Emotional Puerperium

Question 1

What is the puerperium?

Answer 1

Time from delivery of placenta through to around 6 weeks postnatal.

Question 2

What occurs at 6 weeks postpartum?

Answer 2

Most body changes from pregnancy have resolved

Question 3

What are the main physical changes in the puerperium?

Answer 3

Reduction in placental hormones: human placental lactogen, hCG, oestrogen and progesterone
Involution of uterus and gential tract
Secretion of breast milk and establishment of breastfeeding

Question 4

Outline other normal physical changes in the puerperium

Answer 4

Ovaries ovulate as early as 27 days postnatal, non breastfeeding
Suppression of ovulation I’d due to elevation in prolactin levels
Menstruation returns by weeks 6-8 in women who do not breast feed.
Cervix loses its elasticity and regains firmness- may close by the second week
Perineum- sweeping and engorgement usually resolve in 1-2 weeks, muscle tone returns depending on extent of birth trauma

Question 5

Reports and guidelines on maternal care postnatally

Answer 5

MBBRACE (2014) between 2009-2011 there has been an increase in maternal deaths due to psychiatric causes
NICE (2014) movies must make sensitive enquiries into women’s mental health at booking

Question 6

State likelihood of mood disorders

Answer 6

Baby blues- 50% RCPSYCH
PPD- 15-20% in first year NICE
Psychosis- 1380 per annum ONS

Question 7

What can midwives do in the postnatal period?

Answer 7

Continuity of care
Assess for depression 
Birth reflections
Allow time for discussion
Sure start initiative
Help with claiming benefits or entitlements