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The postpartum period is often called the “fourth stage of labor.” It can be divided into three phases:
• Initial or acute period: first 6 to 12 hours after delivery
• Second phase: 2 to 6 weeks after the initial period
• Third phase: Delayed postpartum that can last up to 6 months.
During the postpartum period, you may experience numerous physical, mental, and emotional changes. Due to the vast array of changes affecting all aspects of life, it is highly likely that there may be some complications during the postpartum period. Some of the common consequences of postpartum complications are:
• Concerns regarding sexual intercourse
• Breastfeeding problem
• Sleep disorders
• Urinary incontinence
• Posttraumatic stress disorder (PTSD)
Your health after the delivery will have a significant impact on the well-being of your baby. Therefore, it is crucial to know about the different possible postpartum complications and how to take care of them.
A normal postpartum period after childbirth also has its share of:
• Discomfort from perineal pain and uterine contractions.
However, it is essential to understand the difference between healthy recovery and symptoms of complications.
For example, bleeding in the postpartum period is reasonable. However, in a normal recovery process, the bleeding should gradually slow down. In case it hasn’t slowed down, and you are experiencing significant pain or cramps- it is a complication, and you should see your doctor.
At the time of your discharge from the hospital, some of your symptoms may not be noticeable. Therefore it is your responsibility to be vigilant.
Alert: Postpartum complications, if ignored, can lead to severe problems. Study shows that the number of pregnancy-related deaths (death of a woman during pregnancy or within one year from the delivery) has increased from 7.2 deaths per 100,000 live births (1987) to 16.9 deaths per 100,000 live births (2016).
Normally, the bleeding continues for two to six weeks after delivery. Moreover, immediately after giving birth, the bleeding is typically heavy and red in color often with clots which gradually decreases with time.
If bleeding doesn’t reduce with time or is persistent even after 6 weeks it suggests an abnormality. An increase in blood flow with physical activity or breastfeeding is standard.
When to see a doctor:
• Even after 3 to 4 days, the blood flow hasn’t decreased, and the blood is still red or consists of large clots.
• Intense pain or cramps coupled with an increase in the flow
• If the blood flow suddenly becomes heavier after slowing down and its color once again becomes bright red from a darker or lighter shade.
• Retained placenta
• Failure of the contraction of the uterus
Treatment and Care: You may need to go for an ultrasound that can detect the presence of any retained parts of conception/placenta. In such a case, your doctor would evacuate your uterus with the help of a procedure called Dilatation and Evacuation (D&E).
Breast pain is commonly felt in the postpartum period regardless of whether you breastfeed or not. The milk comes in 3 to 5 days after giving birth, and it can cause breast swelling or discomfort. Breastfeeding helps in taking care of the engorgement.
While breastfeeding, you may experience nipple pain and discomfort; however, over time, breastfeeding shouldn’t be painful. However, if you notice redness of the breast, it might be signs of a breast infection called mastitis.
When should you see a doctor:
• Redness of the breast
• The breast is painful and feels warm or hot on touch
“Baby blues” are a normal part of the postpartum period.
However, if you continue feeling low or depressed for more than a few weeks, you may be suffering from postpartum depression.
You should see your doctor without guilt if the depression after pregnancy prolongs or if you have thoughts of hurting the baby.
Postpartum depression can be treated.
Urinary incontinence (when you lose control of your bladder) and fecal incontinence (involuntary bowel movements) can occur in the postpartum period.
When should you see your doctor: Incontinence can occur sometime during the early part of the postpartum period; however, if this continues for a long time, you should see a doctor.
Treatment and care:
• The regular cases of urinary incontinence can be taken care of with simple kegel exercises.
• Caused by the weakening of muscles or an injury during birth, you can take care of fecal incontinence by wearing pads or menstrual underwear.
• If the fecal incontinence leads to constipation or hemorrhoids, you can test bringing changes in your diet. Creams or pads can also be used to treat hemorrhoids. You should, however, consult your doctor before you take any laxatives or medications.
