Nursing care for a postpartum mother. Nurse caring for a woman in labor

Kamyshinsky branch of GAPOU "Volgograd Medical College"

METHODOLOGICAL DEVELOPMENT OF A LECTURE CLASS

(lecture-dialogue)

Subject:

Title MDK 01.01: A healthy person and his environment

Well: 2

Speciality: Nursing

Form of study: full-time

Number of hours: 2

Developer: Smirnova E.V. - teacher

Methodological development

reviewed and approved

at the meeting of UMO No. 4

(Protocol No. __ dated " ____" __________ 2018)

Chairman of the UMO _________/Tolstokoraya T.N./

" _____" ________________2018

Kamyshin, 2018

Motivation for studying the topic:

A lack of knowledge of a medical worker can not only lead to insufficient assistance, but also provoke the development of complications, both on the part of the woman and the fetus.

The task of a medical worker, knowing the signs of labor, the characteristics and order of the birth process, is to provide qualified, timely and sufficient assistance.

Lesson objectives

Educational: the student must know:

Definition of the concept “Harbors of childbirth”, “Regular labor”, “Lactation”, “Humanization of childbirth”, “Partnership in childbirth”;

Characteristics of generic expelling forces; periods of childbirth, postpartum period;

The influence of the mother's condition on the course and outcome of childbirth;

Principles of observation and care of women in labor and postpartum;

The role of the nurse in promoting natural feeding and a healthy lifestyle.

Educational:

Promote the development of skills in mastering terms and knowledge;

Promote the development of memory, the ability to highlight the main thing in the material being studied;

Promote the development of clinical thinking.

Educational:

Contribute to the formation of interest in a future profession;

Foster a positive attitude towards learning and develop cognitive interest.

Formed general and professional competencies:

	Name of learning outcome	Mark
	Understand the essence and social significance of the future profession, show sustained interest in it.
	Organize your own activities, choose standard methods and ways of performing professional tasks, evaluate their effectiveness and quality.
	Make decisions in standard and non-standard situations, bear responsibility for them.
	Search and use information necessary for the effective performance of professional tasks, professional and personal development.
	Use information and communication technologies in professional activities.
	Work in a team and team, communicate effectively with colleagues, management, and consumers.
	Take responsibility for the work of subordinate team members and the results of task completion.
	Independently determine the tasks of professional and personal development, engage in self-education, plan advanced training.
	To navigate the conditions of frequent changes in technology in professional activities.
	Take care of the historical heritage and cultural traditions of the people, respect social, cultural and religious differences.
	Be ready to take on moral obligations towards nature, society and people.
	Organize the workplace in compliance with labor protection, industrial sanitation, infection and fire safety requirements.
	Lead a healthy lifestyle, engage in physical education and sports to improve health, achieve life and professional goals.
	Carry out measures to preserve and strengthen the health of the population, the patient and his environment
	Conduct sanitary and hygienic education of the population
	Participate in the prevention of infectious and non-infectious diseases

Integration links:

Intradisciplinary:

Human needs at different age periods. The role of nursing staff in maintaining and promoting health;

Infancy;

The role of family in human life. Family planning;

Physiology of pregnancy. Monitoring and caring for a pregnant woman.

Interdisciplinary:

Human anatomy and physiology.

Hygiene and human ecology.

Basics of Latin with medical terminology.

MDK 04.02 Solving patient problems through nursing care

Equipment:

Methodological development of a lecture lesson.

Projector, screen, laptop.

Main stages of the lesson:

Bibliography:

1. Kryukova, D.A. A healthy person and his environment: textbook. allowance. - Rostov n/D: Phoenix, 2012.- 384 pp. - (Medicine for you).

2. Aizman, R.I. Fundamentals of medical knowledge and healthy lifestyle: textbook. allowance /R.I. Aizman, V.B. Rubanovich, M.A. Sbetyalov.- Novosibirsk: Sib. university publishing house, 2009.- 214 p.- (University series)

3. Medic, V.A. Public health and healthcare: textbook / V.A. Medik, V.K. Yuryev. - M.: GEOTAR-Media, 2013. - 288 p.

Progress of the lesson:

	Stage name	Description of the stage	Pedagogical goal of the stage	Stage time
	Organizational	The teacher greets students, pays attention to their appearance, and notes those who are absent. Informs the topic, plan, goals of the lesson, motivates the study of the topic.	Creating a working atmosphere, creating cognitive interest in educational activities on this topic, disciplining and motivating students.
	Explanation material	Communicating new knowledge to students (Appendix 1):	Formation educational interest in this topic.
	Consolidating new material	Frontal survey. (Appendix 2).	Level determination mastering what is being studied material, identification weak points. Formation of OK and PC.
	Homework assignment	1. Lecture notes. 3.Draw up a “Fishbone” diagram (Problem: Lack of knowledge of a pregnant woman when preparing for childbirth) - Appendix 3.	Ensuring fair and conscious execution homework. This task can be use when forming Student portfolio

Annex 1

SUBJECT: Physiology of childbirth and the postpartum period. Observation and care of women in labor and postpartum

PLAN:

1. Harbingers of childbirth. Ancestral expelling forces.

2. Periods of labor, their duration and course.

3. Observation and care of the woman in labor. The influence of the mother's condition on the course and outcome of childbirth. Humanization of childbirth. Partnership in childbirth.

4. Postpartum period: early and late. The course of the postpartum period.

5. Observation and care of the postpartum woman. Hygiene and dietetics.

6.Lactation. Promotion of natural feeding and a healthy lifestyle.

Harbingers of childbirth. Ancestral expelling forces.

If a pregnant woman is attentive to the signals of her body, and the examination by a specialist is high-quality, we will not miss a number of signs that characterize the preparation of a pregnant woman’s body for childbirth. The period of manifestation of this group of symptoms is called the precursor period.

What subjective changes in a pregnant woman’s body can mean the imminent onset of labor?

1. 2-3 weeks before birth, the fundus of the uterus drops and the tightness of the diaphragm stops

(the woman notes easier breathing).

2. Signs of “maturity” of the cervix appear: the cervix shortens, softens, the cervical canal opens, as a result, a pregnant woman may notice the release of the mucus plug (discharge of a viscous mucous secretion from the vagina).

3. Nagging, irregular pain in the lower abdomen, in the sacral area (appearance of precursor contractions)

4. Slight loss of body weight (increased urination)

5. Objectively - the presenting part of the fetus is pressed against the entrance to the pelvis.

What (which generic forces) ensures effective labor activity during childbirth?

Contractions are regular contractions of the uterine muscles. At the beginning of labor, alternate every 10-20 minutes for 10-15 seconds, towards the end of labor up to 1 minute.

Pushing is a contraction of the abdominal muscles and diaphragm.

Are contractions and pushing processes controlled or not and why?

Contractions occur involuntarily and are not regulated by the mother in labor. The woman in labor can control her pushing.

What hormone is responsible for contractions during labor?

The main hormone responsible for contractions during labor is the hormone oxytocin, produced by the hypothalamus and accumulated in the pituitary gland.

Contractions of the uterus begin in the area of ​​the fundus and tubal angles → quickly capture the entire musculature of the body of the uterus to the lower segment. There are fewer smooth muscle fibers in the lower segment of the uterus, so during childbirth the lower segment stretches and thins.

Periods of labor, their duration and course.

Childbirth is a physical process in which the fetus is expelled from the uterine cavity through the birth canal.

How many stages of labor do you know?

Disclosure period

Exile period

Succession period

Let us characterize each of the listed periods.

DISCLOSURE PERIOD

Duration: for primigravidas - from 12 to 16 hours; in multiparous women - from 8 to 10 hours

It begins with the occurrence of regular labor - labor contractions and ends with the complete opening of the uterine pharynx to a degree sufficient to expel the fetus from the uterine cavity.

In primiparas, the cervix smoothes (opening of the internal uterine pharynx), and then the external pharynx opens; in multiparas, these processes occur simultaneously.

