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A postpartum (or postnatal) period begins immediately after the birth of a child and extends for about six weeks,[1] as the mother's body, including hormone levels and uterus size, returns to a non-pregnant state. Less frequently used are the terms puerperium or puerperal period. The World Health Organization
World Health Organization
(WHO) describes the postnatal period as the most critical and yet the most neglected phase in the lives of mothers and babies; most maternal and/or newborn deaths occur during the postnatal period.[2] In scientific literature, the term is commonly abbreviated to Px, where x is a number; for example, "day P5" should be read as "the fifth day after birth". This is not to be confused with the medical nomenclature that uses G P to stand for number and outcomes of pregnancy (gravidity and parity).

Contents

1 Newborns 2 Mothers

2.1 Physical 2.2 Psychological

3 Cultures

3.1 Europe 3.2 East Asia 3.3 India

4 See also 5 References 6 External links

Newborns[edit] Main article: Infant Upon their entry to the air-breathing world, newborns begin to adjust to life outside the uterus. Within about 10 seconds the infant takes its first breath and the caregiver places the baby on the mother's chest. The infant's condition is evaluated using the Apgar scale. The Apgar score is determined by evaluating the newborn baby on five criteria which are summarized using words chosen to form a backronym (Appearance, Pulse, Grimace, Activity, Respiration). Until recently babies were routinely removed from their mothers following birth, however beginning around 2000, some authorities began to suggest that early skin-to-skin contact (placing the naked baby on the mother's chest) is of benefit to both mother and infant. As of 2014, early skin-to-skin contact, also called kangaroo care, is endorsed by all major organizations that are responsible for the well-being of infants. Thus, to help establish bonding and successful breastfeeding, the caregiver carries out immediate mother and infant assessments as the infant lies on the mother's chest and removes the infant for further observations only after they have had their first breastfeed. The World Health Organization
World Health Organization
(WHO) also encourages skin-to-skin contact for the first 24 hours after birth to help regulate the baby's temperature.[3] Mothers[edit] A woman giving birth in a hospital may leave as soon as she is medically stable, which can be as early as a few hours postpartum, though the average for a vaginal birth is one to two days, and the average caesarean section postnatal stay is three to four days.[4] During this time, the mother is monitored for bleeding, bowel and bladder function, and baby care. The infant's health is also monitored.[5] Early postnatal hospital discharge is typically defined as discharge of the mother and newborn from the hospital within 48 hours of birth. Physical[edit] Main article: Postpartum physiological changes The labor process is divided into four stages. During the first and second stage the cervix opens and shortens and the baby moves down through the birth canal. The period from just after the baby is born until just after the placenta is expelled is called the third stage of labor. The fourth stage of labor, also referred to as postpartum, is the period beginning immediately after the placenta is expelled and extending for about six weeks.[6] Following delivery the area where the placenta was attached to the uterine wall bleeds, and the uterus must contract to prevent blood loss. After contraction takes place the fundus (top) of the uterus can be palpated as a firm mass at the level of the navel. It is important that the uterus remains firm and the nurse or midwife will make frequent assessments of both the fundus and the amount of bleeding. The discharge will gradually decrease and turn from bright red, to brownish, to yellow and cease at around five or six weeks. According to the medical site Medscape, "Often, women experience an increase in the amount of bleeding at 7-14 days secondary to the sloughing of the eschar on the placental site. This is the classic time for delayed postpartum hemorrhages to occur."[1] Following delivery if the mother had an episiotomy or tearing at the opening of the vagina it is stitched. At one time an episiotomy was routine, however more recent research shows that a surgical incision may be more extensive than a natural tear, and is more likely to contribute to later incontinence and pain during sex than a natural tear would have. A healthcare professional can recommend comfort measures to help to ease perineal pain. [7] The increased vascularity and edema of the woman's vagina gradually resolves in about 3 weeks. It regresses but does not completely regain its previous size. The cervix rapidly returns to a near-nonpregnant state as well.[8] Postpartum urinary incontinence is experienced by about 33% of all women; women who deliver vaginally are about twice as likely to have urinary incontinence as women who give birth via a cesarean.[9] Psychological[edit] See also: Psychiatric disorders of childbirth In some cases, this adjustment is not made easily, and women may suffer from postpartum depression, posttraumatic stress disorder or even puerperal psychosis. Postpartum mental illness can affect both mothers and fathers, and is not uncommon.[10] Early detection and adequate treatment is required. Approximately 25% – 85% of postpartum women will experience the "blues" for a few days. Between 7% and 17% may experience clinical depression, with a higher risk among those women with a history of clinical depression. Postpartum psychosis (also known as puerperal psychosis) is a more severe form of mental illness than postpartum depression. Rarely, in 1 in 1,000 cases, women experience a psychotic episode, again with a higher risk among those women with pre-existing mental illness. Despite the widespread myth of hormonal involvement, repeated studies have not linked hormonal changes with postpartum psychological symptoms. Rather, these are symptoms of a pre-existing mental illness, exacerbated by fatigue, changes in schedule and other common parenting stressors.[11] Cultures[edit]

