Post Delivery Care

After-delivery Care of the Mother

Well, you have had enough knowledge about the newborn. Isn’t it time we relax for a while and talk a bit about you now?

So, listen.

Once the baby has arrived – hopefully healthy and without making you really sick – your body and organs will take another 6 to 18 weeks to return to “normal” and enable you once again to take up your old responsibilities plus the new ones. This period following delivery is known as puerperium.

How the body changes

A major change is the reduction in the size of the womb by a series of processes known as involution.

Imagine in six weeks time the weight of the womb reduces from 1,000 gms to just 50 gms. The size also comes down from 15×12×9cm to a mere 8.5 × 5 × 2.5 cm.

During the first week or two, a discharge comes out of the vagina. This is called lochia. In the beginning (say for three or four days) it is dark red in colour as it is more or less pure blood. Later it becomes pale and then scanty and creamy. Take advice from an expert if it persists after two weeks, more so if there is reappearance of blood in it.

Remember, the reproductive organs also show involution but the speed is not as fast as in the case of the womb.

Following delivery, the temperature is usually a degree higher than normal. Do not worry; it will return to normal within a matter of hours.

The pulse behaves a little differently. It is almost always normal as you are over with the labour. In the subsequent week or so it is likely to slow down. Do not panic if it is just 50 or so per minute. That is normal.

In the first few days, you may pass a lot of urine. This is called physiological diuresis and need not cause any anxiety. Likewise, urine examination may show a little of albumin. You may suffer from constipation too.

The changes in the breasts are remarkable. Initially they get congested followed by marked fullness and tenderness on the third day. Its initial secretion, as we have learnt elsewhere, is called colostrum

– a thick, sticky yellow fluid which is considered an ideal food for the baby at this stage. True milk comes a few days later. Initiation of milk production and the maintenance of lactation – remember it – depends a great deal on mechanical stimulation like sucking the nipple as also on your “will” to breastfeed the baby and make a success of it.

Mind you, the mother’s body does not have absolutely foolproof involution of all the changes that it underwent during pregnancy and labour. The anatomical structure of the wall of the womb, for instance, is likely to remain permanently altered in some way or the other. Also, the vulva remains somewhat enlarged. The striae on the skin also are likely to remain as permanent scars.

Care during hospitalisation

Most maternity centres discharge the mother and the baby, if all is well, after three to ten days. Going home as early as possible is now being increasingly encouraged.

In the hospital, where you are shifted after the delivery, you are supposed to take plenty of bed rest, including sleep, for two or three days. Then you will be allowed to sit up on the bed. If you wish, you may have a warm bath which, in fact, you should.

In order to regain a normal figure, you must act on the doctor’s advice to start exercises while you are on the bed. He may want you to begin these on the very first day or a couple of days later. Gradually, the range of exercises is increased. The foot exercises will help you not to suffer from pain and aches in the feet which is invariably encountered after resuming activity at home.

In the hospital, you must cooperate with the doctor and nurses who are regularly attending on you, taking care of medical problems, changing sanitary pads and making sure that superimposed infection does not occur.

As I said earlier, constipation is common in the beginning. A mild laxative usually works but, at times, the doctor may advise an enema, which means injection of soap and water into the rectum.

How about the episeotomy or perineal laceration stitches? If the material applied for the stitches is absorbable, these do not have to be removed. In others, removal of stitches is usually done after seven days, before discharge from the hospital.

Most maternity centres would give you the chance to see your baby as soon as you are out of the shock of labour and are relaxed and comfortable. This may take a few hours. Do not be apprehensive in loving him, right away. You may put him to the breast as well. In all probability, he is going to stay in a cradle by your bedside.

And, do not neglect your diet. Take plenty of fluids and good nourishing diet if you want to regain your health and to successfully breastfeed your baby.

Care of the breasts is of utmost importance. Always keep a good, well-fitting brassiere on. Attend to the cleanliness of the breasts. Also, learn how to manually express milk out of them. You may have to do it at one or another time, especially when gross engorgement of the breasts becomes a problem. Learn from the doctors and the nurses things which will stand in good stead to you and the baby once you are back home.

