Management of normal puerperium

Immediately following delivery, the patient should be closely observed. She may be given
a drink of her choice or something to eat, if she is hungry.

Principles - 
- To give all out attention in to restore the health status of the mother.
- To prevent infection.
- To take care of the breasts, including promotion of lactation and nursing of the child.
- To motivate the mother for contraception.

General management -

Rest and ambulance -
It is indeed difficult to categories an uniform period of rest. After a good resting period,
the patient becomes fresh and can breast feed the baby or moves out of bed to go to the
toilet. Early ambulation is encouraged.

Que. - What is the benefits of early ambulation after delivery ?
Ans. -  Advantages of early ambulation are:
           - Provide a sense of well-being.
           - Bladder complications and constipation are reduced.
           - Facilitates uterine drainage.
           - Hastens involution of uterus.
           - Lessens puerperal venous thrombosis and embolism.

Hospital stay -
Early discharge from the hospital is an almost universal procedure. If adequate supervision
by trained health visitors is provided, there is no harm in early discharge.

Diet -
The patient should be on normal diet of her choice. If the patient is lactating, high calories,
adequate protein, fat, plenty of fluids, minerals and vitamins are to be given.

Care of the bladder -
The patient is encouraged to pass urine following delivery as soon as convenient. If the patient
fails to pass urine, catheterisation should be done. Catheterisation is also indicated in case of
incomplete emptying of bladder.

Care of the bawel -
The problem of constipation is much less because of early ambulation and liberalisation of the
dietary intake. A diet containing sufficient roughage and fluids is enough to move the bowel.
If necessary, mild laxative such as Igol (isopgol husk) two teaspoons may be given at bed time.

Sleep -
The patient is in need of rest, both physical and mental. So she should be protected against
worries and undue fatigue. Sleep is ensured providing adequate physical and emotional support.

Care of the vulva and episiotomy -
Shortly after delivery, the vulva and buttocks are washed with soapwater down over the anus
and a sterile pad is applied. The patient should look after personal cleanliness of the vulval
region. The perineal wound should be dressed with spirit and antiseptic power after each act
micturition and defaecation or at least twice a day.

Care of the breast -
The nipple should be washed with sterile water before each feeding. It should be cleaned
and kept dry after the feeding is over. Nipple soreness is avoided by frequent short feeding
rather than the prolonged feeding, keeping the nipple clean and dry.

Maternal-infant bonding - 
It starts from first few moments after birth. This is manifested by fording, kissing, cuddling
and gazing at the infant. The baby should be kept in her bed or in a cot besides her bed.
This is not only establishes the mother-child relationship but the mother is conversant with
the art of baby care so that she can take full care of the baby while at home.

Asepsis and antiseptic -
Asepsis must be maintained specially during the first week of puerperium. Liberal use of
local antiseptics, aseptic measures during perineal wound dressing, use of clean bed linen
and clothing are positive steps.

Immunization - 
Administration of anti-D-gamma globulin to unimmunized Rh-negative mother bearing
Rh-positive baby. The booster dose of tetanus toxoid should be given at the time of
discharge, if it is not given during pregnancy.