**3.9 Perineal care**

In puerperium, the woman is advised to maintain hygiene and clean the vulva from anterior to posterior toward the anus. A cool pack may be applied to the

perineum to bring down edema and pain during the first 24 hours, especially in perineal laceration or an episiotomy.

#### **3.10 After pains**

Uterine involution manifests as several clinical findings. In primiparas, the uterus usually remains tonically contracted after delivery. Whereas in multiparas, the uterus contracts vigorously at intervals and manifests as afterpains, which are almost like labor pains. These pains are more pronounced as parity increases and worsen when the newborn lactates, because of oxytocin release. By the 3rd day post partum, afterpains decrease in intensity and become mild. In women with postpartum uterine infections, there may be severe and persistent after pains. Aspirin can be given with food in those cases.

Severe perineal, vaginal or rectal pain always warrants careful inspection and palpation. Hemorrhoidal veins are often congested at term. Thrombosis is common and may be promoted by second-stage pushing. Treatment for the condition includes topically applied anesthetics, warm soaks, and stool-softening agents.
