Table Of Contents
Post-partum Care
‘Postpartum’ is a general term for the period of time following childbirth. It starts one hour after the delivery of the placenta.
The “postpartum” period can be divided into the following 4 stages:
- Post-placental: the first ten minutes following delivery of the placenta
- Early postpartum: the first seven days following delivery of the placenta
- Late postpartum: from one week, to six to eight weeks following delivery of the placenta
- Extended postpartum: up through twelve months following delivery of the placenta
Common postpartum responses
| Postpartum response | Description | Treatment |
|---|---|---|
| Shivering | This is a common complaint. It usually begins immediately after delivery, and should not last more than an hour. | Blankets and pharmacological treatment (see hypothermia and shivering) if the cause is anaesthesia |
| Pain | Perineal pain is common after vaginal delivery due to swelling and pain. Incisional pain occurs after caesarean delivery. | Analgesia. For perineal pain: ice packs in the first 24 hours, heating pads and sitz baths after 23 hours. |
| Cramping (’Afterpains’) | Cramping is more severe in multiparas. It is due to hypertonic uterine contractions which coincide with breastfeeding as oxytocin is released. A key differential is endometritis. | Analgesia. It spontaneously resolves by one week post-partum. |
| Vaginal discharge (lochia) | Continuous shedding of the superficial portion of the decdua basalis occurs after delivery. | Monitor the amount and colour. Profuse discharge (soaking ≥ 1 pad per hour) may be a sign of PPH. Foul smelling discharge may be a sign of endometritis. |
| Hypotonic bladder and urinary retention | Urinary retention is common after delivery due to reversible pudendal nerve injury. A post-void residual > 250 mL is diagnostic. A urinalysis can be obtained in case of dysuria to rule out UTI | Intermittent catheterization to prevent renal failure. The catheter can be discontinued if the post-void residual is < 150 mL. |
| Stress urinary incontinence | This affects more than 25% of women in the first year post-partum | Bladder training, Kegel exercises, and weight loss |
| Constipation and haemorrhoids | Both of these are self-limiting. Haemorrhoids may be worsened with longer vaginal delivery and post-partum constipation. | Hydration, ambulation, stool softeners, and non-opioid pain medications. Sitz baths and topical anaesthetics for haemorrhoids. |
| Breastfeeding difficulty | Difficulty breastfeeding may be due to nipple soreness, perception of inadequate milk supply, and concerns that the infant is not feeding properly. | A lactation specialist or breastfeeding support nurse can help |
| Diastasis recti abdominis | Midline separation of the rectus abdominis can occur, which leads to long-term back pain and pelvic floor dysfunction | Pelvic floor and core-strengthening exercise |
Progression of vaginal discharge (lochia) in the post-partum period
| Lochia | Colour | Occurrence |
|---|---|---|
| Lochia rubra | Red to red-brown | First few days |
| Lochia serosa | Pink | 1-2 weeks postpartum |
| Lochia alba | Yellow-white | 2-4 weeks post-partum |
Discharge and Follow-up
- Discharge instructions
- Take daily baths
- Keep the perineum clean
- Continue exercise and activities as tolerated
- Sexual activity can occur as long as there is no active bleeding
- Consider contraception
- Lactational amenorrhoea method (LAM) if the criteria are met
- Combined oral contraceptives 3 weeks postpartum
- Progestogen only pill 6 weeks postpartum
- Intrauterine devices immediately or at 6 weeks postpartum
- Contraceptive injections 6 weeks postpartum
- Contraceptive implants 6 weeks postpartum
- Breasts and nipple care
- Return for immunization
- Discharge on Iron and folate supplements
- Warning signs to look out for on discharge
- Significant bleeding
- Fever
- New or worsening perineal pain
- Dysuria
- Breast problems
- Leg pain or swelling
- Significant mood disturbances
- Severe headache (pre-eclampsia/eclampsia)
- Follow-up visits
- 12-week continuous support model
- Initial assessment within the first 3 weeks postpartum
- Comprehensive visits no later than 12 weeks postpartum
- Routine topics discussed
- Health of the infant
- The mother’s mood to screen for post-partum depression
- Contraceptive plan
- Return of sexual activity
- Any difficulties with breastfeeding
- 12-week continuous support model