**3.11 Bowel and bladder function**

Stool softeners may be prescribed, especially if the patient has had a fourth degree perineal tear or a laceration involving the rectal mucosaduring delivery.

Hemorrhoids are varicosities of the hemorrhoidal veins and are commonly found in puerperium. Surgical treatment may be considered only after 6 months postpartum to allow for natural involution. Sitz baths, stool softeners, and local medicinal preparations are useful alongwith reassurance.

She goes to the toilet after 6 hours to pass urine Periurethral edema after vaginal delivery may cause transitory urinary retention.

#### **3.12 Retention of urine**

#### *3.12.1 Causes*


#### *3.12.2 Treatment*

Women go to toilet or sit on bedpan withscreen. Hot and cold water bottles are applied on hypogastrium. Plenty of oral fluid to be given. Catherization if she cannot pass urine. Patients' urinary output should be monitored for the first 24 hours after delivery. If catheterization is required more than twice in the first 24 hours, placement of an indwelling catheter for 1 to 2 days is advisable. Prolonged catheterization needs to be avoided.

#### *3.12.3 Pain, mood, and cognition*

Mild analgesics containing codeine, aspirin, or acetaminophen, preferably in various combinations are given as frequently as every 4 hours during the first few

#### *Normal Puerperium DOI: http://dx.doi.org/10.5772/intechopen.96348*

days. It is fairly common for mother to exhibit some degree of depressed mood a few days after delivery termed postpartum blues. Post partum blues can be multi factorial. Mostly, anticipation, recognition, and reassurance works. This disorder is usually mild and self-limited to 2 to 3 days, but sometimes may last up to 10 days. Persistence or worsening of moods calls for evaluation for symptoms of major depression.

## *3.12.4 Ambulation*

Postpartum patients should be encouraged to begin ambulation as soon as possible after delivery. Early ambulation helps avoid urinary retention and prevents puerperal venous thromboses and pulmonary embolism. Early ambulation is the key to faster recovery post delivery.

## *3.12.5 Breast care*

Nipples are cleansed with sterile water and cotton swab before and after feeding. They are covered with sterile bra. In non lactating women, breast engorgement occurs in the initial days of puerperium and gradually reduces over this period. Painful breasts should be supported with a well-fitting brassiere. Ice packs and analgesics may also help relieve breast discomfort and pain. Women who do not wish to breastfeed should be encouraged to avoid nipple stimulation and advised to avoid continued manual expression of milk. Mastitis, or infection of the breast tissue, most often occurs in lactating women and manifests as sudden-onset fever, localized pain and swelling in the breast. Mastitis is associated with infection by micro organisms like *Staphylococcus aureus*, Group A or B streptococci, β Haemophilus species, and *Escherichia coli*.

Treatment includes continuation of breastfeeding or emptying the breast with a breast pump to avoid engorgement and also use of appropriate antibiotics.

#### *3.12.6 Immunizations*

Women who do not have antirubella antibody should be immunized during the immediate postpartum period [6]. Breastfeeding is not a contraindication for that.

If a patient has not received the tetanus-diphtheria acellular pertussis vaccine, or it has been at least 2 years since her last tetanus-diphtheria booster, she should be administered a dose before discharge from hospital.

If the woman is Rh-negative blood group, not isoimmunized and has given birth to a Rh-positive or weak-Rh-positive baby, 300 micrograms of anti-D immune globulin should be administered postpartum, ideally within 72 hours of delivery.

## *3.12.7 Post partum posture and exercise*

In sitting posture she feeds her baby for sometime daily, she lies in her face for three weeks.

Deep breathing and simple movement of limbs are encouraged. Some simple exercises are practised when she feels it for after a few days to tone up abdominal and pelvic floor muscles as:-.

### 1.Deep breathing.

2.Abdominal wall is tightened on deep inspiration and breatheholding followed by its relaxation. This is done 10 times on floor with knees pulled up.


#### **3.13 Contraception**

Postpartum care in the hospital should include discussion of contraception. Approximately 15% of non-nursing women are fertile at 6 weeks postpartum. Progestin preparations (oral norethindrone or depo-medroxyprogesterone acetate) have no effect or may slightly facilitate lactation. Women may consider initiating progesterone-only contraceptives at 6 weeks if breastfeeding exclusively or at 3 weeks if not exclusively.

Postpartum sterilization is performed at the time of cesarean delivery or after a vaginal delivery and should not extend the patient's hospital stay.

#### **3.14 Sexual activity**

Coitus may be resumed when the woman is pain free and comfortable. However, the risks of hemorrhage and infection are minimal at approximately 2 weeks postpartum. Women should be counseled, especially if breastfeeding, that coitus may initially be uncomfortable because of a dry vagina as a result of low estrogen levels. In such conditions, use of exogenous, water soluble lubrication is helpful.

#### **3.15 Follow-up care**

By discharge, women who had an uncomplicated vaginal delivery can resume most activities, including bathing, driving, and household functions. The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists (2017) recommend a postpartum visit between 4 and 6 weeks. This has proven quite satisfactory to identify abnormalities beyond the immediate puerperium and to initiate contraceptive practices.

Advice on discharge for home:


The discharge carries the following:


She is also referred to infant immunization center for full immunization of infantsupto 10 months.

Post natal care:
