Ideal postpartum care would include several home visits by health care providers in the one to two weeks following delivery to assess the status of the mother and her family. This rarely happens in the United States, but follow-up phone calls by health care providers during the first week and a visit by the mother and baby to her physician or nurse-midwife one to two weeks after the birth are desirable.
Several problems that may arise during the postpartum period do not typically develop until after the new mother is discharged from the hospital. These include mastitis, endometritis, and postpartum depression.
MASTITIS. Mastitis is an inflammation of the breast, usually caused by streptococcal or staphylococcal infection. It can develop any time a woman is breastfeeding, but usually does not occur before the tenth postpartum day. Symptoms of mastitis often mimic those of the flu, and include body aches and a fever of 101°F (38.6°C) or more. Mastitis is treated with a course of antibiotics, and women should begin to feel better within 24 hours of beginning the antibiotics. If this does not happen, the woman may need to be hospitalized for intravenous antibiotics.
Other measures that may help the mother feel better include bed rest for at least 24 hours, moist heat on the infected breast every two to three hours (when awake), acetaminophen for pain and fever relief, increased fluid intake, and going without a bra for several days. Mastitis does not contaminate the breast milk and the baby should continue to nurse from both breasts. If nursing from the affected breast is too painful, use of a breast pump or manual expression of milk may be needed to prevent engorgement and facilitate continued milk production.
ENDOMETRITIS. Endometritis is an inflammation of the endometrium, the mucous membrane lining the uterus. It is usually caused by a bacterial infection. Symptoms of this infection include fever, abdominal pain, and foul-smelling vaginal discharge. Physical examination of the patient reveals a tender uterus. Endometritis is treated with a course of antibiotics and other care, including bed rest, acetaminophen for pain and fever relief, and increased fluid intake. Severe cases may require hospitalization.
POSTPARTUM DEPRESSION. Postpartum depression may appear at any time during the first year after a baby's birth. It ranges in severity from mild, postpartum "blues" that last only a few days shortly after birth, to intense, suicidal, depressive psychosis. Not only does postpartum depression cause distress for the new mother and her partner, but it can also interfere with the new mother's ability to bond with her baby and to relate to any other children she may have.
Symptoms of severe postpartum depression or psychosis include insomnia, hallucinations, agitation, and bizarre feelings or behavior. Any new mother exhibiting signs of postpartum depression should be referred to mental health professionals, support groups, and/or new mother groups. Psychotropic medication is often helpful, as is psychotherapy. About 10% of cases of postpartum depression are caused by postpartum thyroiditis, a temporary inflammation of the thyroid gland that usually clears up spontaneously in one to four months. Whenever postpartum depression occurs, thyroid function should be tested to rule out hyperthyroidism or hypothyroidism as the cause of symptoms.
Nadine M. Jacobson, The Gale Group Inc., Gale, Detroit,