| PurposeThe postpartum period, or puerperium, starts about an hour after the deliver of the placenta and includes the following six weeks. The postpartum period is a very special phase in the life of a woman, if not treated appropriately can lead to ill-health and even death for one or both of them. A good postpartum care and rational diet during the postpartum period is very important for the health of the women.The diet and behavior in the postpartum period varies greatly in various countries and regions. The patterns of diet and behavior are different between Chinese women and western women. There are many taboos in diet and behavior during postpartum period in china. The traditional practices are beneficial or harmful, if these taboos have relation to health of women in puerperium? These questions have attracted public concern and discussion.The purpose of this study is to investigate the diet behavior and healthy status of women in Hubei province during the puerperium, explore the relationship between diet and behavior practice and the health of women, evaluate the effects of carrying out nutrition and health education during pregnancy and puerperium, and explore the effective nutrition education method. On the basis of the study, put forward a kind of modern and scientific diet behavior pattern being applicable to Chinese women in the puerperium.Methods1 .The survey on present condition of diet, behavior and healthy status of women during the puerperium.2100 women who had at least one child under 2 years of age were selected as the subjects of the study by cluster-stratified sampling in the rural area, suburb and city of Hubei province. The data were collected through questionnaires. The achieved sample size was 1975 (637 in city, 628 in suburb, 710 in rural areas).Questionnaires used in this investigation were designed by our study group. Interviewers all received training ensured that they thoroughly understood each question and were able to administer them uniformly without any hesitation.2. The follow-up survey and the project of nutrition education.A total of 410 pregnant women (in the third trimester) were randomly selected from women who attended a local maternal health clinic in Wuhan City and the rural areas of Macheng as the subject of follow-up study. The subjects were divided into two groups. Nutrition education was given in one group, another group as control group. The achieved sample size was 302.The subjects were visited after 7 day, 14 day, 28 day, 42 day of delivery. The data were collected through questionnaires. Dietary intake was assessed by a 9 days dietary record and cross checked by a 24 h recall.Nutritional health education was carried out during pregnancy and puerperium. The method of nutrition education include:a.taking a series of nutritional knowledge lectures among the subjects. b.compiling, printing and distributing the material of nutrition education, c.consulting and giving advice face to face.3. The analysis on maternal morbidity during the puerperium and its influencing Factors.The multiple logistic stepwise regression analysis was used to analyze the eating behavior and other relative factors influencing on the Puerperal diseases.Data analysis was conducted using SAS 8.1 statistical software package.Results1. The survey on present condition of diet, behavior and healthy status of women during the puerperium.During the postpartum, subjects consumed abundant poultry and eggs, and meats, but vegetables, fruits and milk were not enough. The 75.66% of them never drank milk, 78.79% never ate fruits and 18.00% never ate vegetables. The average time women keeping the bed were 17.95 ± 3.75 hours everyday. Only 3.75% did gymnastics every day or every week. Some of them never opened the windows or went out, never taked a bath, washed hair or brushed teeth during the puerperium. The results of Logistic regression analysis showed that the significant factors which influenced the dietary and behaviors were traditional concept, education background, nutrition education, the levels of health knowledges, family incomes, delivery ways. The traditional belief was major negative factor.There are many health problems during the puerperium. 59.34% of the women reported at least one symptom. The reported postpartum problems included backaches, arthralgia or leg clonus, breast problems, constipation, haemorrhoids, anaemia, oral disease, uterine subinvolution etc.The women lacked the knowledges about postpartum nutrition and health. Only 14.68%, 51.98% or 8.71% of them knew the good food source of calcium, iron or protein. 50% of them thought that fruits and vegetables intakes were not permissible during puerperium. The women who had higher knowledge levels had better dietary or health behavior than the others. The significant factors which influenced the level of nutrition and health knowledges were area, education background, source of the knowledge etc.2.The follow-up survey and the evaluation on the effectiveness of the nutrition and -health educationBefore nutrition and health education, the knowing rate of nutrition and health knowledge of the subjects was low, and there was not significant difference between the intervention group and the control group. After the subjects of the intervention group being educated, their levels of nutrition and health knowledge were increased significantly. For example, the knowing rate about the question that milk is the best food of calcium supplement, increased from 43.84% to 89.04% in urban areas and from 32.10% to 55.56% in rural areas, and the knowing rate about the question that the parturien can eat vegetables and fruits, increased from 69.86% and 62.96% to 94.52% and 86.42%. The knowing rate was great significant difference between before education and after education (p<0.01).In urban areas, the intakes of vegetables, fruits and soybean in intervention group were more than the control group, significantly, fruits intakes of the intervention group were also more than the control group in rural areas, and the difference was significant between them. In urban areas, the intakes of vitamin C, vitamin E and calcium in intervention group were significantly high, compared with the control group, too. In the urban intervention group, the rate of doing postpartum gymnastics was higher than the control group, and the rate of basking, bathing and washing hair, doing postpartum gymnastics and outdoors activity was higher in the intervention group than in the control group in rural areas. These results showed that the nutrition and health education played a role on changing wrong behaviors of puerperium woman.In the third-stage pregnancy, the prevalence of anemia of the subjects was 45.24% and 69.87%, respectively. After postpartum, the prevalence was 10.38% in urban subjects and 57.52% in rural subjects. Serum zinc concentration of the rural subjects was markedly lower than the urban subjects in the third-stage pregnancy, and there was insignificant difference after postpartum. During postpartum, the difference was insignificant between the intervention group subjects and the control group subjects whether in rural areas or in urban areas in weight changing, haemoglobin levels, the serum concentration of calcium, iron, zinc and vitamine A.There are significant difference on the prevalence of constipation, leg clonus and arthralgia, low abdomen pain between intervention group and control group in urban areas (p<0.05 or p<0.01). In rural areas, the prevalence of lochia rubra duration prolonging was significantly lower in the intervention group than in the control group (p<0.05). The incidence of anal intestines diseases, backaches and leg clonus, breast problems, lochia rubra duration prolonging was obviously higher in urban areas than the incidence in rural areas.Compared with pregnancy, Eggs and poultry intakes of urban subjects were about once during postpartum more than pregnancy, and the intakes of milk, vegetables and fruits were reduced obviously. Daily milk intakes decreased from 285.33g to 60.43g, daily vegetables intakes reduced from 423.2g to 129.74g, and daily fruits intakes decreased from 318.89g to 60.66g. Rural subjects were short of animal foods during pregnancy, and these foods were greatly added during postpartum. For example, poultry were daily eaten 14.41g during pregnancy, increased to 105.36g in the postpartum period, eggs 54.66g to 221.37g. From 4 week postpartum, the intakes of meats, poultry, fish and eggs were decreasing gradually, especially obviously in rural areas. For example, poultry intakes in the sixth week were 1/25 of that in the second week. These results showed that great many animal foods used to be consumed during puerperium.In urban areas, mean daily intakes of Vitamine C and calcium were only 48.33mg, 37.18% of RNI, and 450.51mg, 37.54% of RNI, and mean daily intakes of retinol, thiamin, riboflavin and zinc were also under 70% of RNI. All nutrient intakes of rural subjects whether reached to or exceeded RNI, except for calcium, energy, and protein intakes reached to 129.0% and 179.53% of RNI, respectively. 3. The influencing factors on maternal morbidity during the puerperium The result of the logistic regression analysis showed:Taking more vegetables was the protective factors of reducing the incidence of anal intestines diseases such as constipation, haