The postpartum period in women. Postpartum period: what is it

1. Small medical encyclopedia. - M.: Medical Encyclopedia. 1991-96 2. First aid. - M.: Great Russian Encyclopedia. 1994 3. Encyclopedic dictionary of medical terms. - M.: Soviet Encyclopedia. - 1982-1984.

See what the "Postpartum period" is in other dictionaries:

POSTPARTUM- POSTPARTUM PERIOD. Contents: T. Physiology .................... 53 3 II. Postpartum hemorrhage ..........541 III. Pathology of P. n..................555 IV. Postpartum psychoses ........... 580 Postpartum period time from the moment of discharge ... ... Big Medical Encyclopedia

POSTPARTUM- begins after the birth of the child and the exit of the child's place with membranes (afterbirth); lasts 6 8 weeks. At this time, recovery processes are taking place in the woman’s body: the changes that occurred during ... ... The Concise Encyclopedia of the Household

The period from the expulsion of the placenta to the completion of the reverse development of changes in the reproductive system of a woman that arose in connection with pregnancy and childbirth; lasts 6 8 weeks. The most significant changes during this period occur in the uterus, ... ... Sexological Encyclopedia

6 8 weeks from the birth of the placenta, during which there is a reverse development of all changes in the body of a woman caused by pregnancy and childbirth ... Big Encyclopedic Dictionary

It starts from the moment the placenta is born (See Placenta) and lasts 6 8 weeks. In P. p. in the body of the puerperal, almost all changes in the systems and organs that have arisen during pregnancy and childbirth undergo reverse development (involution). Uterus… Great Soviet Encyclopedia

6 8 weeks from the birth of the placenta, during which there is a reverse development of all changes in the body of a woman caused by pregnancy and childbirth. * * * POSTPARTUM PERIOD POSTPARTUM PERIOD, 6 8 weeks from the birth of the placenta, in ... ... encyclopedic Dictionary

- (puerperium; synonym: puerperal period, puerperium) the period from the birth of the placenta to the completion of the reverse development of changes in the organs of the reproductive system of the mother that occurred during pregnancy and childbirth ... Big Medical Dictionary

postpartum period called the period from the birth of the placenta (placenta and membranes) until the moment when the reverse development (involution) of those organs and systems that have undergone changes due to pregnancy ends. It lasts 6 to 8 weeks. A woman after childbirth is called a puerperal.

postpartum period according to the terms is divided into early and late postpartum period.

Early postpartum period lasts the first 2-4 hours after childbirth, during which the woman is in the delivery room under the supervision of a doctor and midwife. This is due to the fact that most often complications associated with a violation of uterine contraction, the remains of placental lobules in the uterus, are manifested by the occurrence of bleeding during these hours.

Immediately after birth, the uterus weighs about 1000 g, its height is at the level of the navel. During this period, the doctor examines the cervix in the mirrors and soft tissues of the birth canal. Inspection is mandatory for all puerperas. If injuries of the tissues of the birth canal are detected (ruptures of the cervix, vaginal walls, perineum), if necessary, sutures are applied under local or general anesthesia. The type of anesthesia depends primarily on the size and location of the gaps. Subsequently, the seams must be kept dry, treated 2-3 times a day with alcohol and a solution of brilliant green. Normally, the stitches are removed for 5-7 days.

Throughout early postpartum period the doctor monitors the general condition of the puerperal, the nature of the pulse, blood pressure, the condition of the uterus. From time to time, he massages the uterus through the anterior abdominal wall to remove blood clots that have accumulated in it.

After 2 hours, if the woman's condition does not inspire concern, she is transported on a gurney to the postpartum ward.

late postpartum period

This is the time from the moment the woman is transferred to the postpartum department until the moment when the changes caused by pregnancy and childbirth disappear in the woman's body. It lasts 6 to 8 weeks.

During the first week, the mass of the uterus is halved, that is, it reaches 500 g. By the end of the second week, it weighs 350 g, by the end of the third - 250 g. By 6-8 weeks, the reverse development of the uterus stops. The uterus of a woman giving birth has a mass of about 75 g.

The involution of the uterus occurs due to the degeneration of muscle elements into fatty ones. The breakdown of muscle fibers is accompanied by cell death, but not all. Only a part of the fibers (50%) dies, while the other half forms new myometrial cells.

postpartum discharge from the genital tract (blood, mucus, melted organic elements) are called lochia. The total number of lochia reaches 500-1500 g in 6-8 weeks. They have a peculiar rotten smell.

