Medical brain notes 11

  Introduction   In the previous unit in this module we have acquired enough knowledge to make us manage pregnancy and conduct delivery successfully.   Now we shall discuss the care the woman requires within the first 6 weeks after delivery and how the body readjusts back to the period before pregnancy. We shall review contraception, so that she will get pregnant only when she desires.   Objectives At the end of this lesson the learner will be able to   ·                Assess process of involution of the uterus   ·                Promote the wellbeing of women after delivery recognize when lochia discharge is becoming abnormal   ·                Guide women in making informed choice on the method of family planning.   Main Content   Pu...

  Psychology of puerperium   Most women are happy during Puerperium. Some may be anxious, apprehensive and sensitive. These groups of women cry easily and find the task of caring for the baby too cumbersome. The midwife needs to be understanding in her dealings with the mother. Mothers are always appreciative of the midwife’s advice, kind approach, assurance, and assistance.   Puerperium is a period of excitement, the mother is eager to share her experiences with partner, family and friends. Physiology of puerperium   These are the changes that take place after delivery. This is characterized by endocrine activity. Oxytocin acts upon the uterine muscle and breast tissue. In the 3 rd  stage the action brings about the separation of the placenta and prevents hemorrhage (by the action of living ligature) and initiation of lactation. Other changes include the lochia which undergo sequential changes as involution progresses. The main changes occur in the uterine and ...

  Restoration of ovulation and menstruation   Women who breast feed exclusively and suckle on demand are likely to have delayed ovulation and menstruation for a considerable period. The more the woman suckles the higher the plasma prolactin level and the longer ovulation is delayed. For those who breastfeed partially ovulation may occur and subsequently pregnancy without menstruation for a considerable period. Ovulation may delay up to 5 months in lactating mother though menstruation may start earlier in breastfeeding mothers.   About 10% menstruation may start 10 th   week About 30% menstruation may start 20 th  week About 60% menstruation may start 30 th  week About 80% of non breastfeeding mothers may start 10 th  week and ovulation is likely to occur from this time onwards.   Post partum women should be warned that conception can take place whether they breastfeed or not.   Diminished volume of circulatory progesterone has a reverse effec...

  Management of puerperium   Caring for the woman, her newborn baby and her family after a normal delivery creates a happy, exciting and rewarding experience. It is a time when the midwife exercises her ability of observation and sensitivity to provide excellent nursing care. The puerperal woman is no more treated as ignorant, idle, ill woman, confined to bed. Today the puerperal woman is regarded to be healthy, intelligent, who is anxious to see, touch and care for her baby. The first ten days is regarded as the “lying- in-period” when close observation and adequate care should be given to the patient.   Care during puerperium must aim at: ·                Promote  physical  well  being  of  client  by   ·                correcting anaemia, providing comfort, cleanliness and promoting sufficient phy...