

· provide education on the proper care of her baby

Postpartum care is divided into two phases; immediate and subsequent.

Immediate care: covers the first 24 hours after birth. The first 1hour is most critical is regarded as the 4th stage of labour. Ideally it should be spent in the labour ward. It is the time most Post – Partum Hemorrhage (PPH) occur, shock or sudden collapse.

Close observation is needed. Pulse, BP, involution, Lochia, perineum, could be done every 15minutes. It includes condition of the uterus, condition of the perineum, bladder and voiding.

Rest/Sleep – sedation may be served. If B/P is high , sedation should be given orally or intraveinously to prevent postpartum eclampsia. She is made comfortable and allowed to rest. At the end of one hour, she is observed again, cleaned up and offered a drink- encourage to pass urine and uterus should be emptied. Uterus should be well contracted.

Subsequent Care:

1. Rest and Sleep: very essential calm atmosphere should be provided. No strenuous activities

2. Ambulation: 6 –12 hours after delivery- promote fee ling of well-being, good circulation and drainage of Lochia. She can now participate in the management and care of her baby.

3. Diet, fluids and vitamins: a protein diet, vitamins and minerals to promote good lactation. Adequate fluids – milk, fruit supplementary vitamins , iron, folic acid to prevent anemia

4. Care of bladder and bowel: encourage to empty bladder regularly to prevent Post –Partum Hemorrhage (PPH), sub-involution and Urinary Tract Infection. Catheterize if necessary to prevent constipation. dulcolax suppository or magnesium hydroxide (30mls). May begin to take food rich in roughage.

5. General comfort and cleanliness – vulval toilet re gular perineal care and changing of pad, sanitary towel should be discarded

6. Promote involution – encourage early ambulation good health , prevent infection , breast feeding ,postnatal exercises and estimate fundal height daily Postnatal exercises: this should be done daily in puerperium.

7. Promotion of breastfeeding: this should be encouraged most mothers are eager. Empty breast at each feed nipples must be free from infections cracks and engorgement. Mother must be free from infections.

8. Prevention of infection: reduce visitors, antisepsis and asepsis should be observed when caring for the vulva. On suspicion of infection, patient should be isolated or barrier nursed.

9. Records: all observation vital signs abdomen, uterine tenderness or full bladder. Involution, breast examination, Lochia color , odor amount and consistency , wound for healing or removal of stitches.

10. .Education of the mother – mother must be educated on care of the baby and the need for post natal visit and family planning be emphasized

Method of measuring fundal height during puerperium;

· Done by the same person , same time using same instrument

· Patient should empty her bladder

· Palpate the abdomen and locate the fundus uteri and upper border of the symphysis pubis. using a flat graduated rule estimate the distance between the symphysis pubis and the uterine fundus

Post natal examination: conducted 6weeks later to ensure

· organs affected by pregnancy return to their pregravid state

· lactation : assess if the breast is lactating well

· good condition generally –medically and gynecologic ally

· family planning

Post natal procedure

· Urine testing, vital signs and blood clot

· Vital signs

· Blood test

· Examination –generally, abdomen, breast

· Vaginal Examination (by doctor) to assess if the cervix is closed or still open

· Perineal examination – laceration ,cough to exude prolapse

· Vaginal discharge return of menses

· Baby examination- general condition sleep elimination, circumcision, feeding general appearance etc.

· Ask questions on her wellbeing and that of the baby

Common complications

1. Vaginal discharge – infection

2. Backache- (poor feeding and work)

3. headache, prolapse