In the first 2-3 days, the lochia has a bloody character, on the 4-5th day they take on a bloody-serous appearance. A week after the birth, the lochia have a grayish-white appearance, by the end of the third week of the postpartum period, the discharge almost stops.

The mammary glands begin to actively develop during pregnancy. In the postpartum period in the mammary glands, the formation necessary for feeding the newborn takes place. In the first 2-3 days, the mammary glands secrete colostrum, from 3-4 days - milk.

The value of colostrum in feeding a newborn is truly enormous. It prepares the baby's gastrointestinal tract for the absorption of real milk. Colostrum differs from milk in a significantly lower content of fat and carbohydrates, it is richer in proteins and salts. The presence in it of a huge number of maternal immunoglobulins and biologically active substances determines the formation of primary immunity in the newborn. Therefore, early (already in the delivery room) attachment to the breast is so important.

Human milk contains 88% water, 1.13% protein, 7.28% sugar, 3.36% fat. Milk contains substances necessary to meet all the needs of a newborn.

The process of becoming lactation occurs as follows: from 3-4 days the mammary glands begin to secrete milk, which is accompanied by their engorgement, sometimes a slight single rise in temperature. With each subsequent day, the amount of milk increases. Good lactation is characterized by the release of up to 800-1000 ml of milk per day.

At excessive breast engorgement their elevated position is necessary, which can be provided with a good bra. In addition, you need to limit drinking; After each feeding, completely express the remaining milk; if the mammary glands are not emptying sufficiently, seek help from a midwife.

IN postpartum period may be observed two physiological rises in temperature . The first is noted within 12 hours after childbirth, it is due to the woman's overstrain during childbirth, as well as the entry into the blood after increased muscle work of lactic acid.

The second increase in temperature - 3-4 days after childbirth - is explained by the fact that it is by this time that microorganisms from the vagina penetrate into the uterus, in which the healing processes of the mucous membrane are far from completed. A protective reaction against the introduction of microorganisms into tissues is expressed, in particular, by a short-term single increase in temperature to 37.5º.

IN postpartum period there may be dysfunction of the bladder (urinary retention), intestines (stool retention), slowing down the involution (regression) of the uterus.

At urinary retention they try to call it reflexively (create a sound reflex by opening a tap with water, pour warm water over the urethra), put a warm heating pad on the lower abdomen. If these measures do not help, medications are prescribed, if the above procedures fail, the bladder is emptied using a catheter.

At no independent chair on the 3rd day after childbirth, a cleansing enema is prescribed or a laxative is given; diet is adjusted.

In the first 2 days after childbirth, food should be easily digestible and high-calorie (cottage cheese, sour cream, semolina, jelly, cookies). From the 3rd day after a bowel movement, a regular diet is prescribed with the addition of milk, fresh fruits and vegetables. Food should be rich in vitamins that the body of both the mother and the child needs. It is necessary to avoid spicy dishes, canned food, sausages, fatty meat, alcohol.

Delayed uterine involution - this is the backlog of the uterus in reverse development. In this case, ice is prescribed on the lower abdomen, reducing funds.

Currently, in almost all maternity hospitals, births are taken by a team of medical workers, which necessarily includes a neonatologist and a pediatric nurse. A pediatrician (neonatologist) closely monitors the course of childbirth and begins to deal with the child as soon as his head is born.

To avoid mucus entering the upper respiratory tract a soft rubber sterile canister or electric suction is used to remove mucus from the nasal passages and mouth. A newborn is born slightly bluish, takes its first breath, lets out a cry, moves its arms and legs, and begins to quickly turn pink. And it is at this moment that he is laid on his mother's stomach so that she can see and touch her child. This is very useful not only for the child (this is how his first contact with the outside world takes place), but also for the moral state of the mother, when she sees the baby, she noticeably calms down, which favorably affects the further course of childbirth and the postpartum period. This is currently practiced in almost all maternity hospitals.

During this time, as a rule, the pulsation in the umbilical cord stops (first in the arteries, and then in the vein), before that it is not recommended to pinch it. As soon as the pulsation of the vessels of the umbilical cord stops, a clamp is applied to it at a distance of 10-15 cm from the umbilical ring, the second clamp is placed 2 cm outward from the first. The umbilical cord between the clamps is wiped with 95-degree alcohol and cut.

