2. the normal puerperium (1)

8/19/2019 2. the Normal Puerperium (1)

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2. The Normal Puerperium

Study Session 2 The Normal Puerperium.....................................................................3

Introduction................................................................................................................3

Learning Outcomes for Study Session 2....................................................................3

2.1 Changes in reproductie organs during the puerperium.....................................3

2.1.1 !terus...........................................................................................................3

2.1.2 Ceri"...........................................................................................................#

2.1.3 $agina and ula..........................................................................................#

%uestion.................................................................................................................&

'ns(er...................................................................................................................&

2.1.# Perineum......................................................................................................&

2.1.& ')dominal (all............................................................................................*

2.1.* Oaries.........................................................................................................*

%uestion.................................................................................................................*

'ns(er...................................................................................................................*

2.1.+ ,reasts and initiation of lactation.................................................................+

Suppression of lactation in non-)reastfeeding (omen..........................................

2.1. /"cretion of e"cess )ody fluids...................................................................0

2.2 Important information for the first-time mother.................................................0

2.2.1 Looing after the )a)y.................................................................................0

2.2.2 est and recoery for the mother.................................................................0

2.2.3 ,irth control options....................................................................................0

%uestion...............................................................................................................12

'ns(er.................................................................................................................12

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2.3 In conclusion.....................................................................................................12

Summary of Study Session 2...................................................................................12

Self-'ssessment %uestions S'%s4 for Study Session 2.........................................13

S'% 2.1 tests Learning Outcome 2.14................................................................13

'ns(er.................................................................................................................13

S'% 2.2 tests Learning Outcomes 2.2 and 2.34..................................................1#

'ns(er.................................................................................................................1#

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Study Session 2 The Normal

Puerperium

Introduction

In this study session you (ill learn a)out the normal postnatal changes that occur to

(omen during the si" (ees after child)irth. The postnatal period is also no(n )y

doctors5 nurses and mid(ies as the puerperium. It includes the normal processes of

physical and psychological ad6ustments during this period. 7o you remem)er the

physiological changes in pregnancy from the Antenatal Care 8odule5 Study Session

39 :ere (e focus in detail on the normal ad6ustments during the puerperium5 in

particular the changes that occur in the reproductie system and in other )ody

systems.

Puerperium is pronounced ;poo-ayre-peer-ee-umue opportunity to assist mothers and their families to cope (ith the ad6ustments

during the postnatal period.

Learning Outcomes for Study Session 2

'fter studying this session5 you should )e a)le to?

2.1 7efine and use correctly all of the ey (ords printed in bold. S'% 2.14

2.2 7escri)e the e"pected physiological responses of ne( mothers during the normal

puerperium. S'% 2.24

2.3 /"plain (hat adice you (ill gie ne( mothers for self-care during the

puerperium at home. S'% 2.24

2.1 Changes in reproductie organs during the

puerperium

The important physiological eents that occur during the puerperium include5 among

others5 the return of the reproductie organs and the leels of the female hormones to

appro"imately their pre-pregnant state. @e (ill )riefly descri)e these changes in turn5

al(ays focusing on (hat can )e e"pected in a normal postnatal (oman.

2.1.1 !terus

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The full term uterus has gro(n at least ten times )igger than it (as )efore pregnancy.

On its o(n it (eighs appro"imately 1g not including the )a)y5 placenta5 amniotic

fluid5 etc45 (hereas its pre-pregnant (eight (as only

&A-1AA gm. Immediately after the )a)y is )orn5 the uterus can )e palpated at or near

the (oman


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and the (oman may get pregnant again een )efore the return of her first menstrual

period.

,irth spacing (as discussed in Study Session 1# of the Antenatal Care 8odule.

