Principles Includes
- Restoring health status of mother
- To prevent infection
- To take care of breast
- To motivate mother for contraception
Rest & Ambulance
- Early ambulation is encouraged
- Provides sense of well-being
- Facilitates uterine drainage & fasten involution of uterus
- Decreases puerperal venous thrombosis & pulmonary embolism
- Bladder complications & constipation are reduced
Diet
- In lactating woman, diet with high calories, protein, fat vitamins, minerals & plenty of fluids should be encouraged.
Care of Bladder
- Causes in patients failing to pass urine
- Unaccustomed position
- Reflex pain from perineal stitches
- If patient still fails to pass urine, catheterization is required
Care of Bowel
- Diet containing sufficient fibers & fluid should be taken to avoid constipation. Mild laxatives such as isabgol husk.
- Personal cleanliness especially after micturition & defecation
Care of Vulva & Episiotomy Wound
- Dressing with antiseptic cream twice a day & after micturition & defecation
Care of Breast
- Nipples & breasts should be washed with sterile water before each feeding
- Nipples soreness should be avoided by spout feedings & by keeping nipples clean & dry.
- A clean supporting brassiere should be worn
Postnatal Exercises
Objectives
- To improve muscle tone, which are stretched during pregnancy & labour (especially abdominal & perineal muscles) to prevent genital prolapse & stress incontinence of urine.
- To educate about course of posture to prevent backache
- To decrease risk of venous thromboembolism
- Exercises can be started as early as 7 days after delivery & continued up to 3 months
Exercises
- Breathing exercise & leg movements lying in the bed
Pelvic floor muscles
- Contract pelvic muscles in a manner to withhold an act of defecation & urination should be done several times a day.
Abdominal muscles
- Lie on back with knees bent & feet flat on bed. Abdominal muscles are contracted & relaxed alternatively; should be done several times a day.
Back muscles
- Lie on face with arms by side. The head & shoulders are slowly moved up & down; should be repeated 3-4 times a day & then increased gradually.
Breast Feeding
- All the babies regardless of type of delivery should be given early & exclusive breastfeeding up to 6 months of age.
Advantages
- Ideal composition for easy digestion
- Protection against infections (e.g. gastrointestinal infections) & deficiency states (e.g. vit D, vit C)
- Breast milk is readily available sterile & given to baby directly at body temperature
- No danger of allergy
- Establishes mother-child relationship
First Feed
- Normal delivery after 1/2-1 hr
- Cesarean delivery after 4-6 hrs
Time Schedule
- The baby should be fed every 2-3 hours. Regularity becomes established at 3-4 hrs pattern by the end of first week. The baby should be fed more on demand as well.
- Duration of Feed – Initial feeding should last 5-10 minutes at each breast. Thereafter, baby is fed from one breast completely so that baby can get both foremilk & hindmilk. The next feed should be started with second breast.
Techniques
Feeding in Sitting Position
- The mother holds baby in an inclined upright position on her lap
- The neck is kept slightly extended with baby’s ears, shoulder & hip in one line
- The Infant’s mouth is widely open & chin touches the breast
- The mother should guide nipple & areola into baby’s mouth
Burping
- The baby should be held upright against chest and his back is gently patted until he belches out air
- Burping enables the baby to take more feed
- The mother requires an additional 600 Kcal/day during breastfeeding