Immediately after birth, prevention of blenorrhea (damage to the child's eyes by gonococci), since the possibility of infection of the newborn when passing through the mother's birth canal is not excluded. Currently, a 30% solution of sodium sulfacyl (albucid) is used for this purpose. The eyelids of a newborn are wiped with sterile cotton swabs (separately for each eye) from the outer corner to the inner. The lower eyelid of each eye is pulled back and applied to the everted eyelids, 1 drop of the solution. At the birth of a girl, the same solution in the amount of two drops is also instilled into the vulva. The newborn is washed with warm water, removing mucus, blood, meconium, carefully wiped with a warm sterile diaper, placed on a heated changing table and the umbilical cord is processed. The remainder of the umbilical cord is again treated with alcohol, a clamp is applied at a distance of 0.5 cm from the umbilical ring for 1-2 minutes, then the clamp is removed, and a special plastic clip is placed in its place and the remainder of the umbilical cord is tightly clamped. The tissue of the umbilical cord above the bracket is cut off, the blood is removed. The rest of the umbilical cord is treated with a 5% solution of potassium permanganate and a sterile gauze bandage is applied to it.

After finishing the treatment, the midwife with a swab moistened with sterile sunflower oil removes the remnants of the lubricant from the child's skin, especially in places of natural folds (groin folds, axillary pits). Then the newborn is weighed, its length (from the crown to the heels), the size of the head, and the circumference of the shoulder girdle are measured.

Bracelets are put on the arms of the newborn, which indicate the surname, name, patronymic of the mother, the date, hour and year of birth of the child, his gender, body weight and length, the birth history number of the mother, the number of the newborn. The child is wrapped in sterile warm diapers and a blanket.

Many maternity hospitals now practice putting the baby to the mother's breast in the delivery room 15-20 minutes after birth, unless there are any contraindications. And this is done not even because the child is hungry, but then so that the child's body receives the maternal microflora and many useful protective factors (maternal immunoglobulins) from colostrum. The first drops of breast milk have miraculous properties, they bring health to the child in the full sense of the word. At the same time, a neonatologist talks to the mother, he informs her about the baby’s condition (his assessment on the Apgar scale), about birthmarks on the body or face, and gives the first recommendations.

The condition of the child in the first minute and 5 minutes after birth is assessed by Apgar score. The newborn assessment system was proposed in 1953 by Virginia Apgar. Using this method, you can fairly objectively judge the condition of the child. Most newborns get a score of 7-8 in the first minute due to some blueness and decreased muscle tone. After 5 minutes, the score rises to 8-10 points.

Assessment in points of the condition of the newborn after birth according to the Apgar scale

A newborn baby is considered full-termif the period of its intrauterine development was a full 37 weeks, body weight is equal to or exceeds 2500 g, and height is 45 cm. The average weight of a full-term boy is 3400-3600 g, a full-term girl is 3200-3300 g. 52 cm

full-term baby screams loudly, he has active movements, well-defined muscle tone and a sucking reflex. His skin is pink and elastic. The subcutaneous fat layer is well developed. The bones of the skull are elastic, the lateral fontanelles are closed, the auricles are elastic. The nails extend past the fingertips. In girls, the large labia close the small ones; in boys, the testicles are lowered into the scrotum.

The next 2 hours after the birth, the child, together with his mother, is in the delivery room under the supervision of a doctor and a midwife, and then, if there are no contraindications for cohabitation, they are transferred to the postpartum ward.

In this article:

The postpartum period is the time when the female body after pregnancy and childbirth returns to normal. The duration of the postpartum period is considered to be the first 2-4 hours after the birth of the baby (early postpartum period) and 6-8 weeks after childbirth (late).

physical sensations

Following childbirth, almost all women feel fatigue, lethargy and drowsiness. And already from the 2nd day, with the normal course of the recovery process, the woman feels much better. In the early days, there may be pain in the genital area, even in the absence of tears or incisions. This is a consequence of tissue stretching during childbirth. The pain is moderate and will disappear after a couple of days. With ruptures or cuts, pain can last up to 7-10 days. After a caesarean section, you may notice pain in the area of ​​the stitches.

The first day after childbirth, a woman may not feel the urge to urinate. This is due to the bearing of the fetus, which squeezed the pelvic organs for a long time, especially the bladder. To stimulate the work of the bladder, you need to move more. If urination does not occur for more than 8 hours, you should consult a doctor.

