The puerperium covers the 6-week period following birth, during which time the various physiological changes that occurred during pregnancy revert to the non-pregnant state Guzman 2010). Although for most women, the postnatal period is uncomplicated, care during this time needs to address any departures from expected recovery after birth.
Common puerperal problems include: pain in the perineal area, if the perineum has been damaged during the birth; urinary stress incontinence; painful or difficult urination; constipation; haemorrhoids; insufficient lactation, mastitis; breast abscesses; back pain; headache due to epidural/spinal anaesthesia; persistent fatigue; the ‘baby blues’; and postnatal depression (affects about 10%).
For pain in the perineum, cold compresses and analgesics may be used (NICE 2006). For urinary stress incontinence, the usual treatment is to teach and encourage pelvic floor exercises. For constipation and haemorrhoids, stool softeners may be needed. Making sure all milk is expressed is the first action with mastitis, and cold compresses may be used. If a bacterial infection is suspected, antibiotics are prescribed, while breast abscesses are treated with incision and drainage. Back pain and headache are managed in the same way as in the general population. Persistent fatigue can be the result of anaemia due to excessive blood loss, and may be treated with iron supplements or sometimes a blood transfusion. Women with the ‘baby blues’ need reassurance that it will pass quickly and is a ‘normal’ experience in the first week after giving birth (SIGN 2002). Those with postnatal depression are referred to psychological therapies and possibly given antidepressants (NICE 2007).
References
Guzman GM et al. Normal and abnormal puerperium. eMedicine 2010 [online]. Available:http://emedicine.medscape.com/article/260187-overview
National Institute for Health and Clinical Excellence, 2007. Antenatal and postnatal mental health: clinical management and service guidance. NICE Clinical Guideline, [online]. Available:
National Institute for Health and Clinical Excellence, 2006. Postnatal care: Routine postnatal care of women and their babies. NICE Clinical Guideline, [online]. Available: http://www.nice.org.uk/nicemedia/live/10988/30144/30144.pdf and http://www.nice.org.uk/nicemedia/live/10988/30146/30146.pdf
Scottish Intercollegiate Guidelines Network, 2002. Postnatal depression and puerperal psychosis, [online]. Available:
How acupuncture can help
One systematic review of various treatments for breast engorgement during lactation (Manges 2010) located one eligible and analysable acupuncture study (Kvist 2007), and found that, compared to women receiving routine care, women receiving acupuncture had greater improvements in symptoms in the days immediately following treatment. The original study authors concluded that acupuncture plus care interventions such as correction of breast feeding position and babies’ attachment to the breast, might be more effective and less invasive than oxytocin nasal spray for inflammatory symptoms of the breast, however, the evidence is still very much at a preliminary stage.
In other randomised controlled trials, acupuncture and electro-acupuncture have been shown to delay the time to requesting pain relief medication after caesarean section, and to decrease the patient-controlled analgesia doses used within the first 24 hours (Wu 2009); both auricular acupressure using press seeds (Zhou 2009) and electroacupuncture (Wang 2007) have been found to have some efficacy in hypogalactia. [See Table below]
Also see other Factsheets, such as those for Acupuncture and Back Pain, Acupuncture and Migraines, Acupuncture and Anxiety, Acupuncture and Chronic Fatigue Syndrome, Acupuncture and Urinary Incontinence, Acupuncture and GI tract Disorders.
In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body’s homeostatic mechanisms, thus promoting physical and emotional well-being. Stimulation of certain acupuncture points has been shown to affect areas of the brain that are known to reduce sensitivity to pain and stress, as well as promoting relaxation (Hui 2010)
Acupuncture may increase milk production, help relieve pain (e.g. back pain, headache, pain in the perineum), and improve mood and reduce anxiety in women who have recently given birth by:
- increasing prolactin levels (Wang 2007);
- altering the brain’s chemistry (Samuels 2008), increasing endorphins (Han 2004) and neuropeptide Y levels (Lee 2009; Cheng 2009), and reducing serotonin levels (Zhou 2008);
- stimulating nerves located in muscles and other tissues, which leads to release of endorphins and other neurohumoral factors, and changes the processing of pain in the brain and spinal cord (Pomeranz 1987, Zhao 2008);
- reducing inflammation, by promoting release of vascular and immunomodulatory factors (Kavoussi 2007, Zijlstra 2003).
