The postpartum stage, also called Puerperium lasts 6 weeks, is characterized by the return to normal of all organic and physiological changes that occurred in pregnancy; in addition, it is marked by the appearance of new changes, especially mammary, to allow the adequate nutrition of the newborn, breastfeeding

Evolution and control during the Puerperium

Genital Bleeding

We call them Lochia, it is the expulsion of the intrauterine remnant that allowed pregnancy. It is basically blood with decidual endometrial tissue, initially profuse with some clots, progressively decreases in quantity and blood concentration as the days pass until it becomes little abundant and with serohematic fluid until it becomes a discrete yellowish mucous flow. This takes about two weeks until it finally gives way to the usual vaginal discharge or moisture. Severe bleeding occurs for 1 to 2 days and may have intermittent exacerbations associated with belly pain (stuttering) during feeding of the baby

They should not be fetid or cause genital pruritus. If you acquire these characteristics and are associated with fever, chills and abdominal pain you should contact your obstetrician immediately.

The Episiorrhaphy (Childbirth)

It is the surgical wound that was performed on the genitals to facilitate the vaginal passage of the baby and avoid uncontrolled tears of the vagina and nearby organs. It is a relatively small wound with rapid healing. The repair was made immediately upon evacuating the placenta and using absorbable suture (the stitches “fall off alone” in 18-45 days and you do not have to touch them much) that does not require removal.

How is this wound taken care of ?: Genital cleansing 2-3 times a day with water, it is not necessary to use abrasive soaps since they can weaken the local barrier against infections. If it bothers during the first days you can place cold compresses to diminish the local inflammation. By the time you reach the 7th day, it should be practically painless.

Alarm signals: intense pain, increased volume and purulent discharge. Warn immediately.

The Operative Wound (Caesarean section)

It is the wound that was practiced in the abdomen (incision of Pfannenstiel, Joel Cohen or vertical median infraumbilical) and the uterus to remove the baby. It is a relatively small wound with rapid healing. The repair was made immediately after birth, by evacuating the placenta and using various types of sutures in different tissues until the skin is closed (which is the only visible wound). We usually use techniques with aesthetic results and absorbable suture that does not require removal

How is this wound taken care of? Basically, nothing needs to be done, once the cure has been removed, it is only necessary to wash superficially with the usual bath soap (during the daily bath), to dry very well and to expose, there is no need to put bandages Do not use antiseptics or antibiotics unless indicated. My conservative approach has allowed me a practically non-existent number of surgical wound infections and excellent final cosmetic results. The operative wound and lower abdomen will hurt less every day.

Signs of alarm: progressive increase of local pain in the wound, changes in the color of the edges of the wound acquiring a red appearance, fever, increased volume and purulent discharge. Warn immediately!

The uterus

It is that “hard ball” that is below the navel and that will gradually disappear until you can not touch it (in 10-12 days). It accidentally hurts there when you breastfeed because breastfeeding contracts the uterus to return to its normal size quickly: the wrongs and do not require analgesics.

The uterus should not hurt excessively, if that happens and there is fever and lochia that do not smell good: contact your obstetrician immediately

Hemorrhoids

They usually become more obvious or general discomfort. The most important thing is to avoid constipation (you can take laxatives or stool softeners), be well hydrated and use anti-hemorrhoidal preparations (3-4 times a day) of your preference. If the discomfort is intolerable, call your doctor

Urinary system

Childbirth traumatizes the bladder and urethra locally. Some people can not urinate easily and others suffer from loss of sensitivity to the desire to urinate. These situations spontaneously correct when local inflammation subsides in 48-72 hours. You should warn if there is burning or discomfort to urinate. To urinate very much is normal the first days.

Legs and ankles

It is possible that on the 3rd or 4th day after the birth of the baby there appears a wide “swelling” in the ankles and legs. This is due to the excess of blood / fluid that persists in the system when evacuating the uterus and that translates into lower limb edema. This gives in a few days, all you have to do is raise your legs in your rest periods. If the swelling is unilateral and there is pain in the calf you should tell your doctor because it could represent a deep vein thrombosis.

The moms

They increase in size, consistency, temperature and superficial circulation is evident, they can even bother a little (feeling of pressure) especially if they have not breastfed.

Initially secrete Colostrum (clear liquid, little consistency, but high protein content and antibodies) and from 3-4 days will begin to notice a liquid more like animal milk (white) without getting to be as thick as that we know

The baby will request the breast every 2-3 hours with a cry that will only appease him being fed. Of course, both use causes the nipples to suffer and with them the mother and that is why you have to take care of them a lot: after each blowjob the nipples are cleaned with water (pure, chamomile or aloe in low concentration), you can also apply a Vitamin E droplet after feeding the baby (abrasives and alcohol are never used). Do not use soap

If the secretion is abundant it can be contained with “Nipple Cups” or with gauze or eye patches. If there is unusual pain, red areas or appearance of purulent discharge, alert immediately.

Answers to frequently asked questions (FAQ)

Let’s see other situations that are commonly asked after childbirth and that are associated with daily life:

1. Food and Diet : breastfeeding spends a lot of energy, so Mom has to eat very well and drink plenty of water during this period. In fact, many women who breastfeed their children recover or get closer to their pre-pregnancy weight more quickly.
2. Exercise and Spinning : after the end of the quarantine can be practiced progressively, without reaching exhaustion or excessive fatigue and maintaining a very adequate level of hydration. Remember that intense exercise can limit the production of breast milk. Low-impact exercises such as walking or swimming are best, following the indications of prudence and common sense. There is little information about spinning but it is prudent to start it well into the second month and progressively. The Yoga? Common sense, avoiding very complex and dangerous maneuvers.
3. Sexuality : breastfeeding does not prevent the possibility of pregnancy. You have to respect the quarantine and think about the possibility of an unplanned pregnancy if you do not have a safe method. Usually no pain or difficulties are reported but in the first approaches there may be local discomfort due to dryness and vaginal atrophy
4. Contraception : ask for guidance in the use of oral contraceptives, intrauterine device, condoms, injectable contraception. Hormonal methods can usually be used without impairing lactation or effects on the fetus after the first month. This topic will be discussed when you attend your postpartum visit at the end of the quarantine (5 weeks after birth). Visit my article on postpartum contraception. The hormonal contraceptives favored during lactation are those that only contain progestogens, the daily minipill without rest. The IUD is ideal
5. Travel and Vehicle Management : Stop walking every 2-3 hours to avoid prolonged circulatory stagnation. Use a seatbelt. You could drive your vehicle after the first month of surgery, use extreme caution, a strong collision could injure the operative wound.
6. Constipation : eat plenty of fibers, abundant fluids and use of SOS Laxatives.
7. Drugs I can take : virtually all medications can be used. The definitively contraindicated ones usually do not use routine nor are they easily accessible. I give you several options for each case

Analgesics:

• Acetaminophen (Tylenol): 325-500 mg every 4-6 hours, PO
• Ibuprofen (Motrin, Ibufen, Brugesic): 400 mg every 6 hours, PO
• Ketoprofen (Lindilan, Profenid): 100 mg every 6-8 hours, PO

Laxatives:

• Senosides: 1-2 capsules PO + 2 glasses of water with dinner
• Plantago/Psyllium: 1 teaspoon to swallow dry + 2 glasses of water, with dinner

Hemorrhoids:

• Preparation H (cream): 3 times a day in anal region

Common cold:

• Clariflu or ClariGrip or Rinaris : one tablet orally every 6 hours
• Tempra Grip, Alivet or any anti-flu formulation of your choice as indicated

Vitamins:

Daily if indicated, the brand of your preference or those left over from pregnancy.