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Acta Endocrinol. Postpartum thyroiditis: epidemiology and clinical evolution in a nonselected population. Once the mother has taken control of her physical being and accepted her role as a mother, she is able to extend her energies to her mate and other children. Letting-go Phase: As her mothering functions become more established the mother enters the letting-go phase.
This generally occurs when the mother returns home. In this phase there are two separations that the mother must accomplish. One is to realize and accept physical separation from the infant. The other is to relinquish her former role as a childless person and accept the enormous implications and responsibilities of her new situation.
She must adjust her life to the relative dependency and helplessness of her child. Certain characteristics important: level of trust, level of self esteem, reactions to present pregnancy; interest in child rearing.
Occasionally her appetite and sleep patterns are disturbed. This depression is usually temporary and may occur in the hospital. It is thought to be related, in part, to hormonal changes, and in part, to the ego adjustment that accompanies role transition.
Discomfort, fatigue and exhaustion certainly contribute to this condition. Crying often relieves the tension, but if the parents are not knowledgeable about the condition the mother may feel rather guilty for being depressed. A pregnancy in late child bearing years. Social isolation. Long or hard labor. Anxiety regarding finances. Marital disharmony. Crisis in the extended family The Emotional Needs of the Woman during Postpartum Recognition of the effort made during labor: approval of behavior during labor as well as in the immediate postpartum period.
Someone to listen and help them solve their dependency-independency conflict. Nursing Management of the Postpartum Period Introduction Nursing care during the postpartum provides the means by which the parturient can restore her physical and emotional health, as well as gain experience in caring for her new born infant. Objectives of Care during the Postpartum Period. Teach the mother how to care for herself and the infant. Normally, Nursing Diagnosis Based on Assessment. Nursing Plan and Implementation Palpate the uterus: if it remains firm, well contracted and does not increase in size, it is neither necessary nor desirable to stimulate it.
If the uterus is atonic, blood which collects in the cavity should be expressed with firm, but gentle, force in the direction of the outlet. This is done only after the fundus has been first massaged because it may result in inversion of the uterus and lead to serious complications.
TM as ordered to control bleeding and to promote involution. Perineal care is performed under aseptic technique to prevent infection. Offer food to mother if the policy permits, and after vital signs are stable.
Breast care may be employed. General hygiene: shower may be permissible to clean, comfort and refresh the mother after vital signs are stable according to the hospital policy. Encourage early initiation of breastfeeding to stimulate involution, lactation and to enhance emotional bonding.
Correct dehydration promptly by offering fluid intake orally , or starting IV fluid as ordered. Palpate the uterus to assess firminess, level of fundus, and rate of involution of the uterus. Observe perineum and suture line - if present - for redness, ecchymosis, edema or gapping. Check healing and cleanliness. During the first 8 hrs after labor, the mother is allowed to sleep in any comfortable position.
After that, prone position or either lateral positions should be encouraged in order to facilitate involution, and to help drainage of lochia.
Sitting position is also recommended since it promotes contraction of the abdominal muscles, aids pelvic circulation, and helps drainage of lochia. Knee-chest position is indicated in certain conditions because it prevents RVF of the uterus and hastens its involution. Prevent infection: complete aseptic and antiseptic precautions should be followed during the early postpartum period to prevent infection.
Observe for postpartum blues, which may be caused by a drop in hormonal levels on the 4th or 5th day. Assist the mother with self-care and care of the infant as needed. Stress the importance of postpartum examination, visits and follow up to assess involution, general health and wellbeing of the mother. Discuss community resources that provide maternal services.
Regular and frequent examination for early detection of complications such as engorged breast, cracked nipples, mastitis and breast abscess. If no urine is passed after 12 hrs. Being at bed rest for long periods of time with decreased movements of the body also contribute to the inability to pass urine. If failed, catheterization, under complete aseptic technique is performed.
Glycerin suppository may be used to relieve constipation. Liberal amounts of fluids are required e. Roughage and green vegetables are provided to prevent constipation. REEDA stands for redness, edema, ecchymosis, discharge, and approximation. Redness is considered normal with episiotomies and lacerations—however, if there is significant pain present, further assessment is necessary.
Excessive edema can delay wound healing and the use of ice packs during the immediate postpartum period is generally indicated. Ergometrine can be given to help in contracting the uterus better. Laxatives may be given if the patient suffers from constipation very common at this stage.
Supplements of calcium, iron and Vit B-complex tablets may be given. The presence of pain when eliciting the Homan's sign, is indicative of a deep vein thrombosis DVT. However, lasting edema should be reported for further assessment. Get patients to ambulate as soon as possible after delivery to improve circulation and prevent the development of thrombi.
Teach them not to cross their legs for long periods of time and to keep the legs elevated while Use proper clothing to keep the infant warm. Perform cord dressing.
Encourage early, on demand and exclusive breastfeeding. Ensure adequate hours of sleep. Protect from environmental hazards. Discuss infant care with mother: cleanliness, handling, clothing, cord care, feeding, bonding, diapering, circumcision of male infant, immunization, registration, and community resources.