The process of opening the pharynx is carried out due to: distraction - stretching the circular muscles of the cervix and insertion (wedging) of the tense amniotic sac into the cervical canal.

The diameter of the uterine pharynx when fully opened reaches 10-12 cm. A contact zone is formed - the place where the head is covered by the walls of the lower segment, which divides the amniotic fluid into anterior and posterior.

When strong contractions develop, the boundary between the contracting upper segment and the stretching lower segment begins to appear - a contraction or boundary ring

PERIOD OF EXILE

Duration: for primigravidas - from 1 to 2 hours; for multiparous women - from 20 minutes to 1 hour

It begins with the moment of complete opening of the uterine pharynx and ends with the birth of the fetus.

Soon after the timely release of amniotic fluid, contractions intensify, their strength and duration increase, and the pauses between contractions shorten.

Attempts occur reflexively, under the influence of which the fetus is expelled:

The set of movements of the fetus as it passes through the pelvis is called biomechanism of childbirth:

If there is a threat of perineal rupture, an episiotomy or perineotomy is performed.

Simultaneously with the birth of the fetus, the posterior waters pour out.

Head cutting - during pushing

Eruption of the head - without pushing

FOLLOW-UP PERIOD

Active-wait-and-see tactics for up to 15 minutes.

It begins with the birth of the fetus and ends with the birth of the placenta.

The placenta includes the placenta, membranes and umbilical cord.

The expulsion of the placenta is carried out under the influence of subsequent attempts.

The nature of contractions differs depending on the period of labor.

What function do contractions perform depending on the stage of labor?

Dilation contractions - dilatation of the cervix

Expulsion contractions - expulsion of the fetus

Subsequent contractions help separate the placenta from the uterine wall and expel it.

Observation and care of the woman in labor. The influence of the mother's condition on the course and outcome of childbirth. Humanization of childbirth. Partnership in childbirth.

Observation and care of the woman in labor is carried out on the basis of the clinical protocol for the management of childbirth.

During the first stage of labor, complaints, medical history and life history are collected;

Physical examination (blood pressure, pulse, determination of uterine contractions; determination of fetal position and presentation, listening to the fetal heartbeat);

Assessment of contractions;

The doctor performs a vaginal examination;

Thermometry is taken at least every 4 hours;

Determine the blood type and Rhesus status of the mother in labor

In the second stage of labor the following is carried out:

Listening to the fetal heartbeat after each contraction;

Continuous clinical monitoring of the general condition of the woman in labor (consciousness, color of skin and mucous membranes, pulse, blood pressure), the condition of the lower uterine segment, the nature of labor, discharge from the genital tract.

From the moment the head is cut in - readiness to provide benefits provided at the birth of the fetus.

Assessment of the newborn’s condition using the Apgar scale at 1 and 5 minutes together with a neonatologist.

In the third stage of labor it is important to:

Monitoring the general condition of the woman in labor (consciousness, color of skin and mucous membranes, pulse, blood pressure);

Condition of the uterus, the nature of contractile activity, discharge from the genital tract;

Excreting urine with a catheter, identifying signs of placental separation within 30 minutes;

Assessment of total blood loss, discharge of the placenta, examination of the placenta, examination of the birth canal;

Assessment of blood loss during childbirth.

During the entire period of childbirth, a woman loses a certain amount of blood. Blood loss May be:

Physiological- 0.5% of body weight, but not more than 400 ml.

Border- 400 ml

Pathological- more than 400 ml

Postpartum period: early and late. The course of the postpartum period.

*early- first 2 hours after birth

*late- up to 8 weeks

It begins from the moment of birth of the placenta and lasts 6-8 weeks.

What changes, in your opinion, should occur in the body of a postpartum woman?

During this period, there is a reverse development (involution) of the woman’s genital organs and changes in other organs and systems that arose in connection with pregnancy and childbirth.

The exception is the mammary glands; their function reaches maximum development in the postpartum period.

The healing process of the inner surface of the uterus is accompanied by the formation of wound secretion - lochia

In the first 3 days - bloody

3-4 days - serous-sanguineous

Day 10 - light

3 weeks - scant with mucus from the cervical canal

5 weeks - stop

The process of formation of the cervix occurs within 2-3 weeks of the postpartum period - first, the internal os forms and closes, this occurs by the 10th day, and by the end of 3 weeks after birth, the external os closes.

By the end of the postpartum period, pigmentation disappears on the face, along the white line of the abdomen, on the nipples and areola.

Acromegaly - nose, ears, feet will disappear 1-2 weeks after birth.

After childbirth, the mammary glands enlarge, colostrum is released, and milk is released on the third day.

How long does childbirth last?

Doctors of Ancient Greece said that the sun should not rise twice over the head of a woman in labor.

The duration of labor for a primiparous woman is 10-12 hours, for a multiparous woman - 6-8 hours.

Childbirth can be:

Swift - within 2 hours

Fast - 4-6 hours

Prolonged - more than 12 hours

What status is assigned to the maternity hospital and children's clinics in our city?

Over the past decade, the international child-friendly program has begun to be actively implemented. There is also such a program in relation to the mother. It’s called: “Ten Steps of a Mother-Friendly Childbirth Initiative for Hospitals, Birth Centers, etc.

1. Offers all women in labor:

Access to women's chosen birth attendants, including fathers, partners, children, family and friends;

Unlimited access to a professional, experienced woman or childbirth care provider who provides ongoing emotional and physical support at all stages of the birth process;

Access to professional midwifery care.

2. Publishes accurate descriptive and statistical information about its maternity care services, including intervention and outcome.

3. Provides assistance during childbirth depending on the cultural, religious and ethnic values ​​of the mother.

4. Provides the woman in labor with complete freedom to walk, move at her discretion and take the position of her choice during contractions and pushing (except in cases of medical complications).

5. Precisely defines strategy and order:

Collaboration and consultation during the perinatal period with other maternity support services, including communication with a specialized maternity facility if it is necessary to move the mother from one place to another.

Communication between mother and child in all possible ways, including the prenatal period, postpartum support after discharge and breastfeeding support.

6. Does not regularly use procedures that are not scientifically based, including (but not limited to)

7. Practices limiting interventions such as:

The use of artificial induction of labor and stimulation of the labor process - in 10% of cases or less;

The use of episiotomy is 20% of cases or less, preferably 5% or less;

Cesarean section is performed in 10% of cases or less in regular maternity hospitals and in 15% or less in specialized ones (for women at high risk);

The birth of a child by vaginal method after cesarean section is 60% or more, preferably 75%.

8. Educates staff on non-drug methods of pain relief and does not promote the use of analgesic or anesthetic medications unless required in the event of a complication.

9. Encourages all mothers and their families, including families with sick or premature babies or children with congenital problems, to contact, bond, breastfeed and care for their newborns to the extent their condition allows.

10. Struggles to achieve the WHO (World Health Organization) - UNICEF (United Nations Children's Fund) initiative to create conditions for successful breastfeeding: “Ten steps of a child-friendly attitude.”

Observation and care of the postpartum mother. Hygiene and dietetics.

Lactation. Promotion of natural feeding and a healthy lifestyle.

After childbirth, a woman’s birth canal is an extensive wound surface. Sources of infection can be endogenous and exogenous. Endogenous infection is pustular diseases, carious teeth, sore throat, inflammatory processes of the genitourinary organs of the woman herself. Exogenous infection penetrates through hands, instruments, dressings (microflora of the throat and nose of personnel). The fight against postpartum infections is carried out with preventive measures. The basis of prevention is strict adherence to asepsis and antisepsis in medical institutions and rules of personal hygiene.

During pregnancy, it is of great importance to follow the rules of pregnancy hygiene, eliminate foci of infection, keep the body clean, sexual abstinence in the last 2 months of pregnancy, and isolate the pregnant woman from an infectious patient.

