Introduction
Postpartum women are in a dilemma dealing with multiple responsibilities along with improvement of one’s own health. Child care, over occupies most of the postpartum time and personal wellbeing is usually jeopardised. Women usually forget the importance of improving one’s own health along with the child’s health. Mother, is the pillar of support for the child till the stage of self-dependence.
This article is written based on follow-up of 3 percent of morbid postpartum women – both primipara and multi para, who reported morbidities 5 years back and had impaired physical quality of life. Information was collected by in-depth interview of 3 percent of women with severe postpartum morbidity and impaired physical quality of life. This was triangulated with the quantitative and qualitative information from the base study.
Overall health aspect
On interviewing the women, it was found that all primipara had turned into multipara with two or more children. But over the past 5 years, they are emotionally strengthened for child care and supporting family. They have overcome concerns like, not able to pursue academic pursuits and need for a job immediately to support themselves. They are presently sustaining with family support and also providing support to the family, other than financially. Few are continuing, higher education which they discontinued due to pregnancy and child care.
Specific Health issues
Specific health problems of Gestational Diabetes Mellitus- Gestational Hypertension were managed by diet and medication during the immediate postpartum, and did not turn into overt Diabetes or Hypertension. Hypothyroidism, is also controlled by medication and due follow-up. One woman had primary infertility and had conceived the first time after taking treatment for infertility. The immediate and late postpartum were managed well with physical, emotional, nutritional care and did not progress to secondary infertility. She conceived the second time without medical or surgical treatment and presently is in good health.
Caesarean section and its toll on physical health
There was a significant number of women who had Caesarean section, mostly due to underlying risk factors or emotional stress. Calculation error in the expected date of childbirth due to irregular menstrual cycle was also one of the reasons of Emergency Caesarean section associated with meconium stained liquor. Women who had emergency Caesarean section improved physically and had uneventful pregnancies in the following years. They have overcome stress of the first pregnancy and are experienced in managing trigger factors which led to emergency Caesarean section.
Lactational insufficiencies
Most of the primipara had lactational insufficiencies due to incorrect feeding techniques and dependence on milk supplements for the neonate since childbirth. There was positive response on motivating the mothers to continue breastfeeding along with supplements. This was replaced by exclusive breastfeeding during the following pregnancies. The women learnt the breastfeeding techniques and adjusted themselves to the baby’s requirement. They knew post feed manoeuvres for themselves and the child. Nutritionally deficient children in the cohort are none and there was adequate weight gain, with less frequent illness episodes. The Intrauterine growth retardation was none and neonatal – infant morbidity was less
Coping with motherhood
The women are adjusted to the new environment with child care as their primary role which they are performing well. They are able to manage it with family, peer, ASHA and hospital support, along with self-motivation.
Their main concern was body dysmorphism, persisting after 5 years, mostly due to multiple pregnancy and lack of time resorted to improve one’s own health. They are seeking techniques and ways to manage body disfiguration along with weight gained during antepartum and postpartum, but most in vain. This is indirectly affecting their mental and emotional well-being too.
Health seeking behaviour
Women seek health care from private clinics or hospitals except for mild illnesses of children. This was mostly due to inaccessible of secondary level maternal and child health care. There is a resistance or indecisiveness to seek follow-up care from the government primary health care providers as well, except for immunization for the children and treatment of mild illnesses. Expectations from the government clinics are advices on preventive health care, first aid measures, advice on warning signs to seek health care and night outpatient services.
Recipes for improving physical health
Prescriptions in the form of diet supplements diet and exercises are provided to the women. Supplements included vitamins especially vitamin D, calcium and Iron. Regular diet as small frequent feeds, like that for the children with more vitamin, mineral, calcium, iron rich foods are recommended. Equal amount of energy and bodybuilding food items with inclusion of milk, milk products, fruits and vegetables are the prescribed diet. Cooking of all food items has to be in the most hydrating and nourishing manner for both mother and children. Raggi with jaggery preparations are recommended for the mother to replenish the lost nutrients and for the child as weaning food for growth. Hydration with minimum 1.5 lit per day of water, with extra 500 ml to 1000 ml for mothers more than 60 kg is advised.
Exercising is difficult for the mothers when there is lack of motivation, encouragement and time to do them regularly. Personalized exercises according to their body mass index, abdominal girth and body composition are advised. Most of the exercises are less time consuming, tiring and adaptive to normal routine. Few yoga exercises and meditation are included along with mandatory pelvic floor and abdominal muscle strengthening exercises.
Role of Health programmes
Most of the National and State Health programmes of maternal health focuses on antepartum and intrapartum period. ASHA home visits and doctor follow-up at 6 weeks postpartum are the included activities after child birth. Programs to strengthen the mothers, physically, emotionally and psychologically should be introduced with inbuilt monitoring of the progress along with measures to inculcate self-motivation. Moreover, spacing and contraception should be mandatory advices for the women. Postpartum care, irrespective of the outcome of child birth and post abortion care, are also equally important to strengthen the women after the major physiological changes, during pregnancy, abortion, child birth and postpartum.