For the first day after childbirth, a woman often has constipation. This is most often associated with weakness of the abdominal wall, limited motor activity, malnutrition and fear of suture divergence. But you don't have to worry about seams. You just need to move more and establish proper nutrition.

From the third day there is a significant increase in the amount of milk in the breast, which increases the risk of mastitis. At the same time, the mammary glands can increase in size, their hardening is observed, a feeling of soreness, even the body temperature of a young mother can rise. These are all signs of mastitis. In order to avoid painful problems, it is recommended to limit fluid intake to 800 milliliters per day from 3 days after birth, and also breastfeed the baby more often.
It is imperative to monitor the outflow of milk and consult with doctors, this will help to avoid complications. If necessary, the doctor may prescribe additional procedures that promote the outflow of milk. Already after 1-2 days, with proper application and diet, hardening, in other words, mastitis will disappear.

Psychological condition

How much happiness brings the birth of a child into the life of every woman. But more and more often, tears are observed in the eyes of young mothers in the postpartum period. Experts associate this phenomenon with. During the bearing of a child in the female body, hormonal jumps occur along the extreme boundaries, the maximum during pregnancy and the minimum after childbirth, which affects the emotional state of the woman. In this regard, most mothers experience irritability and nervousness in the late postpartum period, emptiness, excitement for various reasons, sleep and appetite disturbances.

In 10% of women, this postpartum period is delayed for an indefinite time, and becomes painful. If signs of depression persist for longer than 2 weeks, then this may be a sign of a serious illness, in which it is recommended to seek help from specialists.

Signs that depression is getting out of control include:

1. The manifestation of a sense of fear, fear of tomorrow;
2. Indifference, renunciation of food, attraction to absolute loneliness;
3. Long-term aggressive attitude towards the newborn;
4. Sleepless nights haunting nightmares;
5. Systematic feeling of personal dislike;
6. Other deviations in the psychological sphere that have a systematic focus.

How to deal with postpartum depression?

Postpartum depression is a serious problem compared to the usual postpartum blues. Many new mothers were able to overcome the postpartum blues and learned to enjoy every minute spent with their little miracle, but there are those in whom she moved into the next, more difficult stage - postpartum depression. Such women feel depressed and unhappy.

1. Complete rest. It also does not hurt to find a couple of hours in order to lie down in the daytime. For example, during the sleep period of a child.
2. Be sure to include a trip to the hairdresser, beauty salon or light shopping in your to-do list. It is desirable to please yourself with such "forays" as often as possible. Change is the most powerful medicine in the fight against depression, which came with the birth of a child.
3. Complete diet and vitamin therapy.
4. Breathing exercises and fresh air.

Complications

The birth of a child is a big burden for a woman's body. Therefore, young mothers may experience various complications in the postpartum period. Most often, the factors for the deterioration of a woman's health are significant blood loss, anemia, and hormonal failure. In the postpartum period, a woman can also decrease all the natural defenses of the body, which can lead to a variety of inflammatory processes and complications. In addition, during this period, a woman has a high risk of all kinds of infections and microbes that are transmitted only sexually: gonococcus, chlamydia, mycoplasma and others.

Postpartum endometritis

Postpartum endometritis is an inflammation of the uterine cavity. This complication most often occurs after a caesarean section, as well as with a long anhydrous birth period (more than 12 hours). This diagnosis can also be observed in a woman who has had many abortions in the past, and who has had an early birth due to the presence of inflammatory diseases in the past.

Prevention: if there is a real danger for a woman of the appearance of postpartum endometritis, after childbirth, doctors immediately prescribe a course of antibiotics to the woman and carry out special medical procedures.

Chorioamnionitis

The appearance of inflammation of the membranes (chorioamnionitis) can be caused by complete or incomplete rupture of the membranes, which occurs, as a rule, due to the large anhydrous time interval in childbirth.

postpartum mastitis

Mastitis is an inflammation in the mammary gland. The manifestation of mastitis is often observed for the first time months after childbirth. This disease can affect women who are breastfeeding.

The main signs of mastitis:

• temperature rise to 38.5 - 39 degrees,
• sudden pain in the mammary glands,
• breast redness,
• Expressing milk is very painful and does not give the desired result.