During pregnancy honey. the employee visits the pregnant woman at home, teaches her how to care for herself, and provides the necessary assistance. Early registration of a pregnant woman is important. After discharge from the maternity hospital, the antenatal clinic continues to monitor the postpartum woman. Honey. the employee visits her at home, monitors the fulfillment of the doctor’s instructions, helps in organizing everyday life, caring for the child, and ensuring that she is fed properly.

The diet of a postpartum mother in the first week after childbirth consists of consuming easily digestible food at least 4 times a day. During breastfeeding, nutrition should be complete, as during pregnancy, with a high content of vitamins, without limiting salt and liquid, but with the prohibition of alcoholic beverages, hot and spicy dishes,

Even during pregnancy, a woman’s body begins to prepare for the process of feeding a child. Milk production begins in the second trimester of pregnancy.

Lactation is the formation of milk in the breast of a nursing mother, its accumulation and excretion. Each woman's lactation period is individual.

What tasks do medical personnel face when working with a postpartum woman?

The task of the medical worker is:

Training a pregnant woman in hygienic care of the mammary glands, preparing the mammary glands for breastfeeding;

Training in proper attachment and principles of breastfeeding;

Informing about diet during breastfeeding and promoting a healthy lifestyle;

Information about ways to increase lactation (if necessary).

Homework:

1. Study the lecture notes.

2. Kryukova D.A. “A healthy person and his environment” pp. 256-283

3.Draw up a “Fishbone” diagram (Problem: Lack of knowledge of a pregnant woman when preparing for childbirth) - Appendix 3.

Appendix 2

Frontal survey.

1. What are called the harbingers of childbirth?

2. What is childbirth?

3. How do contractions differ from pushing?

4. How many periods of labor are there?

5. When does the postpartum period begin?

6. Define the concept of “lactation”.

7. What principles of humanization of childbirth are used in modern maternity hospitals?

Appendix 3

“Fishbone” scheme

Explanation: the diagram includes the main four blocks, presented in the form of a head, tail, upper and lower bones. The connecting link is the ridge of the fish.

Head - a problem, question or topic that is subject to analysis.

The upper bones (located on the right at an angle of 45 degrees from above) - the basic concepts of the topic and the reasons that led to the problem are recorded on them.

The lower bones are facts confirming the presence of the stated reasons, or the essence of the concepts indicated in the diagram.

The tail is the answer to the question posed, conclusions, generalizations.

Assignment: analyzing all the material covered on MDK 01.01. “A healthy person and his environment”, you need to fill out the “Fishbone” diagram.

Problem: lack of knowledge of a pregnant woman when preparing for childbirth.

The postpartum (puerperal) period is the final stage of the gestational process, characterized by the reverse development of organs and systems that have undergone changes in connection with pregnancy and childbirth, the formation, flourishing of the lactation function of the mammary glands and the restoration of the activity of the hypothalamic-pituitary-ovarian system. The postpartum period lasts 6-8 weeks.

The first 2 hours after delivery are especially distinguished and designated as the early postpartum period. During this period, monitoring of the general condition of the postpartum woman, the height of the uterine fundus and the amount of bloody discharge from the vagina continues. Women at risk of bleeding continue to receive intravenous uterotonics.

30-60 minutes after birth, an examination with the help of speculums of the soft birth canal is necessary, which can also be carried out under intravenous anesthesia. Perineorrhaphy can be performed under local infiltration anesthesia.

An individual sterile set of instruments for examining the cervix and walls of the vagina includes: vaginal speculum, two pairs of window clamps, tweezers, a needle holder, needles, suture and sterile dressing material.

Inspection of the soft birth canal is carried out in the following order:

Treating the external genitalia and the obstetrician’s hands with an antiseptic solution, examining the condition of the perineum and vulvar ring;

Insertion of speculum into the vagina and removal of blood clots from the vagina;

Exposing the cervix using mirrors and sequentially examining it using window clamps (if there are cervical ruptures, catgut sutures are placed on the wound),

Inspection of the vaginal walls, suturing if there is damage to the vaginal walls, removing speculum;

Inspection of the perineum and restoration of its integrity after perineotomy or rupture;

Estimation of the total volume of blood loss;

Excretion of urine.

The postpartum woman is transferred to the postpartum ward 2 hours after birth. The translated epicrisis records her general condition, blood pressure, pulse rate, body temperature, height of the uterine fundus and the amount of discharge from the genital tract, and indicates treatment prescriptions. Daily examination of the postpartum mother is carried out in the following sequence.

1. Assess the complaints of the postpartum woman and her general condition. At least 2 times a day, body temperature, blood pressure, and pulse rate are measured, which are compared with body temperature. In case of somatic pathology, auscultation and percussion of the heart and lungs are performed

2. Determine the formation of lactation and the condition of the mammary glands - shape, features of the nipples (retracted, flat, presence of cracks), degree of engorgement, milk outflow.

3. The abdomen is palpated (superficial and deep), the height of the uterine fundus is determined and compared with the day of the postpartum period. By the end of the 1st day after birth, the fundus of the uterus is located at the level of the navel. Over the next 24 hours, it drops 1.5-2 cm below the navel. On the 5th day, the fundus of the uterus is located in the middle of the distance between the womb and the navel; by the 12th day it is hidden behind the womb. By the end of the 6-8th week after birth, the uterus is not enlarged in size. Assess the consistency and soreness of the uterus.

4. Assess the number and nature of lochia and their correspondence to the day of the postpartum period. In the first 3 days, the lochia is bloody, on the 4-7th day - bloody. On the 10th day, the discharge is light, liquid, without blood, then scanty; 5-6 weeks after birth, discharge from the uterus completely stops.

5. Inspect the external genitalia, perineum, sutures (swelling, infiltration, suture dehiscence, wound suppuration), and treat them.

6. Physiological functions are clarified.

During the physiological course of the postpartum period, a diet with restrictions on citrus fruits, chocolate, strawberries, and honey is recommended (the energy value of the daily diet is 3200 kcal). The amount of liquid should be at least 2 liters per day. From the 2nd day, the following are indicated: therapeutic exercises, daily shower.

Breastfeeding is carried out at the request of the newborn, without observing time intervals. It is necessary to comply with hygienic requirements for caring for the mammary glands.

The external genitalia of the postpartum woman are treated daily (in the examination room). If there are stitches on the perineum, they are treated with tincture of iodine, iodonate or a 1% alcohol solution of brilliant green. If necessary, UV irradiation is prescribed to the perineal area.

Sutures from the perineum are removed on the 5th day after birth (a cleansing enema is given the day before).

The postpartum woman is discharged on the 5-6th day after birth (after receiving the results of a clinical blood and urine test and an ultrasound examination of the uterus).

In the postpartum period, the most common complications are nipple cracks, hypogalactia and uterine subinvolution. For cracked nipples, to accelerate healing and prevent infection, UV irradiation and ointment applications (methyluracil, solcoseryl, actovegin and benopten ointments, sea buckthorn and rose hip oils) are used, and breastfeeding is carried out through a special pad. For hypogalactia it is recommended:

Frequent breastfeeding;

Sufficient fluid intake (2-3 l), currant or rosehip syrup, potato juice, walnuts;

Intramuscular injections of lactin (100 units 2 times a day for 5-6 days);

Metoclopramide (cerucal, raglan) or motilium (1-2 tablets 3 times a day);

Apilak (0.01 g 3 times a day for 10-15 days);

Nicotinic acid (1-2 tablets 15 minutes before breastfeeding);

Ultraviolet radiation, ultrasound on the area of ​​the mammary glands or their vibration massage.

For subinvolution of the uterus, the use of uterotonics is indicated for 1 treatment for 3-4 days:

Oxytocin (2 times a day intramuscularly or intravenously, 1 ml in 400 ml of isotonic sodium chloride solution);

Ergometrine (0.0002 g 3 times a day);

Ergotal (0.001 g 2-3 times a day);

Quinine (0.1 g 3 times a day);

Tinctures of water pepper (20 drops 3 times a day).

