The puerperium

Published on 09/03/2015 by admin

Filed under Obstetrics & Gynecology

Last modified 22/04/2025

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15 The puerperium

Normal postnatal events

Breastfeeding

Physiology

In pregnancy, progesterone stimulates proliferation of the alveoli and breast enlargement. Oestrogen causes darkening of the areola and an increase in the number of lactiferous ducts. At delivery, prolactin acts on the alveoli to initiate lactation and sucking further stimulates this. Colostrum, a high-protein, low-volume fluid is released initially and at day 2–3 milk ejection occurs in response to oxytocin.

The advantages of breastfeeding for the baby are:

The advantages for the mother are:

It is important to encourage breastfeeding as the ideal, although one third of women do not breastfeed at all. This is particularly common if the woman was not breastfed herself, or if her partner does not actively support her breastfeeding.

A small number of women are unable to breastfeed for the following reasons:

These women may feel stigmatized by their inability to give their baby ‘the best’ type of feeding.

Problems in the puerperium

Postpartum haemorrhage (PPH)

Psychological, emotional and psychosexual problems in the puerperium

Many women find the emotional experience difficult during the puerperium. Contributing factors are:

Management involves a careful investigation of the underlying feelings and contributing factors. Counselling and reassurance are generally effective, but women with persistent symptoms should be referred for formal psychosexual or psychological counselling, after addressing the physical factors such as sleep problems.

Postpartum psychiatric illness