In order to prevent the occurrence of mastitis as much as possible, a woman should eat properly and balanced during pregnancy, avoid hypothermia and do self-massage of the mammary glands, but with extreme caution. It is not possible to 100% protect yourself from postpartum mastitis, especially if there is a hereditary predisposition to this disease. The source of mastitis can also be a purulent infection in the body. Anatomical features of the female nipples and previously observed mastopathy can also become a significant factor for the onset or absence of this disease. Mastitis is treated with antibiotics under the strict supervision of a doctor.

The most important thing is timely prevention, treatment, and, of course, early diagnosis of possible complications. Therefore, young mothers should always monitor their own well-being, both before childbirth and in the postpartum period!

How to behave in the postpartum period?

In the first week after childbirth, while staying in the maternity hospital, health workers monitor the woman in labor every day. They assess the general condition in the postpartum period, measure the pulse and pressure, temperature, check the condition of the mammary glands and uterus, etc. In case of complications of the postpartum period, the doctor will prescribe the necessary treatment and procedures necessary to maintain the body. A woman in labor is discharged on the 5-6th day, provided that the delivery is without complications.

One of the most important rules that a mommy needs to follow in the postpartum period is to get as much rest and sleep as possible. Duration, which should be at least 8-10 hours per day. Such a dream will provide an opportunity to restore strength after childbirth for the subsequent care of the child.
They ask to get out of bed after a normal birth after 6 hours, after a caesarean section much later. Already on the first day after childbirth, it is allowed to resort to breathing exercises, as well as to do self-massage to help reduce the uterus to the desired size, which is very important at this stage of recovery.

Personal hygiene rules

It is very important to observe the rules of personal hygiene in this difficult period of life. A woman after childbirth is very weak and vulnerable to resist the bacteria around her well. Therefore, you need to wash yourself after each visit to the toilet, especially if there are stitches on the perineum. If stitches are applied, they are additionally treated twice a day with brilliant green or other antiseptics prescribed by the doctor.

It is necessary to observe the cleanliness of the gaskets. For this stage, special postpartum pads, or ordinary ones with a cotton surface, are best suited. Regardless of filling, you need to replace the gasket every 2-3 hours, as often as possible.

Taking a shower unconditionally twice a day, then you should wash the mammary gland. It is not necessary to wash the breast with every feeding. Taking a bath in the first month after childbirth is prohibited. Underwear and bed linen should be cotton. Underwear is changed once a day, bedding - at least 1 time in 3 days.

Nutrition

The nutrition of a nursing woman in the postpartum period should be natural and high-calorie. The number of calories required is 2500-3000 kcal. For the first 2 days after giving birth, food should not be as nutritious as easily digestible. From the 3rd day, it is preferable to follow a diet with the superiority of sour-milk, cereals, fruits and vegetables.

It is necessary to exclude spicy, fatty, smoked and canned foods from the food menu, as well as alcohol, all of which are harmful allergens for the baby.

Every day try to drink milk or biokefir (at least 1/2 l), eat cottage cheese (50 g) or cheese (20 g), combinations of vegetables and fruits (1/2 kg), use vegetable oils. Water in its pure form with established lactation must be drunk in an amount of at least 1/2-2 liters daily.

Many women are interested in the question of how long the body will recover after childbirth. Only a responsible attitude to one's health, the necessary information and timely actions will help to overcome the postpartum period in the most comfortable and safe way.

Useful video about the third stage of labor

postpartum period- the final stage of the gestational process, which occurs immediately after the birth of the fetus and lasts about 6-8 weeks.

The postpartum period is divided into: early postpartum period- the next 2 hours after delivery; late postpartum period- starts from the moment the mother is transferred to the postpartum department and lasts 6-8 weeks.

During the period, the shifts in the endocrine, nervous, cardiovascular and other systems that have arisen in connection with pregnancy disappear. The exception is the mammary glands, whose function reaches its peak in the postpartum period. The most pronounced involutionary processes (reverse development) occur in the genitals. The rate of involutional processes is especially pronounced, for the first time 8-12 days.

Involution of the sex organs

Uterus. In the postpartum period, there are postpartum contractions that contribute to a significant decrease in the size of the uterus. By the end of the 1st day after birth, if the bladder is empty, the bottom of the uterus reaches the level of the navel (15-16 cm above the womb). In the future, the height of the fundus of the uterus decreases daily by 2 cm (approximately 1 transverse finger).

