Keith Edmonds

The puerperium is a period that lasts from delivery of the placenta till 6-12 weeks after delivery. It is a time of enormous importance to the mother and her baby and yet it is an aspect of maternity care that has received relatively less attention than pregnancy and delivery. During the puerperium the pelvic organs return to the non-gravid state, the metabolic changes of pregnancy are reversed and lactation is established. In the absence of breastfeeding, the reproductive cycle may start again within a few weeks. The puerperium is a time which is steeped in cultural customs and rituals in many different countries and indeed many of the medical recommendations about the puerperium have developed as adaptations of socially acceptable traditions rather than science.

The puerperium is also a time of psychological adjustment and while most mothers' enjoyment of the arrival of a newborn baby is obvious the transition to becoming a responsible parent and the anxiety about a child's welfare will influence the mothers' ability to cope. These anxieties may be compounded if she is tired after her labour or if she has any medical complications. However, the majority of women are subjected to another problem that new mothers find very difficult to cope with and this is the plethora of well-meaning but conflicting advice from doctors, midwives, relatives and friends. Here again, the cultural influences may be at conflict with the mother's own beliefs. It is extremely important that an atmosphere be created whereby a mother can learn to handle her baby with confidence, and here the influence of midwifery and obstetric staff plays an important role in trying to establish what will be an important part of their lives. In caring for a woman during the early puerperium, the role of the obstetrician and midwife is to monitor the physiological changes of the puerperium, to diagnose and treat any postnatal complications, to establish infant feeding, to give the mother emotional support and to advise about contraception and other measures which will contribute to continuing health. It is important to bear in mind that maternal death may still occur in the puerperium and hence its importance cannot be understated.

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