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Common postnatal problems

Perineum

  • If the perineum has been damaged and repaired it may cause considerable pain, requiring analgesia.
  • If the perineum is painful, it is important to check the sutures and check for any signs of infection. Occasionally, sutures may need to be removed.
Micturition
  • Retention of urine can occur and can occasionally require catheterisation. [1]
  • Approximately 50% of women will develop some urinary incontinence and this usually takes the form of stress incontinence. This may persist after the pregnancy. Pelvic floor exercises should be taught and encouraged. [2]

  • :
  • Bowel problems:
    • Constipation may be a problem for a short time and stool softeners may be useful.
    • Haemorrhoids may be more painful after the birth than before. These can occasionally appear for the first time perinatally and these normally disappear within a few weeks.
  • Mastitis:
    • This may be due to failure to express milk from one part of the breast; it can be treated by ensuring all milk is expressed and with cold compresses.
    • It may be complicated by infection with Staphylococcus aureus and require treatment with flucloxacillin.
    • Very occasionally, a breast abscess develops and requires incision and drainage.
  • Backache:
    • This may persist after the birth and affects approximately a quarter of women.
    • Pain may be considerable and last for several months

 Psychological problems:

  • 'Third day blues': on days 3-5, a large proportion of women become temporarily sad and emotional.
  • Approximately 10% of women suffer from postnatal depression which may present at any time during the first year after delivery.
  • The precise cause of this is unknown and may involve hormonal changes, reaction to excitement of childbirth and doubts by the mother about her ability to care for the child.
  • Management consists of reassuring the mother and explaining what is happening

  

 

Signs and symptoms of potentially life-threatening conditions

Faintness, dizziness or palpitations

Fever, shivering, abdominal pain and/or offensive vaginal loss

Headaches accompanied by one or more of the following symptoms within the first 72 hours after birth:
• visual disturbances
• nausea, vomiting

Unilateral calf pain, redness or swelling

Shortness of breath or chest pain.

Medical advise should be sought immediately.

 

Mothers should start walking about as soon as possible, go to the toilet when necessary and rest when she needs to. She may prefer to stay in bed for the first 24 hours or longer if she has an extensive perineal repair.

This is an important time for the woman to be encouraged to breast-feed and learn to care for her infant.Uterine contractions continue after birth and some women suffer after-pains, particularly when breast-feeding, and may require analgesics.

 

 

 

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