The inner wall of the uterus after separation of the placenta and membranes is an extensive wound surface. The epithelization of the inner surface of the uterus is completed by the end of 7-10 days, with the exception of the placental site, where this process ends by the end of 6-8 weeks.

The slow process of the reverse development of the uterus is one of the early clinical signs of the pathology of the course of the postpartum period. One of these signs is the subinvaluation of the uterus, which in the future can cause severe purulent-septic inflammatory diseases. The infection present in the uterus reduces its contractile activity, thereby causing the spread of the infectious process.

In the first days, lochia (uterine wound secretion) have a bright red color, from the 3rd day their color changes and becomes brownish-red with a brown tint, from the 7-8th day due to the abundance of leukocytes they become yellowish-white, finally from the 10th day - white. The amount of ancestral secret by this time is scarce. In general, the amount of lochia in 7 days is about 300 ml.

Cervix. The involution of the cervix is ​​made from the inside to more superficial areas. This occurs much less intensively than the involution of the body of the uterus.

The internal os of the cervix is ​​closed by the 10th day, the external os is closed only by the end of the 2nd or 3rd week after birth. However, even after that, its original form is not restored. It takes the form of a transverse slit, which indicates a previous birth.

Vagina. It shrinks, shortens, hyperemia disappears, and by the end of the 3rd week it becomes normal. However, during subsequent births, its lumen becomes wider, and the walls become smoother, the vagina becomes more closed, the entrance to the vagina remains more ajar.

Crotch. If the perineum was not damaged during childbirth, and when it was torn, it was properly sewn up, it is restored after 10-12 days.

In the presence of a perineal injury in a puerperal, it is necessary to carry out active rehabilitation measures. This need arises due to the fact that, firstly, the injury sites are the entrance gate for infection and can contribute to the occurrence of severe septic complications and, secondly, during the secondary wound healing, the anatomy of the muscles and fascia of the perineum is disturbed, and this leads to an anomaly development of the genital organs and even to the disability of women.

The fallopian tubes. In the postpartum period, hyperemia of the fallopian tubes gradually disappear. The tubes, together with the uterus, descend into the pelvic cavity and by the 10th day take their usual horizontal position.

Ovaries. In the postpartum period, the regression of the corpus luteum ends in the ovaries and the maturation of the follicles begins.

In non-nursing mothers, menstruation usually resumes within 6-8 weeks postpartum, with ovulation occurring 2-4 weeks postpartum.

In nursing mothers, ovulation can occur after 10 weeks of the postpartum period. In this regard, breastfeeding mothers should be aware that the period of contraception due to lactation lasts only 8-9 weeks, after which the resumption of the ovulatory menstrual cycle and the onset of pregnancy are possible.

Abdominal wall. The condition of the abdominal wall is gradually restored by the end of the 6th week. Sometimes there is some divergence of the rectus abdominis muscles, which progresses with subsequent births. Crimson scars of pregnancy on the surface of the skin gradually turn pale and remain in the form of whitish wrinkled stripes.

Mammary gland. The function of the mammary glands after childbirth reaches its highest development. In the first days (up to 3 days) of the postpartum period, colostrum is released from the nipples. Colostrum is a thick yellowish liquid. Colostrum contains, in addition to a large amount of protein and minerals, factors that neutralize some viruses and inhibit the growth of Escherichia coli, as well as macrophages, lymphocytes, lactofferin, lysozyme. On the 3-4th day, the mammary glands begin to produce transitional milk, and by the end of the first month - mature milk. The main components of milk (proteins, lactose, water, fat, minerals, vitamins, amino acids, immunoglobulins) act on the entire body of the newborn, especially on his gastrointestinal tract. It has been proven that breastfed babies are less likely to get sick than formula-fed babies. Human milk contains T- and B-lymphocytes, which perform a protective function.

Metabolism. In the first weeks of the postpartum period, the metabolism is increased, and then becomes normal. Basal metabolism becomes normal at 3-4 weeks after birth.

Respiratory system. Due to the lowering of the diaphragm, the capacity of the lungs increases. The respiratory rate is reduced to 14-16 per minute.

The cardiovascular system. The heart occupies its normal position due to the lowering of the diaphragm. Often there is a functional systolic murmur, which gradually disappears. Under the influence of external stimuli, there is a large lability of the pulse, there is a tendency to bradycardia (60-68 beats / min). Blood pressure in the first days may be somewhat reduced, and then reaches normal numbers.