• Your doctor may also suggest specific exercises to strengthen the pelvic floor muscles.
During delivery, either through C-section or vaginal delivery, there will be stitches or perineal tears. It is common to experience some pain; however, this pain should decrease with time with gradual healing.
If the pain increases with time, it might indicate infection. Some of the forms of experience that women may experience include:
a. Urinary tract infection
b. Kidney infection
c. Vaginal infection
When to see a doctor: Some of the symptoms of infection include:
• Incremental pain
• Pain during urination
Treatment and care: the doctors may recommend a simple round of antibiotics. However, if the infection becomes severe, you may need aggressive treatment or hospitalization. Hence don’t overlook the symptoms of the disease and contact your doctor immediately.
This is a condition in which the force of the blood against the artery walls is very high. If the blood pressure is above 140/90, it is labeled as hypertension, and the case becomes severe if the blood pressure exceeds 180/120
In about 5.7% of the cases, preeclampsia or eclampsia may start in the postpartum period even if there was no hypertension during pregnancy
Causes: the factors that may lead to an increase in blood pressure include:
• Drugs (nonsteroidal anti-inflammatory drugs-NSAID)
• Excessive fluid administration
• The vascular tone (amount of constriction in a blood vessel) to pre-pregnancy levels
When to see a doctor: The symptoms of hypertension include:
• High blood pressure–blood pressure greater than 140/90 mm Hg
• Severe headache
• Decreased urination
• Upper abdominal pain
• Excess protein in the urine – proteinuria
Treatment and Care: If a woman has preeclampsia or pre-existing hypertension:
• Her blood pressure should be monitored regularly
• NSAID should be avoided for pain control
In DVT, a blood clot (thrombus) is formed in the deep veins of your legs which lead to swelling and pain in the legs.
Alert: DVT can prove to be very serious as the blood clots may travel through the bloodstream and go into the lungs leading to pulmonary embolism. This is a life-threatening complication, and you should seek emergency services as soon as you notice:
• Sudden shortness of breath
• Coughing up blood
• Chest pain
• Rapid pulse
When to see a doctor: Occasionally, there may be no symptoms of DVT; however, if you notice the following contact, your doctor:
• Leg pain
• Swelling of the legs
• Red or discolored skin
• Warm sensation in the leg
Note: It is possible that you may not notice any symptoms. In 30% of the women suffering from pulmonary embolism (PE), silent DVT (no signs) is seen. Similarly, in 40-50% of women showing the symptoms of DVT, PE remains silent. This is why frequent visits to your obstetric care provider in your postpartum period is very crucial
Risk factors: Pregnant women are 5 times more likely to develop DVT. Some of the risk factors include:
• Inherited blood clotting disorder
• Previous history of blood clotting disease
• Sickle cell disease – affects the hemoglobin
• An autoimmune disorder like antiphospholipid syndrome or lupus
• Multiple pregnancies
Treatment or care: LMWH is the preferred drug of choice for the treatment and prevention of this condition
Pregnancy-related deaths are low in number. However, women with existing chronic conditions like cardiac disease, high blood pressure, or obesity are at a greater risk.
Typically anything ranging from severe chest pain to heavy bleeding to breathlessness and extreme anxiety can be seen as a warning sign or a symptom.
If you notice any such symptom, immediately seek emergency health services.
1. Postpartum Fever: If you notice you have a body temperature higher than 100.4 Fon any 2 of the first 10 days after the delivery, you should talk to your doctor.
Cause: Commonly, postpartum fever results from a genital tract infection.
2. Abnormal vaginal discharge(lochia): If you notice the following in your vaginal discharge contact, seek medical help:
• Changes inconsistency
• The color appears to be yellow, green or gray
• It looks foamy or frothy
• It is brown or blood-stained
• It is foul-smelling or has a smell that is like a fish or yeast.
