Postpartum Period and Problems

confinement; It is the return of the physiological and psychological changes that the pregnancy creates in women at the end of 6 weeks (42 days) after delivery. This process takes different times for each organ and system.

The word “the tomb of the puerpe remains open for 40 days” is widely used among the people. This word reflects the facts somewhere. Because diseases that occur during childbirth and puerperium can be life threatening.

Very early postpartum represents the first 24 hours after birth, early postpartum first week, and late postpartum period represents the remaining time. Reproductive organs return to normal in 6 weeks, and most of the mothers who do not breastfeed begin to have menstruation at the end of this period. In breastfeeding, it may take up to 6 months before the menstrual returns to normal.

The first change that is noticeable after birth is the return of the uterus, that is, it becomes smaller (involution).

Uterus involution

Uterine involution; It is the name given to the return of the uterus to the state before pregnancy after birth. During pregnancy, the uterus grows about 20 times in weight, but it quickly begins to shrink after birth. Immediately after the baby is born, he descends to the size he was in at about 20 weeks of gestation. At this stage, its weight is about 1 kg. The volume of the uterus returned to its size at 12 weeks of gestation at the end of the first week is at the end of 6 weeks before pregnancy.

We do not have a second organ in our body, whose weight and volume grow so large and then shrink. This feature of the uterus continues to amaze the world of science even today and is still not fully explained scientifically.

The strength of uterine contractions immediately after birth is much greater than during labor. These are called "follow-up pain (afterpains)". These pains can continue for 2-3 days. It is felt more in those who have given birth (in multiparas). In the first 12 hours, their frequency is more, after this hour, both the frequency and severity gradually decrease.

The pain in the groin and abdomen may be felt as a result of contraction of the uterus due to the “oxytocin” hormone secreted from the brain, especially during the nursing of the puerperant's baby.

Immediately after separation of the placenta at birth, the area where the placenta adheres to the uterus shrinks in half. Thanks to this shrinkage, the exposed vessel ends are closed and bleeding is reduced. While it takes 3 weeks for the membrane layer that lays inside the uterus and called the “endometrium” to return to normal, the area where the placenta settles heals within 6 weeks. In cases where recovery is not complete, bleeding may occur.

Vaginal discharge after childbirth (Leukis, Lochia)

The discharge from the uterus after childbirth is called "lochia". Fresh red blood that comes first is called “losi rubra”. This fluid contains blood and tissue particles. In a few days, its amount decreases, it becomes lighter and turns into "losi serosia". After the 2nd week, the darker and light colored “losi alba” starts to come. About 4 weeks after birth, all these vaginal discharge is stopped.

It is a very suitable environment for infection in terms of leukin content. Therefore, much attention should be paid to hygiene.

Postpartum cervix (cervix), vagina and other changes

The opening of the cervix (cervix), which opens 10 cm during childbirth and looks like paper, decreases to about 1 cm after a week. The cervix is separated from those who do not give birth by taking a flat appearance instead of round. It takes another 6 weeks for the cervix to heal completely.

Vagina tissue, which is forced and stretched a lot during birth, begins to heal slowly and takes its final form after 3 weeks, but it never reaches its tension before giving birth.

Abdominal muscles and pelvic muscles that expand and stretch during pregnancy will recover after 6 weeks and exercise is recommended after this period. Changes in other systems such as circulation, excretion and endocrine will return to normal after 6 weeks.

Postpartum Problems

Serious and sudden problems can occur immediately after birth. Therefore, the puerperant should be kept under observation for at least 24 hours. Blood pressure measurements should be made frequently and bleeding should be checked.

Bleeding

The most important complication of early postpartum is bleeding. Having more than 500 milliliters of bleeding after normal delivery is considered abnormal. The most important and serious reason is “atony”.

Atony is the fact that the uterus does not contract after birth and therefore the open veins cannot be closed. It is an extremely urgent and life-threatening condition and is characterized by excessive bleeding in a very short time.

In births that are not performed in appropriate settings, the mother may lose if atony develops and there are no emergency surgery conditions. For this reason, home births are extremely risky.

In the treatment, the uterus is massaged manually and drugs that provide uterine contraction are given via the vein. If the treatment does not work, an urgent operation may be required.

embolism

In another situation threatening the life of the mother, amniotic fluid embolism. Here, the baby's amniotic fluid passes into the mother's bloodstream, leading to congestion in the vessels leading to the organs such as the lungs and brain. The mother died in a very short time. Unfortunately, diagnosis and treatment is very difficult. The most important cause of maternal death in modern obstetrics is amniotic fluid embolism.

Infections

The so-called “postpartum fever” is a condition that occurs after the first 24 hours after birth and progresses with high fever. The most common causes are reproduction, urinary tract and infection of the breasts. Conditions such as prolonged labor and early opening of the membranes increase the risk of infection.

The most common infection is inflammation of the uterus ("endometritis"). It usually occurs on the 3rd day and the fever may rise to 40 degrees. It is very bad smelling. The event can spread to the abdominal cavity (“peritonitis”).

In the examination, the uterus is quite delicate and painful. If the infection spreads via the blood, it is life threatening.

In the treatment, bed rest, fluid support and appropriate antibiotic use are recommended.

