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occurring immediately after birth; "postnatal development" (同)postpartum

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/08/12 21:13:52」(JST)

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New mother with newborn baby

A postpartum period or postnatal period is the period beginning immediately after the birth of a child and extending for about six weeks. Less frequently used are the terms puerperium or puerperal period. The World Health Organization (WHO) describes the postnatal period as the most critical and yet the most neglected phase in the lives of mothers and babies; most deaths occur during the postnatal period.^[1] It is the time after birth, a time in which the mother's body, including hormone levels and uterus size, returns to a non-pregnant state. Lochia is postpartum vaginal discharge, containing blood, mucus, and uterine tissue.

In scientific literature, the term is commonly abbreviated to PX. So that 'day P5' should be read as 'the fifth day after birth'. This is not to be confused with medical nomenclature that uses G P to stand for number of pregnancy and outcome of pregnancy.

Newborns

Upon its entry to the air-breathing world, without the nutrition and oxygenation from the umbilical cord, the newborn must begin to adjust to life outside the uterus.

Postpartum period in mothers

A woman giving birth in a hospital may leave the hospital as soon as she is medically stable and chooses to leave, which can be as early as a few hours postpartum, though the average for a vaginal birth is 1–2 days, and the average caesarean section postnatal stay is 3–4 days. During this time, the mother is monitored for bleeding, bowel and bladder function, and baby care. The infant's health is also monitored.^[2]

Physical

The mother is assessed for tears, and is sutured if necessary. Also, she may suffer from constipation or hemorrhoids, both of which would be managed. The bladder is also assessed for infection, retention, and any problems in the muscles.

The major focus of postpartum care is ensuring that the mother is healthy and capable of taking care of her newborn, equipped with all the information she needs about breastfeeding, reproductive health and contraception, and the imminent life adjustment.

Some medical conditions may occur in the postpartum period, such as Sheehan's syndrome^[3] and peripartum cardiomyopathy.

In some cases, this adjustment is not made easily, and women may suffer from postpartum depression, posttraumatic stress disorder or even puerperal psychosis.

Postpartum urinary incontinence is experienced by 23.4%^[4] to 38.4%,^[5] likely higher during pregnancy.^[6]

During the postpartum period, a woman may urinate out up to nine pounds of water. The extra fluid that her body has taken on is no longer needed, so the mother may note that her fluid output is disproportionate to her fluid input.

Psychological

Postpartum mental illness can affect both mothers and fathers, and is not uncommon.^[7] Early detection and adequate treatment is required. Approximately 25% - 85% of postpartum women will experience the "blues" for a few days. Between 7% and 17% may experience clinical depression, with a higher risk among those women with a history of clinical depression. Rarely, in 1 in 1,000 cases, women experience a psychotic episode, again with a higher risk among those women with pre-existing mental illness. Despite the widespread myth of hormonal involvement, repeated studies have not linked hormonal changes with postpartum psychological symptoms. Rather, these are symptoms of a pre-existing mental illness, exacerbated by fatigue, changes in schedule and other common parenting stressors.^[8]

Postpartum psychosis (also known as puerperal psychosis) is a more severe form of mental illness than postpartum depression, with an incidence of approximately 0.2%.

Cultures

East Asia

In some East Asian cultures, such as Chinese, South Korean, and Vietnamese, there is a traditional custom of postpartum confinement known in English as doing the month or sitting the month (Mandarin zuò yuèzi 坐月子). Confinement traditionally lasts 30 days.^[9] This tradition combines prescribed foods with a number of restrictions on activities considered to be harmful. The new mother is also given special postnatal foods, such as seaweed soup in Korea and "Pork Knuckles and Ginger Stew" in China. It is widely believed in many East Asian societies that this custom helps heal injuries to the perineum, promote the contraction of the uterus, and promote lactation.^[10]^[11]^[12]

In Thailand "yu-fai (lie down by a fire) treatment is traditional postpartum healing. Performed in an open area, it involves using smokeless tamarind wood, local herbs and massage.^[13]

Greece

Traditionally, Greek mothers would spend 40 days confined at home with their infant after giving birth. At the end of the 40 days (the sarántisma, or "fortying"), the child was symbolically taken to church for the first time, where the mother asked for a special blessing on the conclusion of her puerperium. There are many modern theories seeking to justify this traditional practice, including weakness of infant immune systems, unimpeded establishment of breastfeeding, and the need for bonding time between parent and child.