Morphological composition of blood. The composition of the blood has some features: in the first days after childbirth, the number of erythrocytes decreases slightly, the number of leukocytes remains elevated. These changes soon disappear, and the picture becomes normal.

Urinary system. Diuresis is normal or slightly increased in the first days of the postpartum period. Bladder function is often impaired. The mother does not feel the urge or has difficulty urinating.

Digestive organs. As a rule, the digestive system functions normally. Sometimes there is atony of the intestine, manifested by constipation.

Management of the postpartum period

2 hours after delivery, the puerperal on a gurney with a newborn is transferred to the postpartum department. Before transferring a puerperal to the postpartum department, it is necessary to: assess the condition of the puerperal (find out complaints, evaluate the color of the skin, visible mucous membranes, measure blood pressure, pulse and measure body temperature); through the anterior abdominal wall to determine the condition of the uterus, its consistency, configuration, sensitivity to palpation; determine the amount, nature of secretions from the genital tract. Place a vessel under the pelvis of the puerperal and offer to empty the bladder. In the absence of urination, release urine with a catheter; to carry out the toilet of the external genital organs with a disinfectant solution according to the generally accepted scheme; in the history of childbirth, note the general condition of the puerperal, body temperature, pulse, blood pressure, condition of the uterus, the amount and nature of vaginal discharge.

Every day, a nurse monitors the puerperal woman: she measures body temperature 2 times a day (in the morning and in the evening); during the bypass finds out complaints, evaluates the condition, color of the skin and visible mucous membranes, the nature of the pulse, its frequency; measures blood pressure. Pays special attention to the mammary glands; determines their shape, condition of the nipples, the presence of cracks on them, the presence or absence of engorgement. Produces palpation of the abdomen, which should be soft, painless; determines the height of the standing of the bottom of the uterus, its configuration, consistency, the presence of pain. Daily examines the external genitalia and perineum. Draws attention to the presence of edema, hyperemia.

For the prevention of infectious complications in the postpartum period, no less important than monitoring the clinical course is the timely correction of the slightest deviations from the physiological development of the involutionary process and strict adherence to sanitary and epidemiological requirements, as well as personal hygiene rules. Much attention should be paid to the treatment of the external genital organs. At least 4 times a day, the puerperal woman should be washed with warm water and soap. Change diapers after washing. If there are seams on the perineum, they are processed in the dressing room.

The nature and number of lochia is assessed. They don't have to be copious; their character should correspond to the days of the postpartum period and have a normal smell.

Problems of the mother. For the first three days, the puerperal is worried about periodic pains in the lower abdomen (postpartum contractions), lactastasis (breast engorgement), urinary retention and bloody discharge from the genitals.

The pain syndrome is expressed in multiparous women and in women at the time of breastfeeding.

Laktostasis - engorgement of the mammary glands. Only pronounced pathological lactastasis is subject to treatment: decantation of the mammary glands, a decrease in the volume of fluid taken by the puerperal and medications prescribed by the doctor.

Urinary retention is usually observed in puerperas who have had complications in childbirth. The postpartum woman does not have the urge to urinate, which is explained by the fact that during childbirth the sphincter of the bladder is pressed against the pelvic bones for a long time. Urine accumulates in the bladder sometimes up to a large amount (3 or more liters). The second option is also possible, when the puerperal has increased urination, but the amount of urine excreted is insignificant. The rest of the urine also accumulates in the bladder.

Bloody discharge from the genital tract is a physiological process, but blood and mucous membrane residues are a breeding ground for the microorganism. It is necessary to strictly observe the rules of infectious safety in the maternity hospital.

If during pregnancy the nipples of the mammary glands were not prepared for childbirth or the baby was incorrectly attached to the breast, then nipple cracks may form.

Potential issues:

Bleeding

Postpartum septic diseases

Hypogalactia

The first application of the child to the breast should be carried out in the first 30 minutes. after birth, if there are no contraindications. Some obstetricians practically put the baby to the breast before cutting the umbilical cord.

Feeding of the baby is carried out on demand, and the more often the mother will put the baby to the breast, the longer the feeding will take.

Sleep the child next to the mother in the same room.

When breastfeeding, giving the child water, glucose is not recommended.

If there is no lactostasis, then pumping the mammary glands after feeding is not recommended. This is due to the fact that the mammary gland produces as much milk as is necessary for the nutrition of the child.