Postpartum period

New mother with newborn baby

A postpartum period or postnatal period is the period beginning immediately after the birth of a child and extending for about six weeks. Less frequently used are the terms puerperium or puerperal period. The World Health Organization (WHO) describes the postnatal period as the most critical and yet the most neglected phase in the lives of mothers and babies; most deaths occur during the postnatal period.^[1] It is the time after birth, a time in which the mother's body, including hormone levels and uterus size, returns to a non-pregnant state. Lochia is postpartum vaginal discharge, containing blood, mucus, and uterine tissue.

In scientific literature, the term is commonly abbreviated to Px, where x is a number; for example, "day P5" should be read as "the fifth day after birth". This is not to be confused with medical nomenclature that uses G P to stand for number of pregnancy and outcome of pregnancy.

Newborns

Upon its entry to the air-breathing world, without the nutrition and oxygenation from the umbilical cord, the newborn must begin to adjust to life outside the uterus.

Postpartum period in mothers

A woman giving birth in a hospital may leave the hospital as soon as she is medically stable and chooses to leave, which can be as early as a few hours postpartum, though the average for a vaginal birth is 1–2 days, and the average caesarean section postnatal stay is 3–4 days. During this time, the mother is monitored for bleeding, bowel and bladder function, and baby care. The infant's health is also monitored.^[2]

Physical

The mother is assessed for tears, and is sutured if necessary. Also, she may suffer from constipation or hemorrhoids, both of which would be managed. The bladder is also assessed for infection, retention, and any problems in the muscles.

The major focus of postpartum care is ensuring that the mother is healthy and capable of taking care of her newborn, equipped with all the information she needs about breastfeeding, reproductive health and contraception, and the imminent life adjustment.

Some medical conditions may occur in the postpartum period, such as Sheehan's syndrome^[3] and peripartum cardiomyopathy.

In some cases, this adjustment is not made easily, and women may suffer from postpartum depression, posttraumatic stress disorder or even puerperal psychosis.

Postpartum urinary incontinence is experienced by about 33% of all women; women who deliver vaginally are about twice as likely to have urinary incontinence as women who give birth via a cesarean.^[4]

During the postpartum period, a woman may urinate out up to nine pounds of water. The extra fluid that her body has taken on is no longer needed, so the mother may note that her fluid output is disproportionate to her fluid input.

Psychological

Postpartum mental illness can affect both mothers and fathers, and is not uncommon.^[5] Early detection and adequate treatment is required. Approximately 25% - 85% of postpartum women will experience the "blues" for a few days. Between 7% and 17% may experience clinical depression, with a higher risk among those women with a history of clinical depression. Rarely, in 1 in 1,000 cases, women experience a psychotic episode, again with a higher risk among those women with pre-existing mental illness. Despite the widespread myth of hormonal involvement, repeated studies have not linked hormonal changes with postpartum psychological symptoms. Rather, these are symptoms of a pre-existing mental illness, exacerbated by fatigue, changes in schedule and other common parenting stressors.^[6]

Postpartum psychosis (also known as puerperal psychosis) is a more severe form of mental illness than postpartum depression, with an incidence of approximately 0.2%.

Cultures

A mother in Florence lying-in, from a painted desco da parto or birth tray of c. 1410. As women tend to the child, expensively dressed female guests are already arriving.

Europe

Lying-in is the term for the European and Western custom of a woman resting in bed for a period after giving birth. Though the term is now usually defined as "the condition of a woman in the process of giving birth," it previously referred to a period of bed rest required even if there were no medical complications.^[7]

A 1932 publication refers to lying-in as ranging from 2 weeks to 2 months.^[8] It also does not suggest "Getting Up" (getting out of bed post-birth) for at least nine days and ideally for 20 days.^[8][9] When lying-in was a more common term, it was used in the names of several hospitals, for example the General Lying-In Hospital in London.

Women received congratulatory visits from friends and family during the period and, among the many traditional customs around the world, the desco da parto was a special form of painted tray presented to the mother in Renaissance Florence. The many scenes after childbirth painted on these show female visitors bringing presents, received by the mother in bed, while other women tend to the baby. No fixed term of lying-in is recommended in Renaissance manuals on family life (unlike in some other cultures), but it appears from documentary records that the mother was rarely present at the baptism, in Italian cities usually held within a week of the birth at the local parish church, normally a few minutes walk from any house.^[10]

There are many local variations of customs, and the period of lying-in expected. Traditionally, Eastern Orthodox mothers would spend 40 days confined at home with their infant after giving birth. At the end of the 40 days (the sarántisma, or "fortying"), the child was symbolically taken to church for the first time, where the mother asked for a special blessing on the conclusion of her puerperium. There are many modern theories seeking to justify this traditional practice, including weakness of infant immune systems, unimpeded establishment of breastfeeding, and the need for bonding time between parent and child.

East Asia

In some East Asian cultures, such as Chinese, South Korean, and Vietnamese, there is a traditional custom of postpartum confinement known in English as doing the month or sitting the month (Mandarin zuò yuèzi 坐月子). Confinement traditionally lasts 30 days.^[11] This tradition combines prescribed foods with a number of restrictions on activities considered to be harmful. The new mother is also given special postnatal foods, such as seaweed soup in Korea and "Pork Knuckles and Ginger Stew" in China. It is widely believed in many East Asian societies that this custom helps heal injuries to the perineum, promote the contraction of the uterus, and promote lactation.^[12][13][14]

In Thailand "yu-fai (lie down by a fire) treatment is traditional postpartum healing. Performed in an open area, it involves using smokeless tamarind wood, local herbs and massage.^[15]

India

Most traditional Indians follow the 40-day confinement and recuperation period also known as the 'Jaappa' (in Hindi). A special diet to facilitate milk production and increase hemoglobin levels is followed. Sex is not allowed during this time. In Hindu culture, the puerperium was traditionally considered a period of relative impurity (asaucham) due to the processes of childbirth, and a period of confinement of 10–40 days (known as purudu) was recommended for the mother. During this period, she was exempted from usual household chores and religious rites. The father was purified by a ritual bath before visiting the mother in confinement. In the event of a stillbirth, the period of impurity for both parents was 24 hours.^[16] Many Indian sub cultures have own traditions after birth, birth period is called as Virdi(Marathi) starting from birth till 10 days where complete abstinence from puja or temple visit.

See also

• Lochia
• Breastfeeding
• Childbirth
• Doula
• Episiotomy
• Infant
• Obstetric
• Parental leave
• Pelvic girdle pain
• Postpartum depression
• Prenatal and perinatal psychology
• Puerperal fever

References

External links

• eMedicine: Normal and Abnormal Puerperium
• Patient UK: Postnatal Care (Puerperium)
• NHS Choices Birth to Five Planner: Postnatal post-traumatic stress disorder
• Postpartum care of mother and newborn: WHO