Homeopathy in Puerperium

Puerperium is the period following childbirth during which the body tissues, specially the pelvic organs revert back approximately to the pre-pregnant state both anatomically and physiologically. It begins as soon as the placenta is expelled and lasts for approximately 6 weeks when the involution of uterus has completed. Different terms have been used for this period like the post natal period which is the period after delivery; the Lying-in period so often talked about in our literatures are the immediate 5-7 days after the child-birth. The normal changes which encompass puerperium are:

• Involution of uterus and other pelvic structures.
• Reverting of the physiology of body to its pre-pregnant stage.
• Breast changes to cover the demands of breast-feeding.
• Loss of weight.
• Onset of menstruation and ovulation.

Homeopathy is a practical method, an instrument for attaining in best manner a certain end i.e. the cure of disease. Puerperium in itself is not a disease. It is the normal physiology of body to cope up with the increased demands on itself. Owing to these retrogressive changes the female body reverts to its pre-pregnant state. Most of the females cope up with these changes rather uneventfully. But sometimes the puerperal epoch is blemished by some minor ailments and abnormalities. Homeopathy through similimum remedy helps to relieve the patient of his complaints without producing ill effects on the mother and the baby. These include:

1. AFTER PAINS: It is the spasmodic, intermittent pain felt in the back and lower abdomen after delivery for a variable period of 2-4 days. It is often felt more frequently while breast-feeding. Presence of blood clots or bits of the after births leads to spasmodic hypertonic contractions of the uterus in an attempt to expel them out.

Mangement:

Massaging the uterus with expulsion of the clot.

Homeopathic medicines:

After pains distressing, severe: CUPR  

After instrumental delivery: Arn, Calen, Rhus-tox, Hyper

2. RETENTION OF URINE: It is a common complaint. It is due to bruising and oedema of the bladder neck or reflex from perineal injury. If the 24 hours urine extraction is less than 400 ml, suppression of urine is diagnosed.

Management:

Adequate fluid intake

Ensure continous drainage.

Homeopathic medicines: Dr. Guernsey recommends, "If no inclination to urinate has been felt, the bladder is probably semi-paralysed and needs help to resume its proper function. This help it will get from Arsenicum, Causticum or Hyoscyamus according to their indications." Other medicines frequently indicated are:

CANTHARIS 30: Retention of urine after labour, intense burning sensation in the urinary tract. Urine comes in drops even after straining. Desires to wash the parts with cold water. Violent thirst.

ARNICA MONT 30: Retention of urine after labour. Spasmodic pain with very painful micturition. Nervous, cannot bear pain. Urine dark with brick-red sediments.

OPIUM 1M, 1 dose: Urine retained, with full bladder; slow to start; feeble stream; retained after fright.

HYOSCYAMUS: Retention of urine, with constant pressure in the bladder; apparent paralysis of the bladder.

NUX VOMICA: Painful and ineffectual desire to urinate, the pain being burning and tearing; retention of urine, with frequent urging to stool. Irritable, morose and scolding.

STRAMONIUM: Retention of urine, with a sensation as if the urine could not be passed on account of the narrowness of the urethra; after straining a while a few drops are passed, no stream being formed in spite of all straining; retention without any painful sensation.

3. CONSTIPATION.

Homeopathy medicines:

ALUMINA: Hard, dry, knotty stools with no desire. Rectum sore dry. Evacuation preceeded by painful urging long before stool, and then straining at stool.

NUX VOMICA: Frequent urge for stools after every attempt of eating.

OPIUM: Obstinate constipation, faeces protrude and recede. Round, hard, black balls.

PLATINA: Faeces scanty, evacuated with great difficulty. Adheres to the rectum, like soft  clay.

SEPIA -   Sense of weight or ball in the anus, not relieved by stool.

4. INSOMNIA AND ANXIETY STATES: The mother may appear moody, irritable and tends to burst to tears at slightest provocation. She may complain of lack of sleep, and often complain of inability to cope up with the demands of baby. She tends to be worrisome, wondering whether the baby is getting adequate food or not. These anxieties are transient and self limiting lasting for 3-5 days. It can lead to serious depressive psychosis. Sleeplessness may be the first sign of puerperal psychosis

Management:

Reassurances.