3. Red streaks or lumps on breast: This happens because of a breast infection called mastitis. In this condition, you may have a plugged duct that promotes bacterial growth in stagnant milk. It typically causes breast pain, fever, and breast swelling.
4. Pain or burning sensation while urinating and/or increased frequency of urination: This condition happens typically because of an infection in the urinary tract (UTI –urinary tract infection). You may have an infection of the bladder(cystitis) or the kidney (pyelonephritis).
5. Pain in the lower back: You may be experiencing this because of a urinary tract infection.
6. Severe pain in lower belly: If you are experiencing this you might be having Endometritis (inflammation in the uterus lining) or retained parts of conception. This may be associated with low or high-grade fever.
7. Pain or redness near a c-section incision or perineal tear or episiotomy
Alert: In some cases, the body has an extreme reaction to an infection called sepsis. This can be life-threatening, and hence you should immediately go to the emergency room if you notice any of the following after delivery:
• Fever especially high grade
• Extreme pain or discomfort
• Fast heart rate or breathing
• Clammy or sweaty skin
• Chills or feeling cold
• Feeling confused
1. Heavy bleeding –hemorrhage: Postpartum hemorrhage is a rare condition that lasts for 12 weeks after the delivery, therefore immediately get in touch with your healthcare provider if you notice it.
2. Chest pain or breathlessness: If you are experiencing this, you may have developed a condition called pulmonary embolism. An embolism refers to a blood clot moves to different positions within the body. If the embolism reaches the lungs, it is called pulmonary embolism.
Alert: if you are experiencing breathlessness or shortage of breath, it may also be possible that you have developed preeclampsia. It is a severe condition in which certain body parts stop working properly, therefore don’t overlook this warning sign and consult your doctor immediately.
3. Depression: Postpartum depression is widespread among women. It can lead to feelings of sadness or hopelessness or wanting to hurt your baby. If the feeling of sadness lasts longer than 10 days after delivery, you should seek the consultation of your doctor.
4. Pain or swelling in the calves or tender legs: This may occur due to the formation of clots in your leg veins(deep vein thrombosis or DVT).
5. Blurred vision or intense headache or pain in the shoulder and upper right belly, swelling in the legs, hands, or face: If you are experiencing any of these, you may develop a severe condition called postpartum preeclampsia. These are signs of high blood pressure and improper working of some of your body organs.
Your postpartum health is essential not only for you but also for your newborn. Therefore you should always prioritize it.
In your clinical visits during pregnancy, you can discuss everything and seek anticipatory guidance form your doctor. You should discuss labor, childbirth, and possible complications of pregnancy or the postpartum period.
It is always helpful to know what is normal and what is not in the post-partum period. Warning signs help you to know when it is abnormal and when it warrants medical attention.
Moreover, after childbirth, your doctor would ask you to come for postpartum visits. This will allow him to monitor your health closely and screen for any complications.
Certain important aspects of Postpartum visits:
• Health monitoring: monitor all aspects of your health including physical, social, and psychological aspects.
• Regular visits: ensure better well-being of you and your child the postpartum visits must be regular and an ongoing process.
• Anticipatory guidance: it should start during the pregnancy, and it should focus on:
o Transition to parenthood
o Postpartum care so that the woman is ready for any foreseeable postpartum complications.
• Pregnancy risk complications: you should know the risk associated and probable course of the disease if you develop pregnancy-induced diabetes or hypertension.
• Chronic medical condition: regular follow up visits are even more important if you suffer from health issues such as hypertension, diabetes, obesity, thyroid disorders, mood disorders, renal disease.
• Abortion or stillbirth: A follow-up visit with your doctor is also essential in case of a:
o Neonatal death
Note: Postpartum care is critical.
However, routine postpartum visits are often overlooked. Many women don’t visit until four to six weeks after childbirth.
About 40% of the women don’t see a doctor due to limited resources. Due to this, only a tiny portion of mothers gets the guidance they need about postpartum recovery.
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