The word puerperium is derived from Latin—puer, child + parus, bringing forth. It defines the time following delivery during which pregnancy-induced maternal anatomical and physiological changes return to the nonpregnant state. Its duration is inexact but is considered to last between 4 and 6 weeks. Although much less complex compared with pregnancy, the puerperium has appreciable changes, and maternal morbidity is surprisingly common. For example, in a survey of 1246 British mothers, 3 percent required hospital readmission within 8 weeks (Thompson, 2002). Moreover, almost three fourths of women continue to have health problems for up to 18 months (Glazener, 1995). Of self-reported concerns, pain, breastfeeding, and psychosocial topics are prominent. Table 36-1 lists data on these from the Pregnancy Risk Assessment Surveillance System—PRAMS—of the Centers for Disease Control and Prevention (CDC).
TABLE 36-1Concerns Raised by Women in the Puerperium ||Download (.pdf) TABLE 36-1 Concerns Raised by Women in the Puerperium
|Concerns ||Percent |
|Pain after cesarean delivery ||58 |
|Feeling stressed ||54 |
|Breastfeeding issues ||48 |
|Perineal pain after vaginal delivery ||41 |
|Need for social support ||32 |
|Inadequate education about newborn care ||21 |
|Help with postpartum depression ||10 |
|Perceived need for extended hospital stay || 8 |
|Need for maternal insurance coverage postpartum || 6 |
Because the weeks following childbirth are a critical period for the woman and her infant, the American College of Obstetricians and Gynecologists (2018a) promulgated the concept of a “fourth trimester.” This concept reinforces the importance of the 12 weeks following birth, and components of this model are outlined in Table 36-2. Thus, the comprehensive postpartum visit includes a full assessment of physical, social, and psychological well-being.
TABLE 36-2Components of Postpartum Care for the Fourth Trimester ||Download (.pdf) TABLE 36-2 Components of Postpartum Care for the Fourth Trimester
|Care team |
|Postpartum visits |
|Lactation support |
|Infant feeding plan |
|Reproductive life plan |
|Pregnancy complications |
|Cardiovascular risk assessment |
|Mental health |
|Postpartum problems |
|Chronic conditions |
An initial visit is recommended at 3 weeks postdelivery and a final summary visit at 12 weeks. Between this time, visits can be added as needed. For example, women with chronic hypertension, overt diabetes, cardiovascular disease, and depression may require additional multidisciplinary care during this period. For all puerpera, a discussion of positive lifestyle changes can be initiated. This time also affords the opportunity to update immunizations (American College of Obstetricians and Gynecologists, 2019). At the end of the 12-week fourth trimester, follow-up then transitions into well-woman care, ongoing primary or specialty care, and when necessary, preconceptional counseling (Chap. 8).
REPRODUCTIVE TRACT INVOLUTION
Return of the tissues in the birth ...