Postpartum Care

Question 1

The fourth trimester

Answer 1

The fourth trimester — the 12-week period after giving birth.
* A time of great physical and emotional change:
The baby gets used to the world outside of the
womb, and the mother steps into her new role.
* Crucial to have a support network in place for the parents.
* Allow the mother to rest and establish breastfeeding.
Staying in bed for the first week to recover.
* Stock up the freezer with nourishing meals.
* Integrate baby into everyday life — encourage baby wearing.
* Ask visitors to bring food instead of flowers —
you don’t need another thing to take care of!

Question 2

postpartum instability

Answer 2

Some women experience postpartum affective instability, incl.
rapidly fluctuating mood, tearfulness, irritability and anxiety:
* This is due to hormonal changes postpartum →
huge drop in progesterone and increase in
prolactin (prepares for lactation) and oxytocin
(contracts the womb back to its size and
stimulates lactation, can also increase anxiety).
* Symptoms peak on the fourth or fifth day after
delivery and can last for many days (‘baby blues’).
* Symptoms do not interfere with the mother’s
ability to function and care for her child.

If symptoms persist for longer than two weeks
and become more intense, to include:
* Difficulty in bonding with the baby.
* Withdrawing from the family.
* Feeling of hopelessness.
* Excessive crying.
* Severe anxiety.
* Thoughts of harming self or the baby.
* Refer the client (these are red flags). Beyond this referral,
homeopathy, acupuncture or herbalism can be helpful.

Homeopathy:
sepia 30C or ignatia 30C x
2 daily may be considered

Question 3

Other investigations to consider

Answer 3

• Thyroid function — postpartum thyroiditis is often
  common after giving birth (incidence of 4–9%) and
  can mimic symptoms of anaemia and postpartum depression.
  ‒ In most cases it is autoimmune. It is possible that the shift
  in Th1 cell function, loss of tolerance for foetal antigens and
  enhanced IgG secretion, which may be triggered by the
  marked drop in oestrogen and progesterone is contributory.
• Anaemia screening — as it can cause similar depressive symptoms.
  *
  ‘Mum MOT’ — pelvic floor examination, diastasis
  recti, screening for bladder, bowel or sexual dysfunction