Puerperium

The puerperium (traditional "confinement" is only the first 30 days of the puerperium) refers to the period of adjustment and recovery of the fetus and the maternal body, reproductive organs and psychology after the delivery of the placenta. It takes 6 to 8 weeks, which is 42 to 56 days.

During this period, the parturient should focus on rest, especially bed rest within 15 days after childbirth, to maintain a good body, and promote the recovery of the body's organs, especially the reproductive organs as soon as possible.

To adapt to the development of the fetus and prepare for childbirth, the reproductive organs and body of pregnant women have undergone great changes. After childbirth, the reproductive organs and body (except breasts) are restored to a non-pregnant state through a series of changes. The change will take approximately 42 days to complete. After the placenta was delivered, the mother entered the puerperium. During this period, the breasts of the parturient mothers must produce lactation, the uterus must be restored, and various body systems must gradually return to normal, such as reducing excess blood volume by increasing perspiration and urination; and increasing stomach acid. Gastrointestinal tension and peristalsis are restored, so that digestion can return to normal; women who are not breastfeeding or partly breastfeeding may have menstrual regain. In short, the puerperium is a period of the gradual recovery of multiple systems throughout the body, including body shape and abdominal wall.

Clinical manifestations

1. Body temperature, pulse, breathing, blood pressure

Most of the postpartum body temperature is within the normal range. If excessive fatigue is caused by prolonged labor, the body temperature can rise slightly in the first 24 hours after delivery, and generally does not exceed 38°C. Those who are not breastfeeding may have fever due to the extreme filling of breast blood vessels and lymphatic vessels in the 3 to 4 days postpartum. The body temperature reaches 38.5°C, which usually lasts only a few hours, and the body temperature drops for no more than 12 hours at most. It is not a morbid condition. The postpartum pulse is slightly slow, 60 to 70 beats per minute, which is related to the cessation of uterine placental circulation and bed rest.

2. Lochia

After childbirth, the decidua (especially the decidua where the placenta is attached) falls off, and the tissues containing blood and necrotic decidua are discharged through the vagina, which is called lochia. Lochia is divided into:

(1) Bloody lochia is bright red and contains a lot of blood to get its name. The amount is large, sometimes there are small blood clots, a small number of fetal membranes and necrotic decidua tissue.

(2) Serous lochia It is light red in color and named after serous. Contains a small amount of blood, but has more necrotic decidual tissue, cervical mucus, vaginal discharge, and bacteria.

(3) White lochia is sticky, whiter in color and gets its name. Contains a lot of white blood cells, necrotic decidua tissue, epidermal cells and bacteria.

Normal lochia has a bloody smell, but no smell, lasts 4 to 6 weeks, the total amount is 250 to 500 ml, and individual differences are large. Bloody lochia lasts for about 3 days, gradually turns into serous lochia, turns into white lochia after about 2 weeks, and lasts for about 3 weeks to be clean. The above changes are the result of a gradual decrease in uterine bleeding. If the uterus is incomplete or the placenta remains in the uterine cavity, a large number of fetal membranes, or the amount of lochia increases with infection, the bloody lochia lasts longer and has a foul smell.

Health care during the puerperium

The maternal system changes greatly during the puerperium. Although it belongs to the physiological category, there are large wounds in the uterus, and the mammary glands have a strong secretory function, which is prone to infection and other pathological conditions. Need to pay attention to cleanliness, strengthen puerperium care, so that the body recovers as soon as possible.

1. Maintain good habits

Establish a good resting environment and pay attention to hygiene. The indoor temperature is suitable, 18～20℃, fresh air and good ventilation. Even in winter, there must be a certain period of time to open windows for ventilation to keep the air fresh but be careful to avoid direct blowing. After delivery of lochia from the vagina, pay attention to keeping the vulva clean, wash the vulva with warm water every day, and change underwear and sanitary pads frequently. Avoid the wound after urination and defecation, and wipe it with clean toilet paper from front to back. Be careful not to reverse the direction to avoid infection caused by retrograde bacteria around the anus.

2. Pay attention to mood changes

Experiencing the excitement and tension of pregnancy and childbirth, the mother is extremely relaxed; worry about feeding the baby; discomfort during the puerperium can cause emotional instability, especially in the 3 to 5 days postpartum, it can be expressed as mild depression, and the mother should be helped Reduce physical discomfort, and give spiritual care, encouragement, and comfort to restore self-confidence.

3. Diet

Due to heavy physical exertion during childbirth, various organs in the body must be restored, the digestive capacity of the parturient is weakened, and milk must be secreted for the growth of the newborn, so diet and nutrition are very important. One hour after childbirth, the parturient can be given liquid food or light semi-liquid food, and then a regular diet can be taken. Food should be rich in nutrients, sufficient calories and moisture. If you are breastfeeding, you should add more protein and eat more soup foods, and appropriate vitamin and iron supplements.