It is possible to prescribe a diodenamic to the lower abdomen.

Goals of postpartum care:

· the fastest possible return of the postpartum mother to normal life, development of exclusive breastfeeding skills;

· prevention of postpartum complications;

· maintaining the health of the newborn and preventing his diseases.

Good organization of the maternity facility contributes to successful breastfeeding, which lasts for a long time. In maternity hospitals where mother and newborn stay together, mothers in labor are helped to start breastfeeding in the first minutes after the birth of the child (subject to the physiological course of labor). Immediately after cutting the umbilical cord, the newborn is dried with a sterile warm diaper and placed on the mother’s bare stomach, covered with a blanket. In this position, the postpartum mother independently holds the baby for 30 minutes. The midwife then helps with the first breastfeeding. It should not be forced; the child may not immediately develop a desire to suck.

Contact “skin to skin”, “eyes to eyes” contributes to a favorable feeling of psychological comfort in the postpartum mother and the emergence of emotional closeness with the child. The most important point of this technique is to facilitate the adaptation of a newborn to extrauterine life by colonizing his skin and gastrointestinal tract with microorganisms from the mother.

After processing the umbilical cord, the healthy child is placed in the ward with the mother.

The first 2–2.5 hours after a normal birth, the woman in labor is in the delivery room. The obstetrician carefully monitors the woman’s general condition, her pulse, blood pressure, and constantly monitors the condition of the uterus: determines its consistency, UMR, and monitors the degree of blood loss. In the early postpartum period, the soft tissues of the birth canal are examined. Examine the external genitalia, perineum, vagina and its vaults. The cervix and upper vagina are examined using speculums. All detected tears are sutured. When assessing blood loss during childbirth, the amount of blood released in the afterbirth and early postpartum periods is taken into account. The average blood loss is 250 ml.

The maximum physiological blood loss is no more than 0.5% of the postpartum woman’s body weight, i.e. with a body weight of 60 kg - 300 ml, 80 kg - 400 ml.

After 2–4 hours, the postpartum woman is transported on a gurney to the postpartum department.

The processes occurring in the body of a postpartum woman after an uncomplicated birth are physiological, so the postpartum woman should be considered healthy.

It is necessary to take into account a number of features of the course of the postpartum period associated with lactation, the presence of a wound surface at the placental site, and the state of physiological immunodeficiency. Therefore, along with medical supervision, it is necessary to create a special regime for the postpartum mother with strict adherence to the rules of asepsis. In the postpartum department, it is necessary to strictly adhere to the principle of cyclical filling of the wards. Mothers who gave birth within one day are placed in one ward. Compliance with cycles is facilitated by the presence of small wards (2-3 beds), as well as the correctness of their profile, i.e. allocation of wards for postpartum women who, due to health reasons, are forced to stay in the maternity hospital for a longer period. The rooms in the postpartum ward should be spacious. Each bed is provided with at least 7.5 sq.m. area. In the wards, wet cleaning, ventilation, and ultraviolet irradiation are carried out twice a day (up to 6 times per day). After the mother is discharged, the ward is thoroughly cleaned (walls, floors and furniture are washed and disinfected). Beds and oilcloths are also washed and disinfected. After cleaning, the walls are irradiated with mercury-quartz lamps. Soft equipment (mattresses, pillows, blankets) are processed in a disinfection chamber.

Staying together between mother and child significantly reduces the risk of postpartum complications in postpartum women and newborns. This is due to the fact that the mother cares for the child independently, limiting the contact of the newborn with the staff of the obstetric department, reducing the possibility of infection with hospital strains of opportunistic microorganisms. On the first day, the department nurse helps care for the newborn. She teaches the mother the sequence of treating the baby’s skin and mucous membranes (eyes, nasal passages, washing), teaches the use of sterile material and disinfectants, feeding and swaddling skills. A pediatrician examines the umbilical cord stump and umbilical wound.

Currently, active management of the postpartum period is accepted, which consists of early (after 4-6 hours) getting up, which helps improve blood circulation, accelerate the processes of involution in the reproductive system, normalize the function of the bladder and intestines, as well as prevent thromboembolic complications. Women in labor are monitored daily by an obstetrician and a midwife. Body temperature is measured 2 times a day. Particular attention is paid to the nature of the pulse and blood pressure is measured. The condition of the mammary glands, their shape, the condition of the nipples, the presence of abrasions and cracks (after feeding the child), the presence or absence of engorgement are assessed. The external genitalia and perineum are examined daily. Pay attention to the presence of edema, hyperemia, and infiltration.

If urination is delayed, you should try to cause it reflexively (open the water tap, pour warm water on the urethral area, place a warm heating pad on the pubic area). If the result is negative, oxytocin injections of 1 ml 2 times a day intramuscularly, 10 ml of a 10% solution of magnesium sulfate intramuscularly once, and catheterization of the bladder are used. If repeat catheterization is necessary, a Foley catheter should be used for 24 hours.

In the absence of independent stool, a laxative or cleansing enema is prescribed on the third day after birth.

To obtain an accurate idea of ​​the true rate of uterine involution on days 2–3, it is recommended to perform an ultrasound of the uterus using special nomograms of ultrasound parameters. In addition, this method allows you to assess the number and structure of lochia present in the uterus. The retention of a significant amount of lochia in the uterus can serve as a reason for its surgical emptying (vacuum aspiration, light curettage, hysteroscopy).

Caring for the external genitalia, especially if there is a tear or cut in the perineum, includes washing with a weak disinfectant solution and treating the seams on the skin with an alcohol solution of brilliant green or potassium permanganate. In recent years, silk sutures are almost never applied to the skin of the perineum, since caring for them is more complicated and requires their removal no earlier than 4 days of the postpartum period. In addition, there is a possibility of the formation of ligature fistulas. An alternative to silk sutures are modern absorbable synthetic threads (Vicryl, Dexon, Polysorb). Their use does not prevent the earliest possible discharge.

If hyperemia, tissue infiltration, or signs of suppuration appear, the sutures should be removed.

To prevent genital prolapse and urinary incontinence, all postpartum women are recommended to practice Kegel exercises from the first day after birth. This complex is designed to restore the tone of the pelvic floor muscles and consists of their voluntary contraction. The main difficulty of these exercises is to find the necessary muscles and feel them. You can do this in the following way - try to stop the flow of urine. The muscles that are used for this are the perineal muscles.

The set of exercises consists of three parts: · slow compressions: tense the muscles, as to stop urination, slowly count to three, relax; · contractions: tense and relax the same muscles as quickly as possible; · pushing: to push, as during bowel movements or childbirth.

You need to start training with ten slow compressions, ten contractions and ten push-ups five times a day. After a week, add five exercises to each, continuing to perform them five times a day. In the future, add five exercises every week until there are thirty.

Only after the tone of the perineal muscles has been restored, the postpartum woman is allowed exercises to restore the tone of the abdominal muscles.

After childbirth, a healthy mother can return to her usual diet. However, until normal bowel function is restored (usually the first 2-3 days), it is recommended to include more fiber-rich foods in the diet. It is very important to have lactic acid products containing live bifido and lactocultures in the daily menu. Breastfeeding women may be advised to include in their diet special dry dietary formulas used as a milk drink. Oxygen cocktails are very useful.

However, lactation and breastfeeding dictate certain dietary restrictions. It should be remembered that the composition of breast milk deteriorates if a nursing mother overloads food with carbohydrates, eats a lot of sugar, confectionery, and cereals. At the same time, the amount of protein in milk decreases. It is necessary to limit the consumption of so-called obligate allergens: chocolate, coffee, cocoa, nuts, honey, mushrooms, citrus fruits, strawberries, some seafood, as they can cause unwanted reactions in a child. You should also avoid canned food, spicy and strong-smelling foods (pepper, onion, garlic), which can give the milk a specific taste.