A mother in Florence
Florence
lying-in, from a painted desco da parto or birth tray of c. 1410. As women tend to the child, expensively dressed female guests are already arriving.

Europe[edit] Main article: Lying-in Historically, European women were confined to their beds or their homes for extensive periods after giving birth; care was provided either by her female relatives (mother or mother-in-law), or by a temporary attendant known as a monthly nurse. These weeks were called confinement or lying-in, as in the names of maternity hospitals such as the General Lying-In Hospital
General Lying-In Hospital
in London. A 1932 publication refers to lying-in as ranging from 2 weeks to 2 months.[12] It also does not suggest "Getting Up" (getting out of bed post-birth) for at least nine days and ideally for 20 days.[12][13] Women received congratulatory visits from friends and family during the period and, among the many traditional customs around the world, the desco da parto was a special form of painted tray presented to the mother in Renaissance
Renaissance
Florence. The many scenes after childbirth painted on these show female visitors bringing presents, received by the mother in bed, while other women tend to the baby. No fixed term of lying-in is recommended in Renaissance
Renaissance
manuals on family life (unlike in some other cultures), but it appears from documentary records that the mother was rarely present at the baptism, in Italian cities usually held within a week of the birth at the local parish church, normally a few minutes walk from any house.[14] The woman was reintroduced to the community in the Christian ceremony of the churching of women. A modern version of this rest period has evolved, to give maximum support to the new mother, especially if she is recovering from a difficult labour and delivery. East Asia[edit] Main article: Postpartum confinement In some East Asian
East Asian
cultures, such as Chinese, South Korean, and Vietnamese, there is a traditional custom of postpartum confinement known in English as doing the month or sitting the month (Mandarin zuò yuèzi 坐月子). Confinement traditionally lasts 30 days.[15] This tradition combines prescribed foods with a number of restrictions on activities considered to be harmful. The new mother is also given special postnatal foods, such as seaweed soup in Korea and "Pork Knuckles and Ginger Stew" in China. It is widely believed in many East Asian societies that this custom helps heal injuries to the perineum, promote the contraction of the uterus, and promote lactation.[16][17][18] In Thailand "yu-fai (lie down by a fire) treatment is traditional postpartum healing. Performed in an open area, it involves using smokeless tamarind wood, local herbs and massage.[19] India[edit] Most traditional Indians follow the 40-day confinement and recuperation period also known as the 'Jaappa' (in Hindi). A special diet to facilitate milk production and increase hemoglobin levels is followed. Sex is not allowed during this time. In Hindu culture, the puerperium was traditionally considered a period of relative impurity (asaucham) due to the processes of childbirth, and a period of confinement of 10–40 days (known as purudu) was recommended for the mother and the baby. During this period, she was exempted from usual household chores and religious rites. The father was purified by a ritual bath before visiting the mother in confinement. In the event of a stillbirth, the period of impurity for both parents was 24 hours.[20] Many Indian sub cultures have their own traditions after birth. This birth period is called Virdi (Marathi), which lasts for 10 days after birth and includes complete abstinence from puja or temple visits. See also[edit]