&uestion

@hat is the )enefit of using postnatal family planning to space out the )irths of more

children9

'ns(er

'n interal of at least t(o years )et(een )irths5 and prefera)ly a longer gap5 reduces

the ris of complications occurring to the mother during the ne"t pregnancy. It also

increases the health of the ne( fetus and the preious infant (ho may still need it


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silled )irth attendant to (iden the opening and help the )a)y out. 8ost of the muscle

tone strength4 of the perineum is regained )y si" (ees after the )irth5 (ith more

improement oer the follo(ing fe( months. ou can help the mother to regain the

muscle tone )y encouraging her to contract and rela" the muscles of the perineum ten

times as soon as it is comforta)le to do so5 and to repeat this e"ercise seeral times

eery day. Strengthening the perineum is important )ecause it forms the ;pelic floor<(hich supports her uterus5 agina and )ladder.

2.1.* 'bdominal (all

The a)dominal (all remains soft and relatiely poorly toned for many (ees after the

)irth5 )ut it gradually )ecomes stronger oer time. The e"tent of return to the

muscular tone of the pre-pregnant a)domen depends greatly on the amount of e"ercise

the (oman taes as she returns to full fitness. Dor rural (omen5 (ho (or in the

fields as (ell as in and around the home5 the pro)lem can )e putting too much strain

on their a)dominal muscles for e"ample to lift heay (eights4 too soon after the

)irth.

2.1.+ Oaries

The resumption of normal function )y the oaries is highly aria)le and is greatly

influenced )y )reastfeeding the infant. The (oman (ho e"clusiely )reastfeeds her

)a)y has a longer period of amenorrhoea a)sence of monthly )leeding4 and delayed

first oulation after the )irth5 compared (ith the mother (ho chooses to )ottle-feed. '

(oman (ho does not )reastfeed may oulate as early as four (ees after deliery5

and most hae a menstrual period )y

t(ele (ees= the aerage time to the first menstruation for a (oman (ho is not )reastfeeding is seen to nine (ees after the )irth.

'menorrhoea is pronounced ;aye-men-or-ee-ah


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maes it hard to predict (hen she (ill start oulating again. 'nd you could encourage

her to thin of family planning )y e"plaining the riss of another pregnancy so soon

after the )irth5 and the )enefits of spacing )a)ies )y t(o years or more.

/nd of ans(er

2.1., -reasts and initiation of lactation

'nother important eent that happens soon after the )irth is the initiation of lactation5

that is the production of colostrum and then mil )y the )reasts5 and the release of

these nutritious fluids (hen the )a)y sucles the mother


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Digure 2.2 ')out three days after the )irth5 the )reasts )ecome engorged as they fill

(ith mil for the first time. Photo? !NIC/D /thiopia4

ou should adise ne( mothers that early breastfeeding (ithin one hour of the

)irth4 and e#clusie breastfeeding no other foods or fluids to )e gien to the )a)y4

for the first si" months is the )est nutritional start in life. 'llo( the )a)y to )e put to

the )reast (heneer it (ants to feed from the first day on(ards. ,reastfeeding is

neither easy nor automatic5 and it taes a lot of time in eery day and during the night.

It re>uires much effort on the part of the mother to )reastfeed her )a)y e"clusiely for

si" months. Producing plenty of rich )reast mil re>uires a lot of e"tra energy. The

mother (ill need more nutrients and fluids5 so adise her to drin plenty of clean

fluids and to try to eat at least one additional meal eery day (hile she is

)reastfeeding. 8ore detailed information on )reastfeeding is gien in Study Session+.

Suppression of lactation in nonbreastfeeding (omen

There are circumstances (hen the mother cannot or (ill not )reastfeed5 for e"ample if

the )a)y is )orn dead or dies in the first fe( (ees5 or (hen the mother strongly

prefers to feed her )a)y (ith formula mil from a )ottle. To reduce the discomfort of

prolonged )reast engorgement5 it is recommended to (rap a tight compression

)andage around the (oman


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ta)lets containing aspirin or paracetamol may )e gien to reliee the )reast

tenderness.

2.1./ 0#cretion of e#cess body fluids

7uring the pregnancy5 the (oman


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8any options are aaila)le5 (hich (e (ill mention only )riefly= the details of the

different methods are addressed in the 8odule on Family Planning .