Alcohol and tobacco consumption is strictly prohibited. Alcohol and nicotine easily pass into breast milk, which can cause serious disturbances in the child’s central nervous system, including mental retardation.

To prevent infectious complications, strict adherence to sanitary and epidemiological requirements and personal hygiene rules is important.

Compliance with the rules of personal hygiene should protect the postpartum mother and newborn from infection. You should take a shower and change your underwear every day. Keeping the external genitalia clean is of great importance.

Lochia not only contaminates them, but also causes maceration of the skin, and this contributes to the upward penetration of infection. To prevent this, it is recommended to wash the external genitalia with soap and water at least 4-5 times a day.

Caring for a healthy postpartum mother is inseparable from caring for her healthy newborn; it is carried out in accordance with modern perinatal technologies. They are based on the fact that the mother and newborn stay together, which ensures exclusive breastfeeding.

Modern perinatal technologies include a set of measures based on traditional methods of caring for healthy children, recognized by all nations.

Modern perinatal technologies are based on exclusive breastfeeding.

To ensure exclusive breastfeeding you need:

Immediate attachment of the baby to the mother's breast after birth;
· stay of mother and child together in the maternity hospital;
· exclusion of all types of drinking and feeding, except breast milk;
· inadmissibility of using pacifiers, horns and pacifiers, which weaken the oral motor skills of the newborn;
· breastfeeding the baby on demand, without night intervals;
· the earliest possible discharge from the maternity hospital.

First of all, staying together is necessary to reduce the contact of the newborn with other children. Even in a four-bed ward, this contact is limited to three children, and not 20–25 as in “departments”
newborns."

The most important thing is the possibility of feeding on demand, which also prevents children from supplementing with water, glucose, etc.

An equally important result of being together is the formation of a common biocenosis in the child with the mother and the acquisition by the mother of the skills of caring for a newborn under the guidance of medical personnel.

Watering and supplementary feeding of healthy children is generally not required either in wildlife or in human society. Moreover, drinking and feeding performed with the help of nipples and horns leads to a weakening of oral motor skills - the main factor in proper sucking.

When sucking weakens, the myoepithelial zone of the nipple and alveoli do not completely empty, and there is no full stimulus for the production of prolactin. All this leads to the development of hypogalactia. This fully applies to the use of “pacifiers”.

A major role in developing breastfeeding skills and successful subsequent lactation belongs to medical personnel (midwife, neonatal nurse).

Basically its tasks boil down to the following:

· in most cases it is simply observation, communication, psychological and emotional support;
· it is possible to participate together with a doctor in preparing for further breastfeeding (explaining the advantages of such feeding, informing about feeding techniques and processes occurring after childbirth, lactation mechanisms, discussing emerging issues);
· providing assistance with the first attachment of a newborn to the breast immediately after birth;
· at the early stage of breastfeeding, if the mother has difficulties - providing practical assistance (mother's position, nipple latching), encouraging feeding on demand, helping the mother realize that she has enough colostrum (milk) for successful feeding.

Medical personnel should not give newborns any other food or drink, or sedatives.

Absolute contraindications to breastfeeding:

· drug and alcohol use;
T cell leukemia;
· breast cancer (BC);
· herpetic rash on the nipples;
· active form of pulmonary tuberculosis;
· taking chemotherapy drugs for cancer;
· HIV infection;
galactosemia in a child.

The presence of breast implants is not a contraindication to breastfeeding.

Modern perinatal technologies require early discharge of the mother and newborn from the hospital.

A very effective method of surgical cutting off the umbilical cord 12 hours after birth, which provides a significant reduction in infection of the umbilical cord, allows you to speed up discharge from the maternity hospital.

In Russia, discharge is usually possible on the third day after vaccination (anti-tuberculosis vaccine).

In different countries, these periods range from 21 hours (USA) to 4–5 days (Germany, Italy). The purpose of early discharge is to prevent infections in postpartum women and newborns.

The same goal is served by home births, which are making a comeback, particularly in Northern Europe (the Netherlands). Due to the high cost of medical care for home births, they will not dominate in most countries of the world in the near future.

The listed technologies make it possible to minimize postpartum complications in mothers and newborns.

Before discharging a postpartum woman from the hospital, it is necessary to assess the condition of her mammary glands, the degree of involution of the uterus and its pain, assess the nature of the lochia and the condition of the sutures. It is necessary to palpate the soft tissues of the thighs and legs to exclude deep vein thrombophlebitis. In case of complicated pregnancy and childbirth, a clinical blood test and a general urine test should be performed. If there are deviations from the physiological course of puerperia, a vaginal examination may be necessary. The doctor must make sure that the postpartum woman has normal bowel movements and urination, and also inform that lochia will be secreted for at least three, and sometimes five weeks. On the eve of discharge, it is necessary to have a conversation about the peculiarities of the regime at home.

A woman must observe the same rules of personal and general hygiene as in the maternity hospital. She should be advised to reduce the amount of usual physical activity, provide at least two hours of daily rest and mandatory walks in the fresh air. Regular and balanced nutrition is an important condition for the successful course of puerperia. The timing of returning to a normal lifestyle, normal physical activity and returning to work is determined individually. The duration of temporary disability is 6 weeks. Usually, on the first day after discharge, active patronage of the postpartum mother and newborn is carried out at home.

At the first visit to the antenatal clinic within 4-6 weeks after birth, the patient should be weighed and blood pressure measured. Most postpartum women lose up to 60% of the body weight gained during pregnancy. If childbirth is complicated by bleeding and concomitant anemia, a clinical blood test should be performed over time. If there is bleeding, it is necessary to carry out additional studies (ultrasound) and prescribe appropriate treatment. When examining the mammary glands, pay attention to the condition of the nipples (cracks) and signs of milk stagnation (lactostasis). At the same time, it is advisable to strongly support the goal of successful breastfeeding. Breastfeeding women often have dry vaginal mucosa as a result of hypoestrogenism. In these cases, it is necessary to prescribe a topical estrogen cream to reduce discomfort during sexual intercourse.

When examining the external genitalia, you should pay attention to the condition of the scar on the perineum (in case of ruptures or episiotomy) and the presence of signs of pelvic floor muscle failure. When examining the cervix using a speculum, a PAP test should be performed. With a two-manual vaginal examination in the postpartum period, it is often possible to determine a slight deviation of the uterus back, which goes away over time without treatment. For uterine prolapse, stress urinary incontinence, cystocele and rectocele, surgical treatment methods are used only if the woman no longer plans to give birth. Vaginoplasty is recommended to be performed no earlier than 3 months after childbirth.

When visiting a doctor, it is also necessary to choose a method of contraception and diagnose possible complications of childbirth, such as back pain and postpartum depression. A trusting relationship between the patient and the doctor helps preserve a woman’s reproductive health for many years.

Newborn examination

Examination of a newborn baby usually begins with an assessment of his condition. There are 3 degrees of condition: satisfactory, moderate and severe. In addition, there is also an extremely severe or preagonal (terminal) condition. The severity of a newborn baby’s condition can change not only during the day, but even within hours.

Apgar score
In obstetrics and pediatrics, the Apgar scale is used to assess the severity of the condition of a newly born child. The Apgar scale is a method of assessing the condition by examining respiratory rate, heartbeat, muscle tone and activity, and skin color. Each clinical sign studied is tested and scored using a three-point system. A well-expressed sign is assessed with a score of 2, an insufficiently expressed sign - 1, the absence or distortion of a sign - 0. Typically, scoring is carried out in the first and fifth minutes of a child’s life and the values ​​are summed up. The Apgar score can be two-digit, for example - 5/6 points or 7/8 points. The first number corresponds to this sum of points in the first minute, the second number corresponds to the sum of points in the fifth minute. A child’s condition with a score of 7–10 is considered good, optimal, and a child’s condition with a score of 4–6 points indicates a slight deviation in health, 3–4 points is regarded as a condition of moderate severity, 0–2 points indicates serious deviations in health. newborn

Visual inspection
When examined, a healthy newborn is characterized by a calm facial expression and a kind of lively facial expression. The beginning of the examination can often be accompanied by a loud emotional cry. The duration and strength of the cry characterize the child’s maturity indicator.

