The gestation period of humans is 40 weeks which is also known as the antenatal period. After childbirth, the first six weeks is considered as the postpartum period. This period is very crucial to the health of the newborn baby and the mother.
In our culture, though significant attention is paid towards the mother during her pregnancy, the attention suddenly changes after the delivery of the newborn. The family cares more about the newborn baby. Especially, they are concern about breastfeeding. The attention of family towards the mother loses eventually. But, according to statistics, most maternal deaths in the world occur during this postpartum period. In addition, the mother is at risk of developing several health issues. Most importantly, the new mother is undergoing a very stressful situation and she needs a lot of psychological support.
Postpartum health has a lasting impact on the mother’s and child’s health. Maternal deaths can occur during the postpartum period. Though it is rare now, mothers can die due to excessive bleeding during the postpartum period. Mothers can also get various infections during this period. Wound site infections are another problem.
With the advancement of maternal care, we were able to minimise most of these consequences. But nowadays, psychological problems have emerged as an important health issue among postpartum mothers.
Excessive bleeding
Usually, after delivery, the womb shrinks to its original size. This shrinkage arrests bleeding. Hormonal influence leads to this process. But in some women, due to various reasons, this shrinking does not happen and they start bleeding. Sometimes they have massive bleeding. For some mothers bleeding may develop slowly, but could persist, ultimately leading to shock and death. That is why health workers are vigilant about vaginal bleeding until she is discharged from the hospital.
Postpartum care
We start postpartum care for a mother soon after childbirth. Her physical condition is monitored until she is discharged. Specially, we watch for bleeding. We also take special care of the surgical cuts. She is trained on self-care after going home. Medical staff in the hospital help her to gain psychological confidence during this challenging period.
Helping her to initiate breastfeeding is another important aspect. If the mother had high blood pressure or diabetes during the pregnancy, we draw up a follow-up plan and advise her. But the most important part of postpartum care should be performed when she is back home.
Our public health staff (MOH teams) deliver this part of care. Midwives visit homes several times and mothers also attend clinics. According to the system, a midwife visits each home once in the first five days, once within five to 10 days, once within 14 to 21 weeks, and once around 42 days. The mother is requested to attend the clinic in four weeks.
Main concerns of care
During the visits, we examine both the mother and the newborn. But, I would like to highlight the areas of concern regarding the mother. They are postpartum morbidities and the continuation of antenatal morbidities (hypertension, diabetes mellitus, anaemia). Postpartum complications such as bleeding and infection may arise due to delivery.
Special attention is paid to the mother’s psychological status as the postpartum period is known for several psychological problems. Some of these conditions can lead to serious consequences.
There are three main psychological conditions we are concerned with. Nearly 30 percent to 50 percent of mothers develop transient anxiety, sadness and irritability during the first week after pregnancy. This is called postpartum blues and is considered normal. Special concern from family members and offering help will relieve this. The husband also has a special role.
About 15 percent of mothers develop a serious condition called postpartum depression. Extreme sadness, tearfulness, and suicidal thoughts are the salient features of this condition. This condition appears around five days after childbirth and can last up to 12 weeks. Unless managed properly, the mother can commit suicide. So the mother should be referred to medical care.
Postpartum psychosis is the most serious condition. This is rare, but can lead to severe consequences. Abnormal thoughts, beliefs and behaviours are some symptoms. Some mothers believe that the child is not hers and try to kill the baby. These mothers need hospital admission and treatment. But the good news is that this condition is treatable.
During home visits and clinic visits, our midwives pay special attention to detecting these conditions. They are well trained for that. They perform special assessment methods. If they detect any issue, she will be directly referred to MOH doctors and then to a specialist psychiatrist if necessary.
But I should say that still there is a stigma in society about having care for psychiatric illnesses. It is not a sin or a crime. Anyone can get psychiatric illnesses. Rather than letting them end up with unfortunate consequences, we should encourage people to seek appropriate medical care. All these conditions can be treated and well controlled if detected early and referred to appropriate care.
Though breastfeeding exerts some family planning effects up to six months, a woman cannot rely on that. Therefore, once a woman starts sexual activities with her husband, protection should be provided. It should be reiterated that a mother should have a gap of at least two years between children. Therefore, the introduction of an appropriate family planning method by health staff is important. The IUCD (loop) is an ideal method if the woman wants to delay the next pregnancy up to five to six years.
Nutrition of a postpartum mother is another important aspect of postpartum care. Balanced and nutritious meals should be taken from the beginning. It will help to breastfeed as well. There are a lot of myths that certain fruits and vegetables are not safe during the lactating period. But they are just myths. Fresh fruits and vegetables are essential for adequate nutrition. Protein and iron-rich foods such as fish and eggs are also good sources. It is important to continue iron and calcium supplements for six months. A special nutrient source, Thirposha is also given for lactating mothers.
Breast milk is the most suitable nutrient source for the baby. So, every child should be exclusively breastfed up to six months. But some mothers face problems. Though inadequate breast milk production is the commonest complaint by mothers, actually what happens is the baby is not receiving adequate milk due to some problems in the positioning and attachment of the baby (how the mother sits, the way she keeps the child, and the way she takes the baby to the nipple). There are a lot of services to support mothers to correct their deficiencies. In every big hospital, there are lactation management units which support mothers with breastfeeding problems. This service is given by public health midwives. Rushing to start formula milk is not good and is not encouraged.
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