Doula Episiotomy Obstetric Parental leave Pelvic girdle pain Postpartum infections Sex after pregnancy Early postnatal hospital discharge

References[edit]

^ a b "Normal and Abnormal Puerperium: Overview, Routine Postpartum Care, Hemorrhage". Medscape. 2017-08-04.  ^ WHO. "WHO recommendations on postnatal care of the mother and newborn". WHO. Retrieved 22 December 2014.  ^ Phillips, Raylene. "Uninterrupted Skin-to-Skin Contact Immediately After Birth". Medscape. Retrieved 21 December 2014.  ^ "Recovering from a caesarean section". NHS Choices. Retrieved 16 December 2016.  ^ "With Women, Midwives Experiences: from Shiftwork to Continuity of Care, David Vernon, Australian College of Midwives, Canberra, 2007 ISBN 978-0-9751674-5-8, p17f ^ Gjerdingen, D.K.; Froberg, D.G. (1991). "The fourth stage of labor: The health of birth mothers and adoptive mothers at six-weeks postpartum". Family medicine. 23 (1): 29–35. PMID 2001778.  ^ Mayo Clinic staff (30 July 2015). "Labor and delivery, postpartum care". Mayo Clinic. Retrieved 15 August 2015.  ^ WHO (2013). "WHO recommendations on postnatal care of the mother and newborn". World Health Organization. Archived from the original on 22 December 2014. Retrieved 22 December 2014.  ^ Thom, DH; Rortveit, G (December 2010). "Prevalence of postpartum urinary incontinence: a systematic review". Acta Obstetricia et Gynecologica Scandinavica. 89 (12): 1511–22. doi:10.3109/00016349.2010.526188. PMID 21050146.  ^ "Postpartum Depression". Canadian Mental Health Association. Retrieved July 9, 2014.  ^ Dobson, V.; Sales, B. (2000). "The Science of Infanticide and Mental Illness". Psychology, Public Policy and Law. 6 (4): 1098–1112. doi:10.1037/1076-8971.6.4.1098.  ^ a b Lying in by Jan Nusche quoting The Bride's Book — A Perpetual Guide for the Montreal Bride, published in 1932 ^ Jenstad, Janelle Day, Lying-in
Lying-in
Like a Countess: The Lisle Letters, the Cecil Family, and A Chaste Maid in Cheapside, Journal of Medieval and Early Modern Studies - Volume 34, Number 2, Spring 2004, pp. 373-403 ^ " Renaissance
Renaissance
childbirth - Victoria and Albert Museum". Vam.ac.uk. Retrieved 2016-09-10.  ^ "Effect of Alcohol consumption on Maternal lactation characteristics during 'doing-the-month' ritual". Retrieved 2014-02-02.  ^ "Ayuvedic Postpartum Healing Tips". Ayurveda.iloveindia.com. Retrieved 2014-02-02.  ^ "Ayurvedic diet for de-stressing postpartum mothers". Thefreelibrary.com. 2001-12-22. Retrieved 2014-02-02.  ^ Jacobson, Hilary. "Lactogenic Foods and Herbs". Mobimotherhood.org. Archived from the original on 2014-01-26. Retrieved 2014-02-02.  ^ "Lie down by a fire". Bangkok Post.  ^ John Marshall / Jaya Tirtha Charan Dasa. "GUIDE TO RITUAL IMPURITY - What to do at the junctions of birth and death". Hknet.org.nz. Retrieved 2014-02-02. 

External links[edit]

eMedicine: Normal and Abnormal Puerperium Patient UK: Postnatal Care (Puerperium) NHS Choices Birth to Five Planner: Postnatal post-traumatic stress disorder Postpartum care of mother and newborn: WHO

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