The Normal Puerperium
The guidelines recommend management of common obstetric conditions at primary and referral level, based on local experience and evidence-based practice. They are not intended as strict protocols nor as standard operating procedures, but rather as a guide to safe effective management of common obstetric problems. The guidelines should be most useful to interns, medical officers and registrars.
Discharge from hospital after normal birth
The puerperium lasts from delivery of the placenta up to 6 weeks after delivery. It is characterized by a physiological return to the non-pregnant state. Mood swings & ‘blues’ are common.
Uterine involution starts soon after delivery, with the uterus usually not palpable above the pelvic brim 2 weeks after delivery. On vaginal examination, the cervix will admit at least one examining finger up to about one week after delivery.
The postnatal vaginal discharge (lochia) is termed:
- Lochia rubra (blood-stained) from 1-3 days after delivery
- Lochia serosa (serous brown-yellow fluid) from 3-10 days
- Lochia alba (yellow-white discharge) from 10 to about 28 days
DISCHARGE FROM HOSPITAL AFTER NORMAL BIRTH
Discharge from hospital is permissible 6 hours after vaginal birth provided that:
- There are no surgical, medical or obstetric problems that require attention
- The woman looks & feels well
- There is no evidence of anaemia
- The heart rate (<100/min), temperature & BP are all normal
- There is no uterine tenderness
- There is no active vaginal bleeding
- There are no serious urinary symptoms (incontinence, retention)
- There is no excessive pain in the abdomen or perineum
- Breastfeeding, or formula feeding, has been explained & demonstrated
- The HIV, Rhesus blood group & RPR results are known
- Plans for contraception have been discussed
All findings should be recorded & the woman advised to attend her nearest clinic 3-6 days after delivery for midwives’ assessment, & for examination of the baby. Write a short discharge summary for the woman to take to the clinic.