• Natural methods inole looing at the nature of the cerical mucus >uality

and >uantity45 (hich can (or fairly (ell to indicate (hen the (oman is

oulating5 )ut are not a secure (ay to preent pregnancy.• ,reastfeeding e"clusiely and on demand )y the )a)y can gie reasona)ly

good protection from pregnancy for up to si" months5 if the (oman


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•

,arrier methods of contraception create a )arrier )et(een the male sperm and

the agina or ceri". The most commonly used )arrier method is male

condoms5 (hich are (idely aaila)le.

• :ormonal methods of contraception include contraceptie pills5 in6ecta)le

contraception5 and implants a tiny rod containing slo(-releasing hormones

(hich is put under the sin4.

• Intrauterine deices I!7s4 are deices put inside the uterus to preent

implantation of an em)ryo= they can )e inserted at the end of the puerperium.

• Permanent methods of )irth control include cutting and tying the fallopian

tu)es (hich e"tend from the uterus on either side to(ards the oary4 in

females5 and cutting the tu)e transporting male sperm from the testacles to the

penis asectomy4.

&uestion

@ithout looing )ac at the sections a)oe5 (rite a ery )rief note for yourself of the

ey points that you (ill mae to the parents of a ne()orn5 adising them a)out caring

for their )a)y.

'ns(er

No( chec your list against the information in Sections 2.2.15 2.2.2 and 2.2.3.

/nd of ans(er

2.$ In conclusion

In most (omen5 the puerperium passes (ithout pro)lems and is a time of 6oy for the

mother and other mem)ers of the family to )e (ith the ne( )a)y. ,ut it is important

that mothers and their partners are informed of (hat normally happens during this

period5 and that you mae sure there are no danger signs (hich can compromise the

health of the mother or the ne()orn. @e are going to turn to the a)normal puerperium

in Study Session 3 of this 8odule. emem)er that if you detect a)normalities during postnatal follo(-up isits5 refer the (oman and )a)y >uicly for further assessment

and treatment to the ne"t higher health facility.

Summary of Study Session 2

In Study Session 25 you hae learned that?

1. The period of si" (ees after child)irth is called the puerperium= this is (hen

the physiological changes to the mother


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the e"cess fluids retained during pregnancy are >uicly eliminated in the

mother


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' False: all postnatal (omen (ill hae (atery5 coloured aginal discharge lochia4

for around fie (ees after the )irth. This is a)out the same time as the puerperium H

(hich is the postnatal period of physiological changes occurring during the fie to si"

(ees after child)irth.

, True? initiation of lactation H i.e. the production of colostrum a creamy yello(nutrient rich ;first mil< (hich also contains the motheruite true? )reast engorgement is a response to the initiation of the mil

supply and usually happens a)out three days after the deliery. 8others are

encouraged to initiate )reastfeeding (ithin one hour of the )irth.

7 False: the endometrium (hich is the inner lining of the uterus4 heals rapidly and

)y the seenth day is normally restored e"cept at the placental site.

/nd of ans(er

S'& 2.2 3tests Learning Outcomes 2.2 and 2.$"

ou are seeing a (oman (ho gae )irth to her second child 1# days ago. She loos

reasona)ly (ell5 )ut she seems a )it (orried. ,riefly descri)e all the checs you

(ould do to mae sure that eerything is O and she is recoering normally.

'ns(er

There are many checs that you could do H here are some of the ey ones?

• ,y palpating )elo( the (omen


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• 's5 tactfully5 if the mother feels any pressure from her partner to resume

se"ual intercourse )efore she feels ready to do so.

• Try and assess (hether she may )e taing on too much (or too soon.

• @ith the physical checs there are ey signs (hich (ill tell you (hether the puerperium is progressing normally5 and if it is5 you can reassure your (orried

mother. @hat she feels a)le to say to the more personal >uestions (ill )e more

difficult to assess. ou (ill hae to use all your sensitiity and tact in order to

6udge (hether something else may )e going (rong.

/nd of ans(er

1#

2. the normal puerperium (1)

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