Strong family support,

Adapting and coping.

Homeopathic medicines:

Dr. Guernsey says, "For Puerperal Melancholia Platina, Pulsatilla, Aurum and Agnus castus are suitable; but I have much confidence in Agnus castus." Regarding the melancholia Dr. Hughes has given, "It is characterized by irritability of temper, readiness to shed tears at slightest provocation, undue fear of the approaching confinement, and so on. I myself have found Actea racemosa so beneficial for it, that I have rarely had to resort to any other remedy. If I needed such, I should expect to find it in Pulsatilla. When crossness is the most evident symptom, Chamomilla is useful; and when the dread of death in the approaching confinement amounts to Monomania, Aconite". Other commonly indicated medicines are: Stramonium; Veratrum album; Bell; Cimicifuga; Agnus cast

5. PAIN IN PERINEUM: Some degree of pain is felt in the stitches. Abnormal pain should be investigated to diagnose vulvo-vaginal hematoma.

6. BACKACHE: It is found in ill-nourished and overworked multi-parous women. Mother is advised to use abdominal binder to enhance the involution of uterus.

Management:

Advice Post natal exercises: To strengthen abdominal and perineal muscles. To correct posture and strengthening of back muscles preventing backache. To help mother loose weight.

Homeopathic medicines:

KALI CARB: Backache in pregnancy and lying-in period.

Post natal exercises

Types of exercise
Keep in mind that your ligaments and joints will be loose for at least three months following the birth, so avoid any high impact exercises or sports that require rapid direction changes. Vigorous stretching should be avoided too. Recommended postnatal exercise includes:

• Brisk walking
• Swimming
• Aqua- aerobics
• Yoga
• Pilates
• Low impact aerobic workouts
• Light weight training
• Cycling.

General suggestions for aerobic exercise
Be guided by your doctor or midwife, but general suggestions include:

• Give yourself sufficient time to heal, particularly if you have had a caesarean birth.
• Consult with your doctor or midwife before starting any postnatal exercise program - you may be advised to wait, or adapt your exercises.
• If you are having trouble with the techniques required in the above exercises, please consult a physiotherapist, exercise physiologist or other appropriately qualified and certified fitness professional.
• Aim for slow, gradual weight loss of around half a kilogram per week.
• Wear a supportive bra.
• Avoid any activities that place stress on the unstable pelvic floor and hip joints until strength and stability has improved. Be careful about activities that require sudden changes in direction (for example, high impact aerobics, running and contact sports). This varies depending on the type of pregnancy and delivery you may have had.
• Initially, exercise for only five to 10 minutes at a time. Increase the length of your workouts gradually.
• Ideally, your exercise sessions should eventually last between 30 and 50 minutes.
• Drink plenty of water before, during and after exercise.
• Don't push yourself too hard - if you feel breathless, slow down.
• If you experience pain, slow down or stop.
• Remember that it may take you months to return to your pre-pregnancy shape and weight, so don't be discouraged by slow progress.

Some exercises which can be done on a regular basis to increase the tonicity of muscles of body are:

GENTLE TUMMY EXERCISE
Pregnancy splits your abdominal muscles down the middle. It is important to make sure your muscles have healed before you do any vigorous abdominal exercises, such as abdo crunches. In the meantime, you can tone your tummy by performing an exercise that strengthens the deepest muscle layer (transversus abdominus).
Be guided by your doctor, midwife, physiotherapist or exercise physiologist, but general guidelines include:

• You can perform these exercises lying down, sitting, standing or on your hands and knees.
• Keep your lower back flat.
• Breathe out and draw your belly button back towards your spine. Your lower back shouldn't flex or move.
• Hold this position and breathe lightly. Count to 10.
• Relax and repeat up to 10 times per set.
• Do 10 sets, as many times per day as you can.
• You may like to perform your pelvic floor exercises at the same time (see below).