India

Most traditional Indians follow the 40-day confinement and recuperation period also known as the 'Jaappa' (in Hindi). A special diet to facilitate milk production and increase hemoglobin levels is followed. Sex is not allowed during this time. In Hindu culture, the puerperium was traditionally considered a period of relative impurity (asaucham) due to the processes of childbirth, and a period of confinement of 10–40 days (known as purudu) was recommended for the mother. During this period, she was exempted from usual household chores and religious rites. The father was purified by a ritual bath before visiting the mother in confinement. In the event of a stillbirth, the period of impurity for both parents was 24 hours.^[14]

References

^ WHO. "WHO recommendations on postnatal care of the mother and newborn". WHO. Retrieved 22 December 2014.
^ "With Women, Midwives Experiences: from Shiftwork to Continuity of Care, David Vernon, Australian College of Midwives, Canberra, 2007 ISBN 978-0-9751674-5-8, p17f
^ Schrager, S; Sabo, L (2000). "Sheehan syndrome: a rare complication of postpartum hemorrhage.". The Journal of the American Board of Family Practice / American Board of Family Practice 14 (5): 389–91. PMID 11572546.
^ http://members.multimania.co.uk/shiryu01/Pdf/Hvidman%202003.pdf
^ "Promoting urinary continence in women after delivery: ra... [BMJ. 2002] - PubMed - NCBI". Ncbi.nlm.nih.gov. 2013-08-12. Retrieved 2014-02-02.
^ "Antenatal Prediction of Postpartum Urinary and Fecal Inconti... : Obstetrics & Gynecology". Journals.lww.com. Retrieved 2014-02-02.
^ "Postpartum Depression". Canadian Mental Health Association. Retrieved July 9, 2014.
^ Dobson, V.; Sales, B. (2000). "The Science of Infanticide and Mental Illness". Psychology, Public Policy and Law 6 (4): 1098–1112. doi:10.1037/1076-8971.6.4.1098.
^ "Effect of Alcohol consumption on Maternal lactation characteristics during ‘doing-the-month’ ritual" (PDF). Retrieved 2014-02-02.
^ "Ayuvedic Postpartum Healing Tips". Ayurveda.iloveindia.com. Retrieved 2014-02-02.
^ "Ayurvedic diet for de-stressing postpartum mothers". Thefreelibrary.com. 2001-12-22. Retrieved 2014-02-02.
^ Jacobson, Hilary. "Lactogenic Foods and Herbs". Mobimotherhood.org. Retrieved 2014-02-02.
^ "Lie down by a fire". Bangkok Post.
^ John Marshall / Jaya Tirtha Charan Dasa. "GUIDE TO RITUAL IMPURITY - What to do at the junctions of birth and death". Hknet.org.nz. Retrieved 2014-02-02.

External links

New born Care
eMedicine: Normal and Abnormal Puerperium
Patient UK: Postnatal Care (Puerperium)
Postpartum Social Awareness
Discovery Health's Postpartum Planning Tool guides you through the mysteries of motherhood and babyhood from birth to 12 weeks.
Pregnancy & Childbirth
Postpartum Health (India) by Mohit Trendster
NHS Choices Birth to Five Planner: Postnatal post-traumatic stress disorder
Postpartum Care
Postpartum care of mother and newborn: WHO

UpToDate Contents

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Okamura AM1, Gomes PX1, de Oliveira GV1, Araújo FY1, Tomaz VS1, Chaves Filho AJ1, de Sousa FC1, Vasconcelos SM1, de Lucena DF1, Macêdo D2.
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Buschert J1, Sakalem ME2, Saffari R2, Hohoff C2, Rothermundt M3, Arolt V1, Zhang W1, Ambrée O4.
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Barros CA1, Rezende Gde C1, Araujo Júnior E2, Tonni G3, Pereira AK1.
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