Puerperal Period

Period Definition Ruling

1. Puerperal period is the period beginning a few hours after the birth of the placenta to 6 weeks after delivery (Pusdiknakes, 2003:003).
2. Puerperal period begins after the birth of the placenta and ends when the means of returning the content of such a state before pregnancy that lasted about 6 weeks. (Abdul Bari, 2000:122).
3. Puerperal period is a period during labor and immediately after birth, including the following weeks at the time of the reproductive tract return to normal non-pregnant state. (F. Gary Cunningham, Mac Donald, 1995:281).
4. Puerperal period is the period after a mother gave birth to a baby who is used to recuperate back that generally takes 6-12 weeks. (Abraham C, 1998).

Ruling Period Objectives
The purpose of the provision of care during childbirth to:

1. Maintaining the health of mother and baby, both physically and psychologically.
2. Skrinning implement a comprehensive, early detection, treat or refer the case of complications in the mother and baby.
3. Provide health education regarding self care, nutrition, family planning, means and benefits of breastfeeding, immunization and infant care everyday.
4. Providing family planning services.
5. Getting emotional health.

Roles and Responsibilities of the Midwife In Ruling Period
Midwives have a vital role in providing postpartum care. The roles and responsibilities during childbirth include:

1. Provide continuous support during childbirth in accordance with the needs of mothers to reduce the physical and psychological strain during childbirth.
2. As a promoter of the relationship between mother and baby and family.
3. Encouraging mothers to breastfeed their babies by increasing the sense of comfort.
4. Making policy, health program planners regarding the mother and child and is able to perform administrative activities.
5. Detecting complications and the need for referral.
6. Provide counseling to mothers and families about how to prevent bleeding, recognize the signs of danger, maintaining good nutrition, and practice safe hygiene.
7. Doing care management by collecting data, establishing a diagnosis and plan of action and implement it to speed up the recovery process, preventing complications by meeting the needs of mothers and babies during childbirth period.
8. Provide care in a professional manner.

Ruling Period Stages
Puerperal period is divided into three stages, namely:
   1. Early Puerperium
      A recovery period where the mother is allowed to stand and walk.
   2. Puerperium intermedial
      A time when recovery from the reproductive organs for approximately six weeks.
   3. Remote puerperium

The time required to recover and return in the development of state of perfect health, especially the mother if the mother during pregnancy or during labor and delivery complications.

Involution Content Tools

1. The uterus gradually becomes small (involution) and eventually returned as before pregnancy.

Involution	Uterine Fundus Height	Uterus Weight
Babies born	High center	1000 grams
Uri was born	2  finger down the center	750 grams
1 week	Center mid symphysis	500 grams
2  week	No palpable above the symphysis	350 grams
6  week	Burn down	50 grams
8  week	Normal registration	30 grams

2. Former implantation uri: placental bed decreases due to contraction and protruding into the uterine cavity with a diameter of 7.5 cm, after 2 weeks to 3.5 cm, 2.4 cm in the sixth week, and eventually recovered.
3. The wounds in the birth canal if not accompanied by infection will heal in 6-7hari.
4. The pain, called after pain, (Merian or mules-mules) caused contractions of the uterus, usually lasts 2-4hari postpartum. Understanding needs to be given to the mother about this and if too disturbing to be given anti-sickness drugs and anti mules.
5. lochia is fluid secretions originating from uterine cavity and vagina during childbirth.
• Lochia rubra (cruenta): contains fresh blood and the remnants of the amniotic membranes, decidual cells, verniks kaseosa, lanugo, and meconium, during 2hari postpartum.
• Lochia sanguinolenta: yellow red of blood and mucus, 3-7 days postpartum.
• Lochia serosa: yellow, the liquid does not bleed anymore, at days 7-14 postpartum.
• Lochia alba: white liquid, after 2 weeks.
• Lochia purulenta: an infection, like pus discharge foul smelly
• Lochiostasis: lochia discharge is not smooth.  
6. Cervical: After childbirth, the cervix forms a funnel rather gaping like a red-black. Soft consistency, sometimes there are injury-minor injury. After the baby is born, his hand still bias into the uterine cavity; after 2hours to be passed by 2-3 fingers, and after 7 days can be passed only 1 finger.
7. ligament-ligament: ligament, fascia, and the pelvic diaphragm are stretched at the time of birth, after birth, gradually become shriveled and recover so that not infrequently the uterus falls back and becomes lax. After delivery, the habit of Indonesian women do "berkusuk" or "sequential", in which when dikusuk intra-abdominal pressure is getting higher. Because after childbirth ligaments, fascia, and supporting tissues become lax, if done kusu / candidacy, many women will "implies down" or "upside down". To revert back preferably with gymnastic exercises and post-delivery.

National Program Policy On Ruling Period
Policies and programs on post partum period is at least four times a visit during childbirth, with the aim to:

1. Assess the health condition of mother and baby.
2. Prevention of the possibilities of interference puerperal women and their babies.
3. Detect any complications or problems that occur during childbirth.
4. Dealing with complications or problems that arise and disrupt the puerperal women and their babies.

   Visit	Time	Upbringing
   I	6-8 hours post partum	Prevent bleeding during childbirth due to uterine atony.
   		Detection and treatment of other causes of bleeding and do a referral if bleeding continues.
   		Provide counseling to mothers and families about how to prevent bleeding due to uterine atony.
   		Breastfeeding early.
   		Teaches how to strengthen the relationship between mother and newborn.
   		Keeping your baby stay healthy through prevention hipotermi.
   		After the midwife doing childbirth aid, then the midwife must take care of mom and baby for the first 2 hours after birth or until the state of the mother and the newborn in good condition.
   II	6 days post partum	Ensuring barjalan with normal uterine involution, the uterus to contract properly, high fundus uteri under the umbilicus, there was no abnormal bleeding.
   		Assess any signs of fever, infection and bleeding.
   		Ensure mothers get adequate rest.
   		Ensuring the mother gets enough nutritious food and fluids.
   		Ensuring nursing mothers with a good and right and there are no signs of trouble breastfeeding.
   		Provide counseling about newborn care.
   III	2 weeks post partum	Care at 2 weeks post partum with the care given at 6 days post partum visit.
   IV	6 weeks post partum	Asking complications-complications experienced by the mother during childbirth.
   		Providing family planning counseling at an early stage.