EXERCISE FOR THE LOWER ABDOMINAL MUSCLES
The lower abdominal muscles are located below your belly button. To work these muscles gently, guidelines include:

• Make sure your abdominal muscles have healed. Until the gap is closed, only perform the 'gentle tummy exercise' option.
• Lie on your back with your knees bent and both feet flat on the floor.
• Contract your abdominal muscles.
• Slowly slide your feet away from you, aiming to straighten both legs. The idea is to straighten the legs without arching your lower back.
• If your back starts to arch, stop and slide your feet back towards your bottom.
• Aim for 10 repetitions per set.
• Perform around three sets per session.
• As your lower abdominal muscles get stronger, you'll be able to slide your feet further and further away.

PELVIC FLOOR EXERCISES
The pelvic floor muscles are tightly slung between the tailbone (coccyx) and the pubic bone, and support the bowel, bladder, uterus (womb) and vagina. Childbirth can weaken these muscles and cause problems, such as incontinence, later in life. To exercise them, you must first direct your attention to these muscles. To help you identify these muscles, they are the ones that you contract to stop urinating.
Try to relax your abdominal muscles. Don't bear down or hold your breath. Gradually squeeze and increase the tension until you have contracted the muscles as hard as you can. Release gently and slowly. Then perform the exercises, which include:

• Squeeze slowly and hold for between five and 10 seconds. Release slowly. Repeat 10 times.
• Perform quick, short and hard squeezes. Repeat 10 times.
• Squeeze, then clear your throat or cough lightly. Repeat three times.
• Aim for five or six sets each day.
• These exercises can be performed lying down, sitting or standing.

Warning signs to slow down
Don't overexert yourself. Your body gives out warning signs if you are exercising too hard, and these signs may include:

• Increased fatigue
• Muscle aches and pains
• Colour changes to lochia (post-partum vaginal flow) to pink or red
• Heavier lochia flow
• Lochia starts flowing again after it had stopped.

See your doctor for further information and advice.

Things to remember

• You should gently exercise your pelvic floor and abdominal muscles every day.
• Make sure your abdominal muscles have healed before you do any vigorous tummy exercises, such as crunches.
• It is important to consult with your doctor or midwife before embarking on any postnatal exercise program, as you may need more time than you think to heal from the rigours of childbirth.

However, if you had a caesarean, it's wise to wait until your six-week check. Apart from these exercises yoga and meditation can also be practiced for healthy mind and body.

Apart from minor complaints there are also some abnormalities of puerperium which need prompt care. Some of them are:

1. PUERPERAL PYREXIA: A rise in temperature reaching 100.4^。F on two separate occasion 24 hours apart within first 10 days following delivery is called puerperal pyrexia. It may be due to low resistance of patient, malnutrition, unhygienic conditions or retained bits of placental tissue. The patient presents with high fever, often with chills and rigors; offensive lochia with history of recent delivery.

Management:                           

Proper rest with adequate fluids.

Frequent draughts of cold water, barley, milk, strong tea can be given.

Retained products should be removed,

Dressing of the wound (episiotomy) with calendula tincture helps in early healing,

Constipation should be relieved.

Homeopathic medicines:

BELLADONA: A high feverish state with dry perspiration on forehead. No thirst with fever and very offensive lochia.

PYROGEN: Septic fever with coldness and hot sweats.

ARSENICUM :High fever with complete exhaustion and great restlessness.

TEREBINTHINA-fever two days after parturition, heat with violent thirst;

AILANTHUS GLANDOSA-high fever with throat involvement

Milk fever : BRY with distended breasts, CHAM with sore breasts

2. BREAST ENGORGEMENT and MASTITIS: It is due to exaggerated normal venous and lymphatic engorgement of the breasts which precedes lactation. The patient approaches with pain and tense feeling of the breasts, generalized malaise and painful breast feeding. Acute mastitis can be managed excluding the cases with formation of abscess which should be drained.

Management:

Lots of free fluid should be consumed.

Support the breasts with a binder or brassiere.

To apply hot bags on breast before nursing and ice bags after.

To express the milk manually.

The baby should be put to breast regularly after the expression of milk.

Homeopathic medicines:

PHYTOLACCA DECANDRA :Mastitis : Mammae is stony hard, hot, swollen, and painful. When child nurses, pain goes from nipple to all over the body. Mammae purple hue on appearance.

BRYONIA: Stony hardness, hot & painful, Pain < Slightest touch or motion. Must support the breast, feels better lying on the painful side.

LAC. CANINUM :Similar to Bryonia but, pain is alternating in character, shifting from one side to another

3. CRACKED NIPPLES: It is a painful condition caused due to unclean hygiene or vigorous suckling in engorged breasts.

Management:

Local cleanliness should be maintained.

Nipple should be kept dry and exposed to the air.

Breast feeding can be suspended as long as the nipple fails to heal with manual expression of the milk

Homeopathic medicines: Dr. Hughes writes, "Phellandrium, or in the event of its failure, Sabal serrulata, is said to remove the pain felt in these, after each application of the child."

PHYTOLACCA DECAN 30: Cracked nipples with indurated and engorged breasts due to infection (milk abscess). Axillary lymph nodes are enlarged. Nipples are hard, red and tender to touch.

GRAPHITIS 30: Cracks in the nipples which bleed easily with burning and stinging pains. Violent pains with suppression of milk.

HELONIAS- hot, swollen and painful breasts; cracked nipples with intense burning.

CASTOR EQUI- cracked nipples. Multiple ulcers with fetid discharge

ACIDUM NITRICUM: Cracks: intensely sensitive breasts. Breast full of hard, painful nodosities. Pain is unbearable, sure she will die.

PETROLEUM: Itching merely covering nipples.

SEPIA: Deep sore cracks, across crown of nipple.

SULPHUR: After nursing, nipples smart and burn; chaps badly. Breasts look unwashed.

Supportive Treatment for Breast Diseases :

1. Proper positioning of the baby for breast feeding

2. Remove any dried milk on nipple with warm water (no soap)

3. Nurse on affected nipple often and long enough to stimulate it

4. Wear support bra (even in bed at night)

5. Avoid pumping the breast as it will lead to over production of milk

6. Slow down, get rest and stay off feed

7. Warm cloth applied to breast before nursing, cold cloth after nursing. 

4. PUERPERAL VENOUS THROMBOSIS: Thrombosis of leg and pelvic veins is one of the most common complications in puerperium. It may be due stasis of blood in the pelvic and leg veins following prolonged rest during pregnancy; pelvic cellulitis; Obesity and anaemia.

Patient approaches with pain and tenderness of the affected area with slight rise of temperature.

Management:

Bed rest with the foot end raised above the heart level.

As soon as the pain subsides, gentle movement is allowed.

5. PHLEGMASIA ALBA DOLENS (white leg or milk leg) It is a clinico-pathological condition caused usually by retrograde extension of pelvic thrombophlebitis to involve the ilio-femoral vein.

The patient presents with fever, at times with chill and rigor; affected leg is swollen, painful, white and cold due to arterial spasm following irritation of thrombosed vein. Tenderness and induration are also present.

Homeopathic medicines: As Dr. Hughes has said, "When the symptoms of this disease depends upon a phlebitis extending from the uterine into the crural veins, PULSATILLA or HAMAMELIS will pretty speedily effect their removal".

APIS: Fever, with constant restlessness and tossing without relief, absence of thirst; scanty urine; the swelling has a whitish, transparent look; the pain is usually stinging or there are sharp plunging pains.

BRYONIA: Drawing or lancinating pains from the hip to the foot; aggravation from touch or least motion; copious perspiration without relief; a pale pink swelling of the leg; aggravation in the evening and early part of the night.

CALCARE CARB: A whitish swelling of the foot and leg, with a sensation of coldness, as though covered with a cold damp cloth; suppression of milk.

Other medicines often used are : Bell, Cham, Puls, Stram

6. PUERPERAL CONVULSIONS:

Homeopathic medicines:

ARGENTUM NIT: She has a presentiment of the approaching spasm. She is in constant motion from the time she comes out of one spasm till she goes into another. The spasms are violent, and are preceded by a sensation of a expansion of the whole body, especially of the face and head. Sometimes the woman lies quietly for some time after a spasm has ceased, but becomes very before another begins.

BELLADONA: She has the appearance of being stunned; a semi-consciousness and loss of speech; convulsive movements of the limbs and muscles of face; difficult deglutition; dilated pupils. Renewal of fits at every pain, or starts and cries with fearful visions; jerking of muscles between spasms; sound sleep or unconsciousness after a paroxysm.

CAUSTICUM: When the paroxysms are complicated with screams, gnashing of teeth, and violent movements of the limbs.

LAUROCERASUS: She is conscious of a shock passing through her whole body before the spasm.

ZINC has been known to cure obstinate puerperal convulsions after Phosphorus, apparently indicated, had failed.

Other useful medicines are: Cicuta, Cuprum, Helleborus, Hyoscyamus, Stramonium

HOMEOPATHIC THERAPEUTICS:

1. Immediately after labour:

ARNICA MONT 200: For trauma and injuries to uterus during childbirth and to avoid sepsis and relieve sore bruised feeling.

2. Suppressed secretion of milk: Dr. Hughes advises, "If the milk is late in   

appearing, or becomes afterwards diminished in quantity, Agnus castus and    

Asafoetida are the medicines recommended. Sometimes a single dose of

 Calcarea will effect the improvement.

PULSATILLA NIG. 30: Sudden suppression of milk in nursing women. Milk is scanty and watery. Breasts are swollen and engorged. Pain in breasts while feeding the baby.

NUX VOMICA 200: Breasts inflamed with decreased secretion of milk, rise of temperature on 3^rd or 4^th day. Pain in breasts when baby sucks.

SILICEA: Sharp pain in breasts or uterus; pain in back with increase in lochia. Blood flows everytime she puts the child to breasts. Inflammation of nipples, darting burning pains. Nipple drawn in like a funnel.

AETHUSA CYN- Retracted nipples with suppressed lactation;

OLEANDER-breasts engorged, hot and tender, tardy and scanty appearance of milk

RICINUS COMMUNIS 1X or 3X: Increases the quantity of milk in nursing women.

MERC SOL: Milk scanty, with scorbutic gums, swelling of the glands etc.

PHOSPH. ACID: Scanty milk, debility and great apathy.

SECALE COR: In women who are much exhausted from venous haemorrhage. In thin scrawny women. The breasts do not properly fill with milk, there is much stinging in it.

3. Milk abscess: Dr. Hughes says, I can nearly promise you an arrest of this inflammation if taken sufficiently early. BRYONIA is the great medicine for this purpose, in the 6^th or 12^th dilution.

4. Galactorrhoea: Belladona, Bryonia, Borax, Calc. carb, China, Conium, Phosphorus. Dr. Hughes recommends, "In weaning, Bryonia will prevent engorgement of the breasts, and Pulsatilla or Calcarea is recommended to diminish the flow of milk."

5. Improving quality of milk: Dr. Hughes recommends, "Sulphur, Calcarea, Silica, or Mercurius may be given according to the constitutional symptoms when the quality of the milk seems to be at fault, and the child rejects it."

Dr. Borland also regarded, "And yet Belladona, Phytolacca or Pulsatilla is often all that is necessary to establish a free flow of healthy, nourishing milk; or Calcarea or Lac deflor all that is required to bring the milk which was so poor in quality up to the required standard; or NATRUM CARBONICUM OR SILICEA all that the mother needs to change from poison to food."

Child refuses mother's milk - CALC. PHOS., SILICEA.

6. Hairfall after parturition: Acid phos., Lycopodium, Phosphorus, Sepia, Carbo vegetablis

7. Anaemia after parturition: Ferrum, Calc.phos. &  Acid phos.