POSTNATAL CARE

Postnatal care includes a systematic examination of the mother and the baby and appropriate advice was given to the mother during the postpartum period. The first postnatal examination is done and the advice is given on discharge of the patient from the hospital. This has already been discussed. The second routine postnatal examination is conducted at the end of 6th week postpartum.

Aims and Objectives:

·         To assess the health status of the mother. Medical disorders like diabetes, hypertension, thyroid disorders should be reassessed.

·         To detect and treat at the earliest any gynaecological condition arising out of obstetric legacy.

·         To note the progress of the baby including the immunization schedule for the infant.

·         To impart family planning guidance.

 Procedure:

• ·         Examination of the mother
• ·         Advice given to the mother
• ·         Examination of the baby and advice

Examination of the Mother:

 Routine examination includes recording weight, pallor, blood pressure and tone of the abdominal muscles and examination of the breast.

Pelvic examination should be done only when indicated. The following should be noted: A cervical smear may be taken for exfoliative cytological examination if this has not been done previously and insertion of the intrauterine contraceptive device may be done when desired.

Laboratory investigations (e.g. haemoglobin) depending on the clinical need may be advised.

Examination of the baby: This should be conducted by a paediatrician. In this respect, a well-attached baby clinic to the postpartum unit is an absolute necessity. The progress of the baby is evaluated and preventive or curative steps are to be taken. Immunization to the baby is started.

Advice is given:

(1) If the patient is in sound health she is allowed to do her usual duties.

(2) Postpartum exercises may be continued for another 4–6 weeks.

(3) Vaccination MMR, HepB,

(4) To evaluate the progress of the baby periodically and to continue breastfeeding for 6 months.

(5) Family planning counselling and guidance

Management of ailments: 

Additional investigation and appropriate therapy is given according to the abnormalities detected during the check-up. Management of some common gynaecological problems is given below. Some women need psychological support also.

 Irregular vaginal bleeding:

 It is not uncommon to encounter irregular or at times, heavy bleeding after 4–6 weeks following an  uneventful period after delivery. This is usually the first period especially in nonlactating women and simple assurance is enough. Persistence of bleeding dating back from childbirth is likely due to retained bits of conceptus and usually requires ultrasound examination followed by dilatation and curettage operation.

Leukorrhea

The profuse white discharge might be due to ill health, vaginitis, cervicitis or subinvolution. Improvement of the general health and specific therapy cure the condition.

Cervical ectopy (erosion)

Cervical ectopy met during this period without any symptom should not be treated surgically. Hormone-induced ectopy during pregnancy takes a longer time (about 12 weeks) to regress. Thus, asymptomatic ectopy should be examined again after 6 weeks and if it still persists, cauterization is to be considered.

 Backache:

 It is mostly due to sacroiliac or lumbosacral strain. Backache over the sacrum is likely due to pelvic pathology, but if it is over the lumbar region, it might be due to an orthopaedic condition and is often relieved by physiotherapy.

Retroversion seldom produces backache. If associated with subinvolution with symptoms, a pessary is inserted after correcting the position and is to be kept for about 2 months.

The slight degree of uterine descent with cystocele, stress incontinence and relaxed perineum are the common findings at this stage. These can be cured by effective pelvic floor exercise. 

Urinary and anal incontinence: The woman is examined for any sphincter injury. Perineal exercises are advised. Women with persistent symptom after 6 months need special investigations and surgical treatment

Bibliography 

This content is from various web sources and books 

POSTNATAL EXERCISE

Exercises Is a physical activity that is planned, structured and repetitive for the purpose of conditioning any part of the body.

 Importance of Post-Natal Exercises

·         Improve circulation

·         Strengthen pelvic floor muscle

·         Prevent backache

·         Strengthen the tummy muscles

Benefits of Exercises

·         Reduces the risk of developing heart disease, diabetes, and cancer

·         Reduces high blood pressure, high cholesterol

·         Reduces body weight, depression, anxiety and improves psychological wellbeing

·         Builds and maintains healthy muscles, bones and joints

DEEP BREATHING EXERCISE

·         Lie on bed with knees bent, with a pillow behind

·         Breathe in deeply through nose. Sigh out.

·         Repeat 5 times

Breathing exercises help to improve the circulation

FOOT AND ANKLE EXERCISE

·         Keep knees relaxed for both exercises.

·         Bend and stretch ankles vigorously up and down for 30 seconds.

·         Circle both feet 10 times in each direction.

·         Repeat these exercises frequently.

PELVIC FLOOR EXERCISE-KEGAL

·         Pelvic floor muscles are stretched during pregnancy and childbirth.

·         Strong pelvic floor muscles are essential to prevent leakage of urine when sneeze or cough, for enjoyable sexual intercourse and to give complete control of bowels.

·         Strong muscles will also help prevent developing a prolapsed womb

·         Can do this exercise standing, sitting or lying.

·         Pull the area around vagina up and down

·         The contraction should be held for 10 seconds(to a count of 6) and repeated upto10 times

·         The exercise should be continued for 2-3 months.

·         This exercise is especially important if mother have stitches.

·         It helps to improve the circulation and will help to heal quickly

PELVIC TILTING EXERCISE

·         Lie on a firm surface with knees bent and a comfortable pillow beneath the head

·         Pull in your tummy (inhale, while exhale flatten the back)

·         Press the lower part of back down flat

·         Hold for several seconds and repeat.

ABDOMINAL BREATHING

·         This is to strengthen the diaphragm

·         Take a deep breath, raising her abdominal wall and exhale slowly.

·         To ensure correct method ask to keep one hand on chest and one on abdomen.

·         While inhaling the hand on the abdomen should be raised and hand on the chest should remain stationary.

·         Repeat the exercise five times

HEAD AND SHOULDER RAISING

·         On the 2ndpost partum day-Lie flat and raise head until the chin is touching the chest.

·         On the 3 rd post partum day-raise both head and shoulder off the bed and lower them slowly , increase gradually

LEG RAISING

·         Begun on the 7^th post partum day

·         Lying down on the floor with no pillows under the head

·         Point toe and slowly raise one leg keeping the knee straight

·         Lower the leg slowly.

KNEE ROLLING

·         This is to strengthen the oblique abdominal muscles.

·         In back lying with knees bent, pull in the abdomen and roll both knees to one side as far is comfortable, keeping shoulders flat.

·         Return knees to upright position and relax the abdomen.

·         Pull in again and roll both knees to other side.

·         Perform 10 times

 HIP HITCHING OR LEG SHORTENING

·         In back lying with one knee bent and the other knee straight.

·         Slide the heel of the straight leg down word thus lengthening the leg.

·         Shorten the same leg by drawing the hip up towards the ribs on the same side.

·         Repeat up to 10 times

·         Change to the opposite side and repeat.