4. Urination and defecation

Be wary of postpartum urinary retention. The urine output will increase significantly within 5 days after delivery, and women should be encouraged to urinate themselves as soon as possible. The mother should be allowed to urinate 4 hours after delivery. If it is difficult to urinate, the fear of pain caused by urination should be relieved, and the parturient should be encouraged to sit up and urinate, wash the vulva with hot water, and rinse around the outer urethra with warm water to induce urination. Place a hot water bottle in the middle of the lower abdomen, massage the bladder, and stimulate the contraction of the bladder muscles. Pay attention to constipation: eat more vegetables and get out of bed as soon as possible. If constipation occurs, oral laxatives, kaisailu plug the anus, or soapy water enema should be taken.

5. Observe uterine involution and lochia

The height of the fundus of the uterus should be measured at the same time every day to understand the uterine involution process day by day. Before the measurement, the mother should be instructed to urinate, and the uterus should be massaged to make it contract, and then the distance from the upper edge of the pubic symphysis to the fundus of the uterus should be measured.

6. Breast care

Breastfeeding is recommended, and breastfeeding must be instructed correctly. Start breastfeeding within half an hour after giving birth, and discard regular breastfeeding. It is recommended to breastfeed on demand, and breastfeed once every 1 to 3 hours within 24 hours after birth. The mother's lactation is the process of lactation within 2 to 7 days after birth. The number of lactations should be frequent, and the mother should lactate 8 to 12 times a day and night after breastfeeding. The initial breastfeeding time is only 3 to 5 minutes, and then gradually extended to 15 to 20 minutes. Let the newborn suck one breast before sucking the other breast. Before breastfeeding for the first time, wash your breasts and nipples with warm soapy water and warm water, and scrub your breasts and nipples with warm water before each breastfeeding.

7. Postpartum exercise

Appropriate activities and physical exercises after childbirth are conducive to promoting uterine contraction and recovery, helping the abdominal muscles and pelvic floor muscles to restore tension, maintaining a healthy body and conducive to physical and mental health. Proper rest after childbirth, it is best to lie on your side in bed, turn over more, and lie on your back as little as possible. You can sit up 12 to 24 hours after giving birth and go to the ground to do simple activities. You can exercise after 24 hours of production, and you can do it without equipment, just lying on the bed. Someone should help you at first, and then slowly do it yourself. According to your physical condition, you can do something: prone exercise, supine leg bend, sit-up, supine leg lift, anus and perineum, buttocks muscle contraction exercise. It's simple and easy to do. Determine the exercise time and frequency according to your own ability. Be careful not to overwork. It is advisable to start doing it for 15 minutes, 1 to 2 times a day.

8. Health check

At the end of the puerperium, that is, 6 to 8 weeks postpartum, you should go to the hospital for a comprehensive postpartum examination to understand the recovery of the whole body and pelvic organs and breastfeeding, so as to detect abnormalities in time and deal with them early to prevent delays in treatment and remaining diseases. If you have special discomfort, you should check in advance.

9. Postpartum medication

Most drugs taken by the mother can enter the milk through the blood circulation and affect the baby. Therefore, mothers should consider the harm to the baby when taking drugs. Some drugs cannot be used during lactation. For example, erythromycin can cause liver damage and jaundice in infants; chloramphenicol can cause gray baby syndrome in infants; streptomycin and kanamycin can cause hearing impairment; tetracycline can cause yellow teeth in infants; sulfa drugs can cause liver and kidney damage; chlorpromazine and diazepam can also cause jaundice in infants; metronidazole can cause anorexia and vomiting in infants; reserpine can cause nasal congestion and lethargy in infants.

10. Postpartum body

For new mothers who are concerned about postpartum body beauty, the uterus, cervix, vagina, etc. will all return to the pre-pregnancy level during the puerperium. For pelvic enlargement and pubic symphysis separation caused by pregnancy, they will also recover within 2 months after delivery. If it does not return to the pre-pregnancy level within these two months, then the postpartum body shape will be formed and fixed. Because the pelvis is on the left and right of the body shape, postpartum body contouring is mainly about pelvic recovery. If it is an active and scientific postpartum body exercise within two months after childbirth, then the wide pelvis and the separated pubic symphysis can all be retracted, and it will also return to the pre-pregnancy level just like the uterus. The specific method is to lie on your side on a hardboard, and then if you lie on the left side, place the palm of your left hand under the hip bone, and then lift your head and feet. The whole body weight is pressed onto your hand through the fulcrum of the hip bone. Simple actions can effectively reduce the left and right width of the pelvis, that is, the width of the pubic symphysis separation, 3 minutes each time, 2 to 3 times a day, and the separation of the pubic symphysis can be restored to the pre-pregnancy state after 2 to 3 weeks. In addition, swinging can also restore the height of the pelvis to the pre-pregnancy level, and the abdomen belt can restore the anterior-posterior diameter and circumference of the pelvis to the pre-pregnancy level.

产褥期 產褥期

产褥期（传统的“坐月子”只是产褥期的前30天）是指胎儿、胎盘娩出后的产妇身体、生殖器官和心理方面调适复原的一段时间，需6～8周，也就是42～56天。