For mummies who have delivered via vaginal birth, there is much aftercare to consider even without the c-section wound, particularly for those who have received episiotomy (a surgical to the perineum) or have a perineal tear. Even for those without perineal wounds, you would still need to take additional care of the vaginal area. Juansa speaks with Dr Chee Jing Jye, Medical Director at The Obstetrics and Gynaecology Centre, a subsidiary of Singapore Medical Group (SMG) about postpartum hygiene for new mums.
- How long does the lochia (postpartum discharge) last? Generally lochia lasts around three weeks. In the first few days, the lochia is red and heavier (like heavier days of menses). As the days go on, the lochia will became darker in colour before turning brown and ending off as a yellow discharge. The postpartum woman should not experience sudden increase in bleeding, especially fresh bleeding associated with clots. In such circumstances, she should quickly consult her obstetrician.
- What are the most common issues faced by mother who have perineal tear or episiotomy? The most common issues would be pain and swelling. However, most of my patients would be comfortable with very simple analgesia like oral paracetamol alone. If the swelling makes seating uncomfortable, then sitting on an inflated ring may help. If the swelling and pain are very unbearable, do let your obstetrician know. Haematoma (abnormal collection of blood under the skin) needs to be excluded in such circumstances.
- What are the signs of infection and should it be simply treated by medication such as antibiotics?Signs of infection include persistent throbbing pain over the affected area, bloody purulent discharge and fever. If the new mum encounters such symptoms, she should seek the attention of her obstetrician to confirm if the wound is indeed infected. The treatment of an infected perineum wound will involve daily washing of the affected area with anti-septic solution. Antibiotics may or may not be required, depending on the assessment of the obstetrician.
- Some new mums are recommended to use a peri-bottle to wash the vaginal area, is it truly necessary? In my practice, I do not require my patients to use any special medications or gadgets for perineal care after delivery. One has to ensure the area is washed with clean tap water after every visit to the bathroom. A hand-held bidet spray may be more convenient than a peri-bottle for this purpose.
- What are the implications of postpartum infection? Postpartum infections refer to infections that occur after delivery. The infections can be from the episiotomy wound, caesarean wound, urinary tract etc. Clinically, the most dangerous infection would be endometritis – infection of the endometrium or inner lining of the uterus. This infection typically presents with excessive bleeding from the vagina. Implications of this infection include anaemia due to excessive blood loss, scarring of the uterine cavity leading to subfertility (ashermann’s syndrome) and in extreme cases, the severe sepsis may even lead to multi-organ failure. Fortunately, most cases of endomtritis can be treated successfully with a simple procedure where the uterine cavity is cleaned (evacuation of the uterus) and antibiotics.
This article is an extension of an article found in the print edition of Singapore’s Child July Issue 176 with the headline ‘Postpartum Care’.
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