women s health issues
Overview of Postpartum Care
Hospital (What to Expect)
Immediately after delivery of a baby, the mother is monitored for at least 1 hour. If an anesthetic was used during delivery or if there were any problems during delivery, she may be monitored for several hours after delivery, usually in a well-equipped recovery room with access to oxygen, fluids given by vein (intravenously), and resuscitation equipment. Staff members check the mother’s pulse rate and temperature. Normally, within the first 24 hours, the mother’s pulse rate (which increased during pregnancy) begins to decline toward normal and her temperature may increase slightly, usually returning to normal during the first few days. After the first 24 hours, recovery is rapid. Hospital staff members make every effort to minimize the new mother’s pain and the risk of bleeding and infection. Minimizing bleeding is the first priority. After delivery of the placenta (afterbirth), a nurse may periodically massage the mother’s abdomen to help the uterus contract and remain contracted, thus preventing Excessive Uterine Bleeding at Delivery . If needed,oxytocinis given to stimulate contraction of the uterus. The drug is injected into a muscle or given intravenously as a continuous infusion until the uterus is contracted. If women lose a lot of blood during and after delivery, a complete blood count is done to check for anemia before they are discharged. Urine production often increases greatly, but temporarily, after delivery. Because bladder sensation may be decreased after delivery, hospital staff members encourage a new mother to try to urinate regularly, at least every 4 hours. Doing so avoids overfilling the bladder and helps prevent bladder infections. Staff members may gently press on the mother’s abdomen to check the bladder and determine whether it is being emptied. Occasionally, if the new mother cannot urinate on her own, a catheter must be inserted temporarily into the bladder to empty the urine. Infrequently, an indwelling catheter (a catheter that is left in the bladder for a period of time) is needed. The new mother is also encouraged to have a bowel movement before leaving the hospital. But because hospital stays are so short, this expectation may not be practical. Doctors may recommend that if she has not had a bowel movement within 3 days, she take stool softeners or laxatives to avoid constipation, which can cause or worsen hemorrhoids. If the rectum or muscles around the anus were torn during delivery, stool softeners are important to avoid pressure on that area. Opioids, which are occasionally given after cesarean delivery to relieve severe pain, can worsen constipation. So if an opioid is needed, the lowest effective dose of such drugs is used. A new mother can have a regular diet as soon as she wants it, sometimes shortly after delivery. She should get up and walk as soon as possible. A new mother can start exercises to strengthen abdominal muscles, often after 1 day if delivery was vaginal. Cesarean delivery is major surgery, and women should not begin exercising until they have had time to fully recover and allow healing, which typically takes about 6 weeks. Women can resume their prepregnancy exercise routine after approval from their doctor at their postdelivery visit. (See also Vaccines During Pregnancy , Before the mother leaves the hospital, she is given the Prevention if she has never had rubella or never been given this vaccine. Ideally, the Diphtheria-Tetanus-Pertussis Vaccine is given during each pregnancy, preferably between weeks 27 and 36. If a mother has never been given the Tdap vaccine during this or a previous pregnancy nor as an adolescent or adult, it should be given to her before she is discharged whether she is breastfeeding or not. If family members who will have contact with the newborn have never been given the Tdap vaccine, they should be given Tdap at least 2 weeks before they have contact with the newborn. The Tdap vaccine immunizes them against Pregnant women who have never had Chickenpox or been given the Doctors may recommend other vaccines, depending on the woman's vaccination and health history. If a new mother has Rh-negative blood and the baby has Rh-positive blood (called Hemolytic Disease of the Fetus and Newborn ), she is given Rho(D) immune globulin by injection into a muscle within 3 days of delivery. This drug masks any of the baby’s red blood cells that may have passed to the mother so that they do not trigger the production of antibodies by the mother. Such antibodies may endanger subsequent pregnancies. Before a new mother leaves the hospital, she is examined. If mother and baby are healthy, they commonly leave the hospital within 24 to 48 hours after vaginal delivery and within 96 hours after a cesarean delivery. Sometimes discharge is as early as 6 hours if no general anesthetic was used and no problems occurred. The mother is given information about changes to expect in her body and measures to take as her body recovers from having a baby. Regular follow-up visits are scheduled, usually starting at 3 to 8 weeks after delivery. If delivery was cesarean or if problems occurred, the first visit may be scheduled sooner. 