But, if necessary, barrier contraceptives like condoms should be used. This is because other birth control methods like oral contraceptive pills can cause a decrease in the milk production of the breasts. It is also possible to use intra-uterine devices like Copper-T after this period. Minor Discomforts during the Postpartum Period Minor Complaints They are minor complaints felt by the parturient during postpartum period. Acharya Cakrapani says that the morning irrigation should be given before digestion of oleaginous substance afterward rice gruel should be given.
After use of this regimen for five or seven days, gradual administration of vrmhana substances anabolic or likely to increase flesh and energy should be done. This regimen is not suitable for the women of Anupadesa marshy land , because in the residents of this area, the kapha is dominant. This regimen is suitable for the women of jangala Wild ordry area.
Benefits of Sutika Paricharya In sutika kala, proper sutikaparicharya enhances complete involution of uterus and other pelvic organs, so that they reach to their pre pregnant state. Even less consumption of vatala diet in a small quantity may create many problems. So pathya and apathya of the sutika should be understood. Sutika should be advised to follow the following pathyas26 Pathya Aahar 1. Boiled water should be taken for drinking purpose.
Diet and drinking items should be prepared with jeevaniya and Brimhaniya drugs. She should always take snigdha unctuous diet. Whatever the diet sutika takes must be in lesser quantity than her routine diet. Pathya Vihar 1. Sutika should have the bath with much quantity of warm water.
Parisheka, Avagahana is always beneficial for sutika. She should be done udaravestana. Snehana and swedana must be done every day as per desha, kala, etc. Apathya Apathy is that which is harmful to pathya of the body and is not according to liking which is certainly not at all desirable. The puerperal women should be advised to avoid the following: 1. The sexual intercourse. Physical stress, anger and indulgence in irresistible emotion. Heat and its preparation at least up to 12 days. Conclusion:- Motherhood is the most sacred and greatest boon that god has best wed upon a woman.
God has specially gifted proud of mother hood to a women, importance of sutika and sutika paricharya is more than other diseases of women.
The post-delivery period is a very crucial phase in a woman's life. Ignorance about proper care, excessive concern about the child, and an inability to cope with motherhood may lead to post natal disorders and even depression.
The Ayurvedic system of medicine describes Sutika Paricharya - a complete health regimen for the post natal woman. The management of puerperium consists of providing the means whereby the woman can recuperate physically and emotionally and gain supervised experience in the care of her infant. By using Ayurvedic and herbal medicines you ensure physical and mental health without side effects.
All these methods help the body to combat the stress felt during pregnancy and labour and to regain and restore its physiological and anatomical state. So, the early and correct puerperium care is important. Ayurvedic treatment is non-invasive and non-toxic, so it can be used safely as an alternative therapy or alongside conventional therapies.
If the infant weighs less than 2. Following a spontaneous vertex delivery in a clinic, you have delivered the placenta and membranes completely. The maternal and fetal conditions are good and there is no abnormal vaginal bleeding.
You are the only staff member in the clinic. You are called away and will have to leave the patient alone for a while. A patient returns to a clinic for a visit three days after a normal first pregnancy and delivery. She complains of leaking urine when coughing or laughing, and she is also worried that she has not passed a stool since the delivery.
She starts to cry and says that she should not have fallen pregnant. Her infant takes the breast well and sleeps well after each feed. On examination the patient appears well, her observations are normal, the uterus is the size of a week pregnant uterus, and the lochia is red and not offensive. The patient appears healthy with normal observations, and the involution of her uterus is satisfactory.
Stress incontinence is common during the puerperium. Therefore, the patient must be reassured that it will improve over time. However, pelvic floor exercises must be explained to her as they will hasten improvement of her incontinence.
She need not be worried about not having passed a stool as this is normal during the first few days of the puerperium. Also explain that her feelings are normal and are experienced by most mothers. Following a prolonged first stage of labour due to an occipito-posterior position, a patient has a spontaneous vertex delivery. The placenta and membranes are complete. There is no excessive postpartum blood loss and the patient is discharged home after 6 hours. Within 24 hours of delivery the patient is brought to a clinic.
The uterus is tender to palpation and the lochia offensive. Genital tract infection, i. This diagnosis is suggested by the general signs of infection and the uterine tenderness and offensive lochia.
The patient had a prolonged first stage of labour, which is usually accompanied by a greater than usual number of vaginal examinations and, therefore, predisposes her to genital tract infection.
The patient should not have been discharged home so early as she had a prolonged first stage of labour which places her at a higher risk of infection. She should have been observed for at least 24 hours. She must be made comfortable. Paracetamol Panado 1 g orally may be given for the headache. If necessary, she should be given a tepid sponging. An intravenous infusion should be started and she must then be referred to hospital.
The infant must accompany the patient to hospital. The need to start antibiotic treatment, such as intravenous ampicillin and oral metronidazole Flagyl , before transfer must be discussed with the doctor. A patient is seen at a clinic on day 5 following a normal pregnancy, labour and delivery.
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