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Saturday, November 6, 2010

POSTPARTUM CHANGES II: MAKING YOURSELF COMFORTABLE AND PREVENTING INFECTION

The perineum is the area between the vagina and rectum. This area may be swollen and painful after stretching to allow your baby to be born. Your doctor or midwife may have made a surgical incision, called an episiotomy, to enlarge the vaginal opening. This area may also be painful. During the time that the lining of the uterus and the episiotomy are healing, you will want to be extra-careful to prevent infection. It is important to keep your perineum very clean. Each time you use the bathroom or change your pad, be sure to remove the pad from front to back and clean the area from front to back (from your vagina to your rectum). After going to the bathroom, you can squirt yourself off with warm water, using a squirt bottle, and then pat yourself dry with clean tissue. You may feel discomfort or pain in this area for two or three weeks. There are several different ways to relieve the soreness and keep down swelling:

·         Place an ice pack on the perineum continually for the first 24 hours to minimize swelling.
·        Have your nurse show you how to use a sitz bath. A sitz bath is a small tub you place on the toilet. It can be filled with warm or cool water, whichever is more comfortable. As you sit on the toilet, the water washes over your perineum, relieving pain and speeding healing. Many women find this bath very relaxing and soothing. Women who are extremely uncomfortable may find it soothing to use cold water and add ice to the tub. When you are at home you can clean your bathtub well and sit in there if your perineum is still uncomfortable. If your doctor or midwife placed stitches, they will dissolve over time. Be sure that the water you sit in is not extremely hot, since this could dissolve the stitches prematurely.
·         If your health care provider suggests a spray or ointment for your perineum to relieve pain, read the instructions on the container. Most can be used three or four times a day. There are also small pads containing witch hazel that can be placed on the sanitary napkin and placed against your perineum to relieve pain. Talk to your health care provider about these options if not suggested.
·          Your doctor or midwife may also prescribe an analgesic for the pain.

Lochia
Your body will begin to expel the blood and mucus built up in your uterus. This flow is called lochia, and it will last about four to six weeks. For the first three days, your lochia is dark-red and made up of blood and some small clots. From the third to the tenth days, the fluid is pink or light-brown. Finally, the discharge will turn to a yellowish-white mucus and lasts for another two to eight weeks. Lochia should have a clean smell, like fresh blood or mucus. The amount of lochia may increase slightly when you first get out of bed in the morning, when you breastfeed, or when you stand up after lying down for a period of time. Contact your health care provider if:
·         your flow suddenly becomes heavier than it has been,
·          if it is bright-red beyond the first three or four days,
·          or if you notice large clots or a foul odor at any time.

 If your lochia suddenly becomes bright-red or contains clots after it has turned paler, this should also be reported to your health care provider.

Uterus
Your uterus will gradually shrink over the next six weeks, though it will probably never be as small as before your pregnancy (Mums, please believe me on this one!!).
For the first week or two, you can make sure your uterus is shrinking normally by gently pressing down and feeling it through your belly. PLEASE DO NOT PRESS HOT WATER AGAINST YOU TUMMY, IT IS AN ARK AGED TECHNIQUE THAT HAS BEEN PROVEN UNSAFE!!Have your nurse or doctor show you how to do this correctly. Your uterus should feel firm and round. The top of your uterus is normally just below your bellybutton on the first day or two after birth. It should descend one or two finger-widths every 24 hours. After the second week, you should no longer be able to feel your uterus, since it has grown much smaller. You can also wear a post pregnancy girdle to help with the uterus shrinking. Its also a great idea to have that girdle on while you excersice!!

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