Sally Marchant

A survey of women's experiences of vaginal loss from 24 hours to three months after childbirth (the BLiPP study).

OBJECTIVE To describe the range of normal vaginal loss as reported by women from 24 hours after delivery until three months postnatally. SETTING Two health districts in the south of England. METHODS A prospective survey of womens experiences and expectations of the duration, amount and colour of vaginal loss after childbirth. The term vaginal loss includes all types of fluid loss from the vagina following childbirth. FINDINGS Five hundred and twenty-four women were recruited to the survey in 1995. Vaginal loss, as reported by the women, was considerably more varied in duration, amount and colour than descriptions in current midwifery textbooks. The median number of days reported for the duration of vaginal loss was 21 days and the interdecile range (10th to 90th percentile) was 10-42 days. For colour of lochia, women overall reported their vaginal loss to be more predominantly red/brown in colour and the traditional descriptions of the timing and colour phases of lochia rubra, serosa and alba are not supported by the majority of the womens experiences. Primiparous women were significantly more likely to report feelings of surprise or shock about their experiences of vaginal blood loss after the birth (odds ratio 4 [95% Confidence Interval 2-9]). Seven primiparous women (2%) were unaware that they would have a blood loss at all after the birth. IMPLICATIONS FOR PRACTICE The findings from this survey have been used to develop information leaflets for women and health professionals about vaginal loss following childbirth. These leaflets include descriptions of normal ranges for the colour, amount and duration of vaginal loss in the first three months after childbirth.

The need to talk after birth: evaluating new services

There has been a growing interest in providing women with the opportunity to discuss their birth experience, and many new initiatives have been set up to address this. In part, this is the result of an awareness that some women continue to have unresolved emotional distress linked to the birth. In addition, there is an increased appreciation that it is the woman’s perception of the labour and birth, rather than how the birth is assessed by care-givers, that is of importance (Crompton 1996a, 1996b). In this chapter, we explore how these themes are related, considering the material under three headings: Women’s varied needs for information and discussion about birth events; The current range of services being offered; The need for evaluation of what is being offered. Figure 2.1 is intended to illustrate the linked topics that underpin this complex area.

Routine clinical care in the immediate postnatal period

This chapter aims to look at the clinical components of the care given by midwives to postnatal women. The postnatal daily examination requires the midwife to observe and record the state of health and recovery of the postnatal mother. The form this examination takes has become a routine midwifery procedure described in standard textbooks. There has been little, if any, evaluation of the value that this form of care has for the majority of women.