Finally, some women who are greatly exhausted during delivery and are also nervous may develop emotional disturbances, irritability and apprehension after the birth of the baby. Depression and insomnia may worsen the mother’s condition. The so-called puerperal psychosis responds well to reassurance and to drugs like tranquillisers and sedatives. If the condition takes a serious turn, the obstetrician would, as a rule, consult his psychiatrist colleague.

Care after returning home

Once you are back home, make use of the routine you learnt in the hospital and follow the doctor’s advice and instructions religiously.

During the first week, take plenty of rest, a good deal of it in the bed. Take short strolls but do not exert too much. Climbing stairs is not permitted. If you do not get exhausted, you may render a helping hand to the mother-in-law or others in doing easy things. There is nothing wrong in doing light pleasant reading, listening to the radio or watching the television. Also, do see the visitors but avoid longish chatting sessions.

After a week, you may increase your activity and render more help in cooking and other household affairs. You may now begin to climb the stairs. Sleep enough. Have a good nap in the afternoon too.

In the third week, you may go shopping to the nearby market. You may also go out for an evening walk. Expose yourself to fresh air in your lawn and to the sunshine.

Take care of your nutrition. Else you will be harming your physique as well as the baby you are breastfeeding. Include in your diet milk, cheese, eggs, fish, meat, fresh vegetables and fruits. Drink plenty of fluids; fruit juices are very useful.

It is quite possible your doctor has prescribed for you some haematinic tablets (iron, folic acid, vitamin B_12, B-complex or multivitamin in variable combinations) and/or calcium pills. See that you do not skip the dose.

What about bathing? As I said a little while ago, doctors do not usually forbid the “bath”. In the first three days after delivery, the mother is encouraged to go for it. At home, you should have a daily bath (sponge in the first week and then shower), especially during summer days but please avoid swimming at least for the first six weeks after delivery.

Buy yourself a nylon abdominal belt and use it constantly to safeguard against abdominal “paunch” and the waistline getting too big.

Something which always puzzles the young mother is – when is sexual intercourse permitted after childbirth? Take an expert’s good counsel. They say: “Avoid it during the first six weeks or so, perhaps a little longer if you can.”

And, do not forget to continue the post-natal exercises that you learnt in the hospital. Make exercise a routine.

More about post-natal exercises

While you are revelling over the arrival of the baby and trying to return to the routine, don’t forget to regain the tone of your abdominal, thigh, hip , perineal and pelvic muscles, shed the extra fat and resume your figure.

Continuing breastfeeding for at least six months (but as long as you can comfortably do it) considerably assist in regaining good figure.

Over and above this, it is advisable to practice post-delivery exercises as detailed below.

Household work as an exercise: When you resume doing housework – do not delay it much – keep your posture straight and your muscles of the abdomen contracted. A lazy posture will make your muscles of the abdomen still more flabby and increase the waistline rather than make it trim.

Climbing stairs: Contract your abdominal muscles and then climb upstairs. Remember to walk two stairs at a time.

Standing exercises: Contract your abdominal muscles while you stand. Bend forward from the hips while you hold the back of a chair. Try to push the chair with the contracted muscles of the abdominal wall.

Stand with contracted abdominal muscles against a wall. Try to

flatten the middle of the back against the wall.

Lying-down exercises: There are quite a few of these.

To begin with, lie on back, hands behind the head. Now, slowly raise yourself to the sitting position.

Lie flat on back, arms stretched overhead. As you sit up bringing forward the body, try to touch the toes with your hands. Repeat several times.

Lie flat on back, feet crossed. Now make the muscles of the abdomen and buttocks tight by contraction.

There are many more.

Kneeling exercises: Begin by kneeling on all fours, keeping your head high. As you contract the abdominal muscles, tuck your head under the arched back.

As you keep your abdominal muscles contracted, kneel, sit on the heels and roll the head down on the knees.