Urinary tract infection

In 5% of cases, urinary tract infection (UTI) may occur, accompanied by burning, groin and low back pain, and high fever. It usually gives symptoms on the 2nd or 3rd day.

Injuries to the vagina increase the risk of UTI. Appropriate antibiotics are recommended for treatment.

Any systemic disease that exists before pregnancy can be adversely affected by the postpartum period. Therefore, extreme care should be taken in postpartum.

What is Perineum Care?

During normal delivery, an incision is made by the doctor to avoid uncontrolled tears in the area. This incision is called "episiotomy".

When the word "perineum" is mentioned, the area between the vagina entrance and the breech is understood. It is of great importance during and after birth.

Postpartum perineum care covers all of the things to be done to make the episiotomy area easier to heal and to prevent infection. Care takes about 1-3 weeks.

Symptoms of problems in the perineum

The most common problem in perineum is pain and swelling. Due to the compression of the baby's head during labor, edema occurs around the perineum and vagina. Again, even if an episiotomy (vagina incision) was made during childbirth, unnoticed tears or abrasions may have occurred in the vagina. When these tears are not noticed and stitched, they may bleed or become infected.

If the bleeding does not go out and accumulates in the tissue range, there may be severe pain in the vagina with a feeling of fullness. In this case, a "hematoma" (inward bleeding) is suspected.

Again, due to strains during delivery, hemorrhoids may form around the anus. These hemorrhoids can cause pain while sitting, sometimes even bleeding. Surgical treatment may be required for hemorrhoids that do not respond to sitting baths and drug treatments.

What To Do In The Care Of The Perineum

Ice application or sitting baths are recommended from time to time to reduce pain and bleeding after birth. For pain, you can use pain medication prescribed by your doctor. If you have constipation or hemorrhoids problems, you can use stool softening medications to prevent strain.

While only clean water is sufficient to clean the area, solutions containing antiseptic agents are often recommended. In addition, daily pads are important for hygiene and bleeding.

If there is more than normal and clotted bleeding after delivery, you should definitely inform your doctor.

Also take the following measures:

  • Take care to keep your perineum as dry as possible. Change your sanitary pads frequently.
  • Clean with clean water or preferably an antiseptic solution (such as saloon or iodized solutions) for at least two minutes after toilet. In the meantime, make sure to clean from front to back, not from back to front.
  • Avoid contamination of this area with stool in your toilets.
  • Keep a sufficient amount of sanitary pads, cleaning materials and painkillers in your home.
  • Keep a sufficient amount of sanitary pads, cleaning materials and painkillers in your home.
  • "Ice molds" applied to this area can reduce pain due to edema or small hematomas. To prepare ice molds, water is placed in a glove and frozen in the freezer of the refrigerator. These formed molds are then wrapped with a soft cloth and applied to the perineum. Application is suggested as 20 minutes every 48 hours.
  • Warm or hot water baths are not recommended in the perineum.

If the amount of your bleeding is increasing (for example, if you pollute more than 1 pad in 2 hours), if your bleeding turns red, if a bad smell appears, if your fever rises, if you get pain in the abdomen, call your doctor immediately.

Other Solutions in Postpartum

  • In confinement, as in pregnancy should also be attention to some issues. Nowadays the 24 hours after a normal birth after cesarean section is enough to stay in the hospital for 48 hours.
  • Homebound mother after birth, whatever the mode of delivery should rest as much as possible. However, this rest should not be in the form of continuous lying.
  • Getting around in the house, doing simple chores both increases self-confidence and supports blood circulation.
  • The mother who comes home after birth can eat and drink everything she wishes and knows that she does not touch her. Protein-containing foods and fresh fruits and vegetables are particularly recommended. It is recommended that mothers who give milk take an average of 2600-2800 calories per day.
  • Slow motion and constipation may occur in bowel movements after the baby is born. For this reason, fiber foods that soften the stool and taking plenty of fluids are beneficial to prevent constipation.
  • After normal delivery, immediately after cesarean, from the 3rd day, a standing shower can be taken. Unless it is difficult during the bath, water does not get into the vagina. The washing of the vagina is inconvenient.
  • The “episiotomy (episio)” that is opened and sutured during normal delivery is usually the process of not having a left-handed doctor on the right side of the vagina. It is necessary not to give weight to the right side while sitting and lying down.
  • Exercise is recommended to strengthen the abdominal muscles after birth, but exercises should be started after 6 weeks and exercises that strain the muscles should be avoided.
  • There is a decrease in sexual desires for a while after birth. This decrease is generally of psychological origin. Usually, the request is restored after 12 weeks. There may be sexual intercourse after 20-25 days after birth. Breastfeeding rising period "Prolactin hormone" (milk hormone) can cause vaginal dryness by suppressing the hormone estrogen in women. if it is too much examination of your complaint you should go to your doctor.

Op. Sibel Malkoç, MD

Gynecology and Obstetrics Specialist

Dr. Sibel Malkoç attended many domestic and international training seminars and congresses during 25 years of specialised physician service.

Pregnancy follow-up, urinary incontinence surgery and laser treatments, genital aesthetic surgery and laser applications and vaginismus treatment are of special interest.

It serves its patients especially in surgical and laser-assisted Vagina aesthetics.

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