October 22, 2018

Childbirth is a critical time for a mother and her baby. Marked by strong emotional and physical changes, and adjustment to new roles and responsibilities, the postpartum period begins an hour after the delivery and continues for six weeks.

Women’s needs during this period are often overshadowed by the attention given to the newborn. This can be seen in the fact that most maternal deaths and disabilities occur during this time.

According to the WHO, major complications that usually occur after childbirth, account for nearly 75% of all maternal deaths.

These include severe bleeding, infections, high blood pressure during pregnancy (pre-eclampsia and eclampsia), complications from delivery and unsafe abortion.

Here are some key things to do to keep a new mother and her child safe and healthy after childbirth.

1. Duration of stay

It is recommended that mothers should stay for at least 48 hours in a health facility after delivery, especially if her home is far and care is difficult to obtain in the home environment.

2. Recommended timing of post-natal visits and immunisation schedule

Follow the timing of post-natal visits and the immunisation schedule for the baby. These visits ensure breastfeeding practices and address any difficulties with attachment or positioning.

3. Major Maternal health challenges in the postpartum period

Some serious complications may occur in the postpartum period.

  • Postpartum haemorrhage or loss of blood occurs within the 24 hours following childbirth. The hours are also critical in the diagnosis and management of abnormal bleeding.
  • Postpartum eclampsia, where symptoms may include headaches, visual disturbances and pain in the upper abdomen area.
  • Puerperal genital infection where fever is the main clinical symptom, accompanied by chills, lower abdominal pain and vaginal discharge that could be foul smelling. Puerperal infection encompasses a wide range of postpartum infections mainly caused by bacteria and is most common on the raw surface of the interior of the uterus or the genital tract.

4. Maternal Nutrition

The nutritional status of the woman during adolescence, pregnancy and lactation has a direct impact on maternal and child health in the postpartum period.

  • General diet postpartum: Women’s dietary intake should be increased to cover the energy cost of lactation. Access to adequate foods is essential and if necessary, through food supplements. For a balanced and nutritious diet, include food items from all food groups: cereals, pulses, milk and milk products, flesh foods, eggs, vegetables and fruits, fats and nuts and oilseeds. It is also important to consume coloured fruits and vegetables as these are very good sources of minerals and vitamins and help in preventing micronutrient deficiencies such as iron and Vitamin A. Consume lots of fluids during the day as this helps in the production of breast milk as well.
  • Prevention of micronutrient deficiency: One of the main nutritional deficiencies in the postpartum period is iron deficiency or anaemia. The National Iron Plus Initiative recommends 1 IFA tablet daily for 100 days, starting after the first trimester, which should be repeated for 100 days postpartum as well.

5. Infant Feeding and Breast Care

According to the WHO, the establishment and maintenance of breastfeeding should be one of the primary goals of postpartum care. Human breast milk is the optimal food for newborn infants.
It is recommended that the baby be given to the mother to hold immediately after delivery, to establish skin-to-skin contact (also known as ‘Kangaroo Mother Care’) and for the baby to start suckling within an hour after birth.

Supplementary feeds should be avoided because a healthy baby does not need extra fluids or nutritional supplements before breastfeeding. Further, bottle feeding may interfere with the initiation and continuation of breastfeeding.

Keeping babies with their mothers in the same room or on the same bed after birth prevents infections and increases the success of breastfeeding.

Signs to watch out for during the postpartum period

Women should visit the hospital or health centre immediately if any of the following signs are observed:

  • increased vaginal bleeding
  • fits
  • fast or difficult breathing
  • fever and too weak to get out of bed
  • severe headaches with blurred vision
  • calf pain, redness or swelling; shortness of breath or chest pain
  • swollen, red or tender breasts or nipples
  • problems in urinating or leaking
  • increased pain or infection in the perineum
  • infection in the area of the wound (redness, swelling, pain, or pus in the wound site)
  • smelly vaginal discharge

6. Mental health in the postpartum period

Many women who have just given birth, experience a mental disorder, primarily depression. They often hide or underplay the severity of their condition. If untreated, these illnesses may have an impact on them and their families.

Mild to moderate depressive illness and anxiety include symptoms like persistent sadness, fatigue, loss of interest in everyday life and enjoyment in activities. It often occurs in association with anxiety, uncontrolled worries, panic or obsessive thoughts.

Postpartum depression is characterised by irritability, sadness, inability to sleep, lack of appetite and problems with concentration. It influences the mother-infant interaction during the first year.
Women who suffer from depression need emotional support, whether professional or in the form of reassurance from their partners and families.

7. Adequate Rest

It is important to rest, sleep adequately and avoid hard physical labour because pregnancy and childbirth are taxing enough. In situations where a woman is suffering from a prior condition or has had an unusually taxing pregnancy or childbirth (in cases such as twins, a cesarean birth, significant blood loss, etc.) rest is much more important.

8. Sexual Relations

It is crucial to seek counsel on sexual issues related to the postpartum period, including fertility regulation and the use of contraceptives. Sexual intercourse should be avoided until the perineal wounds heal.

9. Newborn babies with special needs

A baby who had breathing difficulties at the time of birth and needed resuscitation should be carefully monitored over the following 24 hours. It is particularly important that they are kept warm and that extra attention is paid to the initiation of breastfeeding.

Low birth-weight babies are at a greater risk of infections or even death. Kangaroo Mother Care is one way to care for them.

Every day, approximately 830 women die from preventable causes related to pregnancy and childbirth. The first 24 hours postpartum and the first week has a high risk of deaths, which continues until the second week after delivery. According to WHO, almost all of these deaths are preventable if mothers receive appropriate post care assiduously.

This article written by Saloni Gautam, Technical Associate, CARE India, appeared in Better India on October 22, 2018

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