Movements in newborns are mostly unconscious, excessive, uncoordinated, and athetosis-like.

Usually the newborn lies on his back: the head is brought to the chest, the arms are bent at the elbows and pressed to the side of the chest, the hands are clenched into fists, the child’s legs are bent at the knees and hip joints. When the child is lying on his side, the head is sometimes thrown back. This is the so-called embryonic position (flexion position due to the physiological increase in the tone of the flexor muscles).

When examining a child, you can also note various birth defects: strabismus, facial paralysis, drooping upper eyelid, nystagmus.

A newborn baby has a normal smell. A peculiar odor emanating from a newborn may be one of the early symptoms of hereditary metabolic diseases.

When examining the skin of a mature, full-term newborn, one notices soft, elastic, pink, velvety to the touch and slightly dry skin. When you try to fold it into a fold, it immediately straightens out. Immediately after birth, it is covered with vernix (caseous, cheese-like lubricant). It is whitish in color and a greasy viscous mass. In some newborns, whitish-yellowish dots (milia) are found on the wings and dorsum of the nose, less often in the area of ​​the nasolabial triangle, telangiectasia - reddish bluish vascular spots, petechial hemorrhages. Mongolian spots can be detected, which are located in the sacrum, buttocks, less often on the thighs and are bluish pigment spots; Brown birthmarks can be localized in any area of ​​the newborn’s body. Milliaria crystalina - pinpoint bubbles in the form of dew droplets that are found in newborns in the nose area. They are retention cysts of the sweat glands.

The skin of a newborn is covered with a network of capillaries that are easily visible through the skin.

The skin color of a healthy newborn baby may vary. So in the first minutes after birth, cyanosis around the mouth, cyanosis of the arms and legs, hands and feet are possible. But a few hours after birth, the baby’s skin takes on a bright red tint. Subsequently, the skin may acquire a jaundiced tint as a result of the appearance of physiological jaundice in the newborn. The skin of a healthy newborn is warm to the touch, although in the first hours after birth it may be cool (especially the extremities) due to a physiological decrease in body temperature.

When assessing the condition of the skin, it is also necessary to evaluate the color of the sclera of the eyes and visible mucous membranes. Examining the eyes of a newborn is difficult because the baby's eyes are mostly closed. When examining the eyes, it is clear that the eyes of a healthy newborn are clear, the cornea is transparent, the pupils are round, about 3 mm in diameter, and the reaction to light is lively. When the eyeballs move, convergent strabismus may periodically occur. When changing the position of the head or sometimes at rest, short-term sweeping horizontal nystagmus is possible. The eyes are shiny, and tears usually do not appear when the child cries.

Along with assessing the skin, you should definitely pay attention to the baby’s hair, nails and vellus hair (lanugo), which is usually located on the shoulder girdle.

Subcutaneous tissue is quite well developed, especially on the face, limbs, chest and back. Turgor of the soft tissues of a healthy child gives a feeling of firmness and elasticity. The head of a newborn is covered with hair 2 cm long, eyelashes and eyebrows are almost invisible, nails are dense, reaching to the tips of the fingers. The bones of a newborn’s skull are elastic and not fused to each other.

At the sites of fusion, the bones remain soft. These are non-ossified areas of connective tissue - fontanelles. The large fontanel has the shape of a diamond, it is located where the connection of the parietal and frontal bones occurs, its dimensions are 1.5–2 cm, 5–3 cm. The small fontanel is located in the place where the parietal and occipital bones are located, it has a triangular shape and most often it is closed. The head circumference of a newborn is 1–2 cm greater than the chest circumference, and the body length is longer than the lower limbs, as well as the arms are longer than the legs, the height of the head is 1/4 of the body length. The chest is wide and short (barrel-shaped), the ribs are horizontal. The muscular system is poorly developed, but already formed, the bulk of the muscles in a newborn are the muscles of the trunk, in relation to the weight of the whole body, the muscle mass in a newborn is 1/4; The diameter of the muscle fiber is on average about 7 microns. Motor skills are absent due to the immaturity of the nervous system. The spine has no physiological curves and consists of cartilage tissue. The joints have great mobility.

Bone tissue in a newborn has a fibrous-bundle structure (in adults it is lamellar). When examining a child, you should pay special attention to the integrity of the collarbones (they can often be damaged when the shoulders are removed) and to the separation of the legs in the hip joints. With neurological pathology and congenital diseases of the musculoskeletal system, symptoms of “clawed foot”, dangling hand, “seal foot”, drop foot, and heel foot may be observed.

When examining the oral cavity, the oral mucosa is tender, easily wounded, and richly vascularized. The color of the mucous membranes is bright pink, they are usually dry due to insignificant salivation.

The mucous membrane of the lips has transverse striations and forms pads, covered in some children with a whitish coating. When examining the oral cavity, a fairly large tongue is visible, on the mucous membrane of the lips there are small elevations in the form of pads; they are separated from each other by deep grooves and located perpendicular to the length of the lips, their color is usually whitish. The fold in the gums along the jaw processes in the oral mucosa provides a seal in the mouth when the mother suckles. In the thickness of the cheeks there are dense accumulations of fatty tissue - Bisha lumps, which give elasticity to the cheeks.

Yellowish dots can be seen on the mucous membrane of the hard palate along the medial line. Characteristically low hard palate.

When examining the cardiovascular system, one should evaluate the heart rate, heart size, character of heart sounds, and the presence of heart murmurs. The heart of a healthy child has a round shape. The sizes of the right and left ventricles in a newborn are almost the same. During the neonatal period, the borders of the heart shift to the right, its upper border descends from the level of the first intercostal space - the 2nd rib to the second intercostal space. The left border extends beyond the midclavicular, and the right beyond the edge of the sternum. The pulse rate of a newborn is 120–140 beats per minute. Blood pressure on the first day of life averages 66/36 mm Hg. Art. In healthy children, a weak pulsation of the carotid artery can be observed. The respiratory system is characterized by a description of the shape of the chest, percussion and auscultation data. In newborns, the nasal passages are narrow, with a delicate mucous membrane, which is covered with a large number of blood vessels. The cartilages of the nose are soft. Due to the horizontal position of the ribs and poor development of the respiratory muscles, breathing in a newborn is superficial, largely due to the diaphragm.

The tidal volume of the lungs of newborns is only 11.5 ml, and the minute respiratory volume is 635 ml. During the newborn period, breathing is arrhythmic, its frequency is 40–60 breaths per minute.

When examining the abdomen and abdominal organs, attention is paid to the participation of the abdominal wall in the act of breathing. Normally, the anterior abdominal wall does not extend beyond the plane, which is a continuation of the chest. An external examination determines the roundness of the abdomen, its enlargement or retraction, and whether there is asymmetry. When palpated, the abdomen of a newborn with a calm behavior is soft, the liver protrudes from under the edge of the costal arch no more than 2 cm along the midclavicular line. The spleen can be palpated at the edge of the costal arch, and the kidneys can be palpated only in children with a poorly defined subcutaneous fat layer. The number of urinations up to 5–6 times a day is considered normal.

In healthy full-term boys, the testicles descend into the scrotum; the head of the penis is hidden under the foreskin and is usually not completely removed from under it. The sizes of the penis and scrotum are strictly individual. In healthy full-term girls, the labia minora are covered by the labia majora. Slight swelling of the labia mucosa, as well as the presence of mucous or bloody discharge, is considered normal.

