The postnatal or puerperium period, refers to the period after delivering during which the mother's body returns to its prepregnant state This period begins about one hour after the delivery of the placenta and extends through the next six to eight weeks. Some people refer to this period as the fourth trimester of pregnancy. During this period women should be under medical surveillance because is important that they receive mental and physical care.  Many physiologic and psychological changes occur in the mother during this time and the care should be directed toward prevention, detection and treatment of any complications or diseases that may appear in the postpartum period. Postnatal care should also include family planning, immunization, breastfeeding and maternal nutrition. Nursing care should focus on helping the mother and her family adjust to these changes and on easing the transition to the parenting role.

Diet for Postpartum Recovery
It is important to have a well-balanced diet especially if  you are breastfeeding. In general women require about 2200 calories each day. But if you are breastfeeding you'll need 500 more calories each day to keep your milk nutritious and stay healthy. You must have a nutritious diet for tissue repair and body rebuilding after delivery. In order to fulfill these special needs, you must have a well balanced diet that contains the appropriate amount of calories and nutrients. As a reference you may consult the food pyramid and can also ask you doctor if you need take vitamins or iron supplements. It is also important that you ingest plenty of liquids, especially if you are breastfeeding.

Weight loss
Much of the weight gained during pregnancy is lost immediately after the delivery of the baby and the placenta. The extra weight gained during pregnancy is a great concern to lot of women. You will naturally lose some weight in the first 2 to 4 weeks with the reduction of the uterus and the decrease of the blood circulation. The weight gained in the nine months in body fat stores should be lost gradually. It isn't  advisable that you start any weight reduction diet for 2-4 weeks after delivery if you are bottle-feeding or 6 weeks if breastfeeding . To burn some extra calories you can begin doing some exercise and walking. But you must ask your practitioner about when you can start exercising.

Help at home
It will be of great help if in the first week you have some one to help you at home. This person can help you with your daily activities and release you to take care of you and your baby. During the second week you can had some light household tasks but you should avoid lifting heavy objects.  Be sure that you rest a lot and avoid heavy tasks. By the time you have your six-week checkup, you can ask your practitioner if you may return to all your normal activities.

Personal care
You may bathe alone as soon as you feel secure standing up by yourself. Avoid bathing if you feel dizzy or fainting. You may wash your hair as often as you like but you must keep the shower water at a moderate temperature to prevent weakness and fainting.

Return of the menstrual period
The first period may be longer or shorter than usual and if you are not breastfeeding, you will have a menstrual period within 6 to 8 weeks after delivery. Your normal menstrual cycle and period will return in 2–3 months. Although breastfeeding may delay the return of a period for 5–6 months or even until breastfeeding is stopped. Don't worry if you start a period while continuing to breastfeed because these will not affect or interfere with breast milk. Even if you don't have a period, keep in mind that your ovaries may begin to function any time and pregnancy is possible even though you have not returned to a regular menstrual cycle.

Perineal care
In the following first two weeks following delivery the stitches will dissolve and the perineal area will continue healing. Continue your cleaning routine as usual always wiping from the front to the back. You may find some of the caring materials in a drug store and if you have any concerns regarding bath talk with your practitioner.

Skin and body care
During some time you may experience an increase of perspiration. This is temporary and is caused by the return of your hormone levels to a normal. This hormonal changes may also cause skin dryness. It is not advisable to take tub bath for at last two weeks after delivery.

It is important that you limit your visitors in the firt two weeks. Friends and family will want to come and visit and see the new baby, but you have to rest and you should decrease the exposure of the baby to different people. Don't blame yourself if you aren't the perfect hostess and make sure all hostess are healthy.

Drink plenty of fluids and use medicines to relief the symptoms if you need. Ask your practitioner what is recommended to use. And remember that if you be able to keep a regular bowel routine and keep your bowel movement soft will cause less irritation to the hemorrhoids.

Rest periods
During the first week it is recommended that you have frequent rest periods. While the baby sleeps take some time to rest, sleep or lie down or simply to do something that you enjoy. This extra font of energy will help you recover.

Sexual relations
To retake sexual intercourse it is essential that your cervix is tightly closed and your perineal area should be healed to prevent uterine infection. Be sure to talk with your doctor regarding this subject, he/she can advise you about the best time to restart your sexual life.

It is a common symptom during the first weeks after delivery. Try to drink plenty of fluids and eat fresh vegetables, fruits and whole grain cereal because this may help to maintain your bowel movements more soft.

Self breast exam
The recommended time to examine your breasts is at the end of the menstrual cycle and it is an important procedure in the early detection of breast lumps. This examination should be done once a month. Ask your nurse or doctor the best technique for self-examination. When breastfeeding women should delay self-breast examination for three months and the best time to to this is at night after the last feeding of the day. In a lactating breast, lumps my seem harder to find, if you have any concern about a lump which persists in the same place talk with your physician.

Vaginal discharge
Vaginal discharge usually stops three weeks after delivering, although for some women it may continue for a longer period of time, especially if are very active at work at home. Try to rest. This discharge, after you leave the hospital, should decrease and change its color to more pinkish color and then, after one week, to brown. If the discharge changes to a bright red bleeding or has an odor, check your body temperature to see if there were any increase and call your physician.

Return to work
Always consult your doctor about when you will be able to return to work. Your return will depend on the type of work you do and on your rate of recovery. This rate isn't equal to all women and  for all pregnancies. You can not use your last pregnancy as a reference or ask someone you know what they have done. You can continue breastfeeding even after you return to work by using a breast pump.

Emotions and postpartum depression
The hormonal changes combined with fears, feelings and new responsibilities can affect your emotions. You may experience some mood swings, and It is possible that you experience periods of excitement followed by feelings of sadness. This is normal and may occur for a couple of weeks after delivery. You will feel more stable when your body returns to normal as well as your hormone levels. The use to your baby routine will help too. Try to get plenty of rest because if you be more rested you will be able to better deal with some small emergencies that may occur. Allow your self to do something that you like.
Although be attentive to some signs that could be a sign of a more serious depression like inability to handle daily activities or accomplish anything; withdrawal from friends and family; feelings of sadness that last longer than two weeks; increase feeling of frustration towards the family and the child. If you have any of this symptoms, call you partitioner immediately


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