The elements in midwifery care for puerperium: Water

The Water-Evolution element

Another key element of puerperium is without any doubt Water: the more contained the woman is, the more evolutional-, growth-, and opening aspects this element naturally represents can take place. Emotional expansion is so great that the mother reports that she “has never been so happy” and post-partum euphoria lasts in time, however cyclical, supporting by breastfeeding hormones.

Water, which is expansion, is also emotion, endorphins, senses, and relation.

The mental sedation required during puerperium, which can be activated thank to the presence of ecologic powers, allows the use of the right brain, with a sensorial intensification mainly aimed at caring for the newborn.

The increase in REM sleep allows to elaborate deep emotions arising from birth and meeting the baby.

In fact, evolution is relational, since the biggest work during puerperium is building the relationship with the newborn, but also returning to the couple relationship, to a two-people (instead of a three-people) sexuality.

Milk and hormones

The evolutionary process in the body consists, macroscopically speaking, of two phenomena: the proliferation of the mammary gland linked to the Earth-structural element, and the hormonal development, linked to the Water element, aimed at producing, maintaining, and ejecting breastmilk.

From the endocrinological point of view, puerperium is characterised by the end of foetal-placental activity (involutive) and the beginning of the galactopoietic one (evolutionary).

While the mother’s glands (adrenal glands, thyroid, hypophysis) go back to their pre-pregnancy functionality within about a week, the expulsion of the foetus and the placenta is followed by a phase of elimination of the hormones – stimulated and synthesized by these important endocrinological producers during pregnancy – a rest phase and a functional recovery phase that may change depending on the woman and the baby.

Sexual hormones reach basal levels and maintain them throughout breastfeeding, inhibited, in their ovaric receptiveness, by prolactin.

The prolactin levels, increased during pregnancy thanks to the oestro-progestinic inhibition of dopamine, stabilise during puerperium, around the 5° day, to later modulate during the first milk feeds.

Lactation is therefore not only linked to the action of prolactin, but also to the synergic action of the growth hormone (ACTH), corticoadrenal steroids, thyroid hormones, and insulin, as well as to the maintenance of production, ensured by the suction-activated mammillo-hypophiseal reflex.

Lastly, the milk-ejection reflex is ensured by the secretion of oxytocin triggered by relational, auditory, visual, tactile, and olfactory stimuli and, of course, by suction itself.

What to do?

Rituals and rebonding

When the attention is aimed at these situations, the element to stimulate is water. From the emotional-relational-environmental point of view, the water rituals typical of puerperium are, for instance, baptism, evening bath, and the use of herbal teas favouring breastfeeding.

The midwife may also use tools such as visualisation and rebonding, an incredibly powerful and simple mean, mainly recommended to cure birth-related traumas, but also when the first meeting between mother and baby (or between mother, father, and baby) has been delayed, difficult, or traumatic, on a conscious or unconscious level, on the physical- or emotional level.

The technique requires, first and foremost, intimacy and respect: the environment must be warm, dark, barely lit by the light of the candles.

It can begin with a relaxing massage for the woman, to go on with the immersion of the woman in a tub of warm water.

Sometimes, through the guide of a visualisation, you can retrace the step of birth: the mother accompanies the baby from the immersion in the water to emersion, then to being born in the air, and welcomes them on her naked breast, warm and wet. The couple or trio stays skin-to-skin, covered and warm, for the necessary time.

At the end of the experience, or a few days after, you collect reactions and experiences from the woman and couple.

By Silvia Garelli