To assess the neurological status, the examination of a newborn child should be carried out on a flat, semi-rigid surface in a warm, well-lit room. During the examination, his motor activity is revealed, and the quantity, quality and symmetry of the child’s movements are assessed. An external examination of the child can reveal signs of increased neuro-reflex excitability. One of these signs is small-scale tremors of the hands and lower jaw when screaming and restlessness.

The next sign is the spontaneous Moro reflex, when, when tapping a finger on the sternum, the child spreads his arms to the sides and then returns them to their original position, crossing his arms over his chest. Spontaneous startles and spontaneous and induced foot clonus are also possible.

A newborn baby may react to sharp light and auditory stimuli with anxiety and screaming, which is also accompanied by blinking of the eyelids, changes in the rhythm of breathing and pulse. In the first days of life, the child usually does not fix his gaze, his eye movements are not coordinated, nystagmus, physiological strabismus are often observed, and tear fluid is not produced.

Muscle tone in newborns is often weakened. A sharp decrease or absence of muscle tone may be a sign of prematurity or immaturity.

Pain sensitivity is somewhat reduced, but temperature and tactile sensitivity in the newborn are already quite well developed. A child is born with a mass of unconditioned reflexes, which can be divided into three categories: persistent lifelong automatisms, transient (passing) reflexes, reflecting different levels of development of the motor analyzer, and reflexes or automatisms that only appear at the birth of a child, but they cannot always be identified. Unconditioned reflexes must be assessed in the supine, prone, and vertically suspended positions.

Proboscis reflex. When you hit the lips with a finger, the orbicularis oris muscle contracts, causing the lips to stretch out with the proboscis.

Search reflex or Kussmaul search reflex. If you stroke the skin in the area of ​​the corner of the newborn's mouth (but should not touch the lips), the lip lowers, the tongue deviates and the head turns towards the stimulus.

Pressing on the middle of the lower lip causes the mouth to open, the lower jaw to lower, and the head to bend.

When painful stimulation occurs, the head turns in the opposite direction. The reflex is well expressed before feeding and helps the baby find the mother's nipple.

Babkin's palmar-oral reflex. When the thumbs press on the baby's palm in the tenor area, he responds by flexing his head, shoulder, and forearm. The child opens his mouth, closes his eyes, and at the same time strives to pull himself up to his fists.

Defense reflex. This reflex protects the baby and prevents him from suffocating when the baby is placed on his stomach, as he turns his head to the side.

Grasp reflex. If you place the index fingers with the child in the supine position on the palm of the newborn, without touching the dorsal side, and press on them, the child bends his fingers and grasps the fingers of the person being examined. Sometimes the newborn wraps his fingers so tightly that he can be lifted up (Robinson reflex). By pressing at the base of the second and third fingers on the baby's feet, you can induce a tonic reflex - plantar flexion of the fingers (Werkom's symptom).

Support reflex. It is necessary to take the child under the armpits from the back, supporting the head from the back with your index fingers and place the baby’s soles on the surface of the changing table, while he stands as if on half-bent legs on a full foot.

Automatic walking reflex. This reflex lies in the fact that if at the moment of performing the support reflex the child is tilted forward, then he will move his legs, performing stepping movements. In this case, the legs are bent at the knee and hip joints, sometimes when walking they cross at the level of the lower third of the lower leg and feet.

Babinski reflex.

This reflex cannot be evoked in all newborns. It can be defined as follows: when line irritation of the surface of the foot occurs, the toes fan out, while the big toe bends.

Kernig reflex. With a child lying on his back, one leg is bent at the hip and knee joints, and then an attempt is made to straighten the leg at the knee joint. With a positive reflex this cannot be done.

Talent Reflex. With a child lying on his side, you need to run your thumb and forefinger along the paravertebral lines in the direction from the neck to the buttocks. Skin irritation causes the body to arch in an arch that is open to the rear. Sometimes the leg is extended and abducted.

Perez reflex. In the position of the child on the stomach, a finger is passed along the spinous processes of the spine in the direction from the tailbone to the neck, which causes flexion of the torso, flexion of the upper and lower extremities, raising of the head and pelvis, sometimes urination, defecation and screaming. This reflex causes pain, so it should be examined last.

Related information.

Every pregnant woman is preparing for the birth of a child, and the closer the due date, the greater the anticipation. But often the expectant mother knows nothing about what happens in the first hours and days after the birth of a child. But the postpartum period is a special time for a woman who is now learning in practice to be a mother, breastfeed, care for a baby, and understand motherhood.

Let's talk in more detail about what happens to the body during the postpartum period, what it is, what phenomena can be expected and what you should prepare for.

“The postpartum period is a period lasting approximately 6-8 weeks, starting immediately after the birth of the placenta. During this period, the reverse development (involution) of all changes that arose in connection with pregnancy and childbirth occurs until the woman’s body is restored to its original state.

In obstetrics The postpartum period is conventionally divided into early and late.

• The early postpartum period lasts only 4 hours after the end of labor. At this time, the woman who has given birth must be closely monitored, since it is in the first hours after birth that the most serious postpartum complications are most likely to occur. Most often it is carried out under the supervision of medical personnel of the maternity hospital.
• The late postpartum period begins 4 hours after birth and ends with complete recovery genital organs, nervous, cardiovascular and other systems of the female body, as well as changes in the endocrine system and mammary glands that ensure the function of lactation. At the same time, psychological changes occur: the woman needs to comprehend what happened, get used to new feelings and sensations.

Physiological changes that occur in the body after childbirth

Let us list the physiological changes that necessarily occur in a woman’s body after childbirth and are associated with the end of pregnancy and the beginning of the lactation period.

• The uterus contracts and returns to its original size, its mucous membrane is restored. The transverse size of the uterus immediately after birth is 12-13 cm, weight is 1000 g. At the end of 6-8 weeks after birth, the size of the uterus corresponds to its size at the beginning of pregnancy, and the weight is 50-60 g.
• Soft tissue injuries heal: cracks and tears. The cracks heal without a trace, and scars form at the sites of ruptures.
• Swelling of the external genitalia subsides, which formed in the last weeks of pregnancy and during childbirth.
• Ligaments lose their elasticity who bore heavy loads during pregnancy and childbirth. The mobility of joints and other bone joints, which also bore loads during pregnancy and childbirth, is lost.
• Internal organs return to their previous position that were displaced due to the large size of the uterus (stomach, lungs, intestines, bladder, etc.)
• Gradually all organs return to work as before who bore a double load during pregnancy (kidneys, liver, heart, lungs, etc.)
• Happening changes in the endocrine system. The endocrine glands, which were increased in size during pregnancy, gradually decrease to their normal state. However, the organs of the endocrine system that ensure lactation continue to work actively.
• The mammary glands increase in size. Now they must provide feeding to the newborn and learn to produce milk in accordance with the age-related needs of the child’s growing body.

Now let's discuss the course of the postpartum period and the features of postpartum care, based on knowledge about the changes occurring in a woman's body.

The course of the postpartum period and features of postpartum care

• For successful contraction of the uterus, it is very important to attach the newborn to the breast within the first hour after birth and frequent(once every 2 hours during the day) and long feedings further.
• The baby's sucking on the breast stimulates the production of the hormone oxytocin and is therefore a very effective means of contracting the uterus. During feeding, the uterus actively contracts, which is why a woman may experience cramping pain in the lower abdomen. In the first days after childbirth, to contract the uterus, you should put on a heating pad with ice for 30 minutes and more often lie on your stomach.
• It is also worth using preventive herbal treatment, aimed at contracting the uterus, starting from the 4th day after birth. Can be used for this shepherd's purse grass, nettle, yarrow and birch leaves.Herbs can be alternated (for example, shepherd's purse for 3 days, then for a week alternate every other day with nettle and yarrow, then birch leaves; or change all the herbs in turn every other day) or mixed in equal proportions.

1 tablespoon of herb is poured into a glass of boiling water and left for 30 minutes, then filtered. Drink the finished decoction ¼ cup 4 times a day.

• Too strong an impact on the uterus and other abdominal organs, which have not yet assumed their original position, may lead to a change in the position of these organs or cause an inflammatory process. That's why It is not recommended to wear compression bandages or engage in active physical exercises aimed at tightening the abdominal muscles.
• Due to the contraction of the uterus in the first week after childbirth, copious postpartum discharge is released from it - lochia. When standing up or changing body position, the discharge may increase. This discharge will gradually lighten from bloody to pale pink and will finally stop 6 weeks after delivery. , as well as to accelerate the healing process of ruptures or soft tissue injuries, it is necessary to thoroughly toilet the external genitalia. In the first week after childbirth, washing three times a day with warm water ends with washing the external genitalia. decoction of oak bark.

Pour 4 tablespoons of oak bark into an enamel bowl with 500 ml of boiling water. Boil for 15 minutes, adding boiling water. Remove from heat and leave for another 15 minutes, strain.

From the second week until the discharge clears up, you can use chamomile decoction for this purpose twice a day.

Pour 2 tablespoons of chamomile into 1 liter of boiling water, leave for 20 minutes, strain.

• It is very important for tissue fusion dry the seams after washing and treat them with additional healing agents. It is recommended to use it throughout the postpartum period underwear made only from natural fabrics and, if possible, the same gaskets.

Starting breastfeeding

It is important to establish adequate breastfeeding from the very first days. The processes of normal lactation contribute to the normalization of hormonal levels in the female body, which will make the postpartum recovery period more successful.

On days 2-7, depending on the nature of labor, the milk rush. From now on it is convenient to use for breast support nursing tops or tank tops. In some cases, milk flow may be accompanied by high fever, pain and lumps in the mammary glands. In this case, it is necessary to reduce fluid intake. You should resort to pumping only when painful sensations arise in your full breast, 1-2 times a day, and express your breasts only until a feeling of relief appears. Lasts milk fever 1-3 days.

From the moment milk appears, it is important to put the baby to the breast quite often, this improves the contractile activity of the uterus and promotes the formation of lactation.
If the child is with the mother, you must try apply it to your chest at least once every 2 hours. When kept separately, it is necessary to establish regular pumping every 3 hours, except for the night interval from 24.00 to 6.00 in the morning. At this time, a woman needs rest.

Before the baby develops sucking rhythms, there may be restless sucking, where there are practically no pauses, or, conversely, sluggish sucking, when the baby sleeps and skips feedings. That's why, starting from the third week after birth, the mother needs to monitor the number of attachments so that weight loss and dehydration do not develop, and allow the baby to be at the breast as long as he needs to compensate for the stress of birth.

It is important from the very first days to ensure that the child sucks not just the nipple, but also captured as much of the areola as possible, in order to avoid abrasions or cracks of the nipple.

You have to feed the baby in a comfortable position so as not to get tired. At first, especially if the woman has tears, this will be the “lying on her arm” pose. Then the mother can master the “sitting”, “standing”, “under the arm” poses and begins to alternate them. By the seventh week, the mammary glands adapt to the process of lactation and feeding.

Prevention of postpartum depression

The term " postpartum depression“is familiar to everyone these days, even those who have never given birth. There are many reasons for this, and listing them would require a separate article. Therefore, it is imperative to prevent postpartum depression, starting from the 6th day after birth, for at least two weeks.

• For this they take infusion of motherwort, valerian or peony, 1 teaspoon 3 times a day.
• It is also of considerable importance support and understanding of family and friends, first of all husband.
• Worth it for the first month limit the reception of guests, even with the best intentions, since this requires additional effort from a woman.
• Important don't overload a woman who has given birth by taking care of the household, allowing her to restore her strength and adapt to her new role as a mother.
• Healthy get enough sleep, including going to bed 1-2 times a day. For proper sleep, a mother needs to learn to sleep with her baby. With this, the woman has the opportunity to relax, and not jump up at every squeak of the newborn, and the children themselves sleep much more calmly next to their mother.
• It is very important to find a person who will help a young mother get used to her new responsibilities, advise and teach her how to handle the baby, and will calmly listen to conversations about events and experiences related to the child.

“Traditionally, the first nine days after childbirth, a woman was considered sick, and she was entitled to especially careful postpartum care. Until the 42nd day, it was believed that the woman and child still needed special care.

Therefore, she was not allowed into the household, allowing her to establish relationships in the mother-child pair and get used to changes in life. And those around her took care of the woman herself, making sure that she did not need anything and could fully recover after childbirth.

• That's why There is no need to go for walks for 6 weeks after giving birth. At this time, the mother and baby need to recover from childbirth, establish breastfeeding and rest, and not go for walks. Especially if the baby was born during the cold season. Due to a decrease in immune forces, even slight cooling can lead to the development of an inflammatory process.
• For the same reasons, a woman is not recommended to walk barefoot and in light clothing, and It is better to replace a bath with a shower.
• Pleasant drinks in the form of drinks can also help take care of the health of a woman who has given birth. Restores strength well drink based on chaga.

Chaga mushroom drink

Pour 2 tablespoons of crushed chaga into 900 ml of warm boiled water. Separately, boil a whole lemon in 100 ml of water for 10 minutes. Then crush the insides of the lemon and mix with chaga, add 2 tablespoons of honey. Leave for 6-8 hours.

To better restore and maintain immunity, a woman can take rose hips, in the form of syrup (2 teaspoons 3 times a day) or in the form of compote, infusion, or with thyme herb.

Pour 2 tablespoons of rose hips and 1 tablespoon of thyme into 300-400 ml of boiling water. Let the thermos sit for 30 minutes and drink throughout the day.

The postpartum period is no less important for a woman than pregnancy and childbirth itself. At this time, not only the functioning of the body is restored, but the woman also transitions to a new state. She learns how to care for a newborn, breastfeeding, lays the foundation for the child’s future health, understands her maternal role and comprehends maternal science.
The success of the postpartum period, and subsequently the physical and mental health of the mother and child, depend on compliance with the rules for postpartum care and the application of traditional recommendations for caring for a woman in labor.

11.04.09
Shmakova Elena,
antenatal instructor
and lactation consultant
Center "Mom's House" Novosibirsk,
mother of four children

The postpartum period begins from the moment the placenta appears and ends after 7 weeks. The main symptoms of this important period can be safely called excellent contraction of the uterus and thickening of its walls. Every day after childbirth, the uterus begins to gradually shrink. It was revealed that during the first 10 days after birth, the fundus of the uterus drops approximately one transverse finger every day.

If the postpartum period proceeds normally, then the state of health remains normal. The pulse is rhythmic, breathing is deep, and the temperature is within normal limits. Urine flow is usually normal, but in some cases it is difficult. Postpartum women are often concerned about stool retention, which appears against the background of intestinal atony.

But on the fourth day after birth, the mother’s breasts begin to secrete milk. The mammary glands become the most vulnerable and sensitive. But it is possible that the chest swells greatly, and then unbearable bursting pain follows. Remember that pumping at this time can be considered extremely harmful.

Basic rules for caring for a postpartum mother.

The most important thing is to monitor the general well-being of the lady. Regularly measure your pulse, monitor the condition of the mammary glands, measure the height of the uterine fundus, and examine the genitals from the outside. All indications are included in the birth history.

If contractions are painful, antipyrine or amidopyrine may be prescribed. If urination is difficult, a number of measures are necessary. If you have stool retention, it is recommended to do an enema or resort to a laxative in the form of Vaseline or castor oil.

The postpartum mother must wash her hands before each feeding and maintain intimate hygiene at least twice a day. Also, change your shirt every day. But the breasts must be rinsed with a 0.5% solution of ammonia, and the nipples with a 1% solution of boric acid. You can also use warm soapy water for these purposes.

The diet for postpartum women should include more vegetables, fruits, berries, cottage cheese, kefir, and milk. It is best to avoid excessively fatty and spicy foods.

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