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Clinical Specialties - Maternity

Other Maternity Information Resources


Postnatal Perineum Care

Many women who have a vaginal birth will experience some degree of trauma to the perineum, the area between the vagina and the anus. In the first few days after birth it is essential to manage and care for the perineum to decrease pain, prevent infection and promote healing. (1) Your Obstetrician will explain if trauma has occured, and will repair this trauma appropriately.

During your stay in hospital your obstetrician and midwife may ask you about your perineal pain and may inspect it to monitor healing or risk of infection.

HIPPS - An easy way to remember (3)

  • H – Hygiene
  • I – Ice
  • P – Pelvic floor exercises
  • P – Pain relief
  • S – Support


Hygiene:
To prevent infection and promote healing, keep the perineum clean and dry:

  • Change sanitary pad every 3-4 hours and wash your hands before and after
  • Lean forward when passing urine to prevent stinging (2)
  • If you experience stinging and excessive discomfort when passing urine even when leaning forward, a urinary alkalizer such as URAL can be given to you by your midwife to reduce the acidity and decrease the burning sensation (4)
  • Wipe front to back, washing the area with warm water after passing urine or bowel movements and patting the area dry (2)


Ice:
Use ice pads to perineum for the first 24-72 hours to reduce pain, swelling and aid in healing. These should be applied to perineum for 20 minute intervals every 2 hours. (2)

Pelvic Floor Exercises:
Pelvic floor exercises are encouraged from 24 hours after birth to strengthen the muscles. (2) Ask your midwife if you are unsure of how to do pelvic floor exercises.

Pain Relief:
Oral pain relief such as Paracetamol (Panadol) and Diclofenac (Voltaren) are usually the first line of defence. Your Obstetrician will prescribe what they prefer you to have and your midwife will administer it. (2)

Avoid prolonged sitting as it may place a lot of pressure on the perineum and delay healing. (4)

Support:
Your Obstetrician and midwife are here to support you holistically so do not hesitate to ask any questions. If you have concerns after you have left hospital, contact your Obstetrician or GP. (4)

DIET

  • Eat a diet that is nutritious and balanced with high fibre to avoid constipation. Straining while trying to do a bowel movement can delay healing process.
  • Drink plenty of water. (2)


Support the perineum with a folded bunch of toilet paper, allowing you to push a small amount to open your bowels. DO NOT STRAIN. (4)

REFERENCES

  1. Bick, D., & Bassett, S. (2013). How to provide postnatal perineal care. Midwives Magazine, Retrieved from http://www.rcm.org.uk/print/9250
  2. Queensland Clinical Guidelines. (2015) Perineal care. Retrieved from http://www.health.qld.gov.au/qcg/documents/g_pericare.pdf
  3. Department of Health Western Australia. (2015). Perineal Care. Retrieved from http://guides.is.uwa.edu.au/c.php?g=324904&p=2809557
  4. South Australia Perinatal Practice Guidelines. (2014). Perineal Care. Retrieved from http://www.sahealth.sa.gov.au/wps/wcm/connect/76d1590047ff0344qffeff21d1663cdf/Perineal+Care_Mar2015.pdf?MOD=AUPERES&CACHEID=76d1590047ff0344affeff21d1663cdf

Settling Chart


Settling Activity Order

1.  Feed baby
2.  Burp baby, nappy change, cuddle time, play time, bath time - at night, do not have play time
3.  Baby shows tired signs - yawning, jerky body movements, crying, grizzling, clenched fists, arching back, stiffness, fluttering eyelids, staring
4.  Put baby to bed - reduce stimulation (dim lights, talking & singing quietly)
5.  Baby wakes within 2 hours & fed well - check the following & resettle baby:
          - Does baby have wind? Angry red face, firm stomach, draws legs up, crying
               -- Pick baby up and allow burp time, try other settling techniques
               -- Put baby to bed
          - Is baby over tired? Has baby been over-handled or over-stimulated? Baby showing tired signs as listed above
               -- Put baby in cot to settle; remove baby from visitors or area of stimulation
6.  Baby wakes 2 - 5 hours after feed; or baby wakes and did not feed well at last feed - Offer another feed

SOME OTHER SETTLING TECHNIQUES TO TRY:

  • Gently rock baby in the cot
  • Quiet music
  • Walk in pram
  • Relaxation bath
  • Massage
  • Pat or stroke baby

Crying that is difficult to console in the early weeks and months of an infant’s life is part of normal behavioural development. Always exclude any health-related explanations for the unsettled behaviour.

SLEEP CYCLES

  • Baby sleep cycle generally last 20 – 40 minutes. In older children the sleep cycle increases with longer periods of deep sleep.
  • A sleep cycle begins with light sleep, then deep sleep and back into a light sleep.
  • In light sleep cycles, your baby may open their eyes, grimace, suck, grizzle, look restless, smile and occassionally twitch their fingers and feet.
  • Some babies and children will be able to resettle themselves back into another deep sleep phase.
  • For those that do not resettle, place a hand on your baby and say some reassuring words or pat them to encourage your baby back to sleep.
  • Try to have a positive, consistent sleep routine to establish healthy infant sleeping behaviours.


HOW MUCH SLEEP?

  • Newborns sleep on average 16 – 18 hours a day having 2– 4 hour sleeps at a time.
  • At 2 – 6 months of age; 2 – 3 'day' sleeps for up to two hours each (some babies just 'cat nap' for one sleep cycle). Babies this age commonly wake once or more during the night.


References:

  • Community Paediatric Review. The Royal Children’s Hospital, Melbourne. Sept 2011. Sleep, Vol 19, No 2.
  • Gethin A. and Macgregor B. 2011. Helping your baby to sleep why gentle techniques work best. Finch. Sydney Australia. SidsandKids Safe Sleeping www.sidsandkids.org/safe-sleeping

COMMUNITY RESOURCES FLOW CHART

Following your discharge from hospital there are a number of community resources available to assist you. Maintain contact with your Early Childhood Centre (ECHC), and if you require further assistance you may like to:

  • Phone Tresillian (24/7), Karitane (24/7), Australian Breastfeeding Association (ABA) (24/7), GP or Paediatrician
  • Phone or see SAH Lactation Consultants - available 9am-3pm Mon-Fri, 10am-2pm Sat-Sun, for up to 6 weeks post-discharge. Please phone 9480 4071 for an appointment
  • Phone or see a Social Worker
  • Organise a home visit through the Parent Support Service at your ECHC
  • Make an appointment to see a private Lactation Consultant or Mothercraft Nurse
  • Make an appointment to see your GP


If you still require assistance there are Day Stay and Residential programs and services available:

  • Day Stay Programs - Tresillian, Koala Cottage, Camelia Cottage, Dalwood Homes
  • Residential Programs - Tresillian (Mon-Fri), Karitane (Mon-Fri), St John of God Hospital


Throughout the process of settling in at home with baby, it is important to maintain contact with your Early Childhood Centre (ECHC).

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Sydney Adventist Hospital Clinical Specialties and Services