Pregnancy and childbirth are natural in the life cycle of a woman. Having a baby and being a mother is also a joy and pride in itself. It is not only the period of pregnancy that is important to pay attention to, after childbirth it is also equally important because there are many conditions that can potentially become problems after childbirth.
This postpartum period is also known as the puerperium / puerperium, which is the post-delivery condition until it returns to its pre-pregnancy state, usually occurring between 4-6 weeks. During the puerperium, the reproductive organs will gradually return to their pre-pregnancy state or what is called the involution period. In general, there are 2 important things that need to be considered in postpartum mothers, namely their physical and psychological conditions.
1. Postpartum
Two hours after delivery of the baby is the most critical time that requires close supervision. Within 2 hours, closely monitor blood pressure every 15 minutes, body temperature every 4 hours for the first 8 hours, then every 8 hours for the next 8 hours. The contractions and the size of the uterus are noted, the amount of vaginal bleeding is monitored. If necessary, drugs are given to contract the uterus so that bleeding does not occur. Two hours after it was confirmed that there were no complications due to childbirth, they were allowed to eat. Calories & Protein needed a little more. Iron supplements are needed for at least 3 months postpartum.
2. Breasts
Female breasts have mammary glands, 15-20 lobes in each breast. Shortly- five days after delivery the breasts begin to produce colostrum, which is yellowish in color. Colostrum contains little sugar and fat but is rich in immune components, minerals, protein globulins, amino acids, immunoglobulin A (IgA), macrophages, lymphocytes, lactoferrin, lactoperoxidase, and lysozymes which are very good for babies. The breasts will produce colostrum until about 2 weeks and then start transitioning to milk at 4-6 weeks. Slightly different from colostrum, mature breast milk consists of fats, proteins, carbohydrates, bioactive factors, minerals, vitamins, hormones, and immunity products. The concentration and composition of breast milk is influenced by the mother's food intake, the age of the baby, and the needs of the baby. Mothers who breastfeed can produce 600 ml per day.
How to care for breasts:
Milk nipples are routinely cleaned of dirt or dried milk which can irritate between the nipples using warm water and mild soap. Cleaned before and after feeding . Injured fissures can cause pain and affect milk production as well as being a source of infection. If the nipple is injured, lanolin ointment can be given and a nipple protector is given for 24 hours. Usually gets better in 10 of. Babies can be given breast milk through a healthy breast and sick breasts can be removed through a pump. The wrong position of the baby when breastfeeding can also affect the blisters on the nipples. Contraindications to breastfeeding are certain drugs, alcohol, HIV infection and untreated tuberculosis, and breast cancer treatment.
Some viral diseases such as Hepatitis B and C, Citomegalovirus can still breastfeed the baby. Mothers with Herpes simplex can still breastfeed as long as they make sure there are no chafed nipples. Some drugs that should not be consumed by nursing mothers include cyclosphamide, cyclosporine, doxorubicin, methotrexate, mycophenolate, marijuana and alcohol.
Another problem that is often encountered when breastfeeding is the condition of Breast Engorgement. That is a condition characterized by breast pain due to blockage of milk secretion and fever between 37.8-39˚C which usually peaks 3-5 days after delivery. How to deal with it by wearing a comfortable bra, compresses with ice and pain medication. Apart from the blockage of milk, breast enlargement can occur due to infection. Another problem that is often found in the breast is the inverted nipple. This makes it difficult when breastfeeding. The way to overcome this is by sucking the nipples regularly and often for a long time before the time of delivery so that the nipples can protrude.
3.Perineum
The perineum is the area around the genitals and anus. Usually it is in the perineal area that an episiotomy or widening the birth canal is performed during labor. This area should be cleaned from front to back. Cold compresses can be given to the sutured area to reduce swelling. If there is severe pain in the perineum and anal area, you must be careful about the occurrence of a hematoma (bleeding). The stitches usually heal in about 3 weeks. Although it is rare to find uterine prolapse where the uterus descends or is turned upside down from the genitals, this is a serious condition and requires immediate treatment. Hemorrhoids or piles or hemorrhoids often occur usually due to pressure and when straining. Treatment is with anti-pain ointments, soaking in warm water, and stool softeners.
4. Bladder
In the long and difficult process of giving birth with a large baby, or with the help of tools such as a vacuum or forceps, the use of a urinary catheter, caesarean section, can result in complications in the bladder, namely urinary retention. Urinary retention is a condition in which you are unable to urinate so that the urine is stuck in your bladder, causing it to be very painful.
If within 4 hours after delivery you cannot urinate, it indicates a problem. The fix is to insert a urinary catheter for at least 24 hours to drain the urine and rest the bladder while evaluating the cause of the retention. In addition, drugs can be given and laboratory checks for urine if there is an infection. If yes, you can be given antibiotics.
5. Mood & psychology
It is important to observe whether postpartum depression occurs. Often depression occurs in the few days after giving birth. Some more severe cases can occur post partum baby blues syndrome. This condition is characterized by fear and anxiety about the ability to take care of children, provide for needs and changes in body shape after giving birth. Usually these symptoms disappear in 2-10 days. In severe conditions, there may be a desire to commit suicide or kill the baby. In this condition, further drug therapy is needed.
6. Muscle and bone complications during childbirth.
Can occur when stretching positions that are too excessive. Suspicious of an abnormal condition if the postpartum woman is unable to walk and or feels lower abdominal pain to the back and legs. If it occurs, it can be evaluated with further examinations such as Xray.
7. Time to have sex again
After 2 weeks after delivery, sexual activity can be carried out if it feels comfortable. According to research, 90% of 484 women after giving birth to their first child had sexual activity after 6 months. Having sex that is too fast can be unpleasant and disrupt the stitches and result in lacerations of the birth canal. Dyspareunia (pain during intercourse) can occur in some people after a cesarean section.
8. Contraception
Contraception is the thing that is most often ignored by postpartum mothers because they feel it is not very important and can be postponed. In fact, it is an important matter. Women who are not breastfeeding may return 6-8 weeks postpartum. Ovulation occurs at an average of 7 weeks (between 5-11 weeks). In breastfeeding women menstruation and fertility return about 18 months postpartum.
Other conditions that can occur after delivery include fatigue, constipation (difficulty having bowel movements), anemia (lack of blood), headaches, complications of stitches. In general, monitoring the condition of postpartum mothers is carried out for up to 18 months. These are the things that need to be considered in postpartum mothers. I hope this article can provide some insight to prospective mothers or those who have given birth. A healthy mother can certainly care for and raise healthy children for the next generation of young people.
Adapted from William Obstetrics textbook 25 by dr. Efilda Silfiyana, SpOG (Obstetric Gynecologist at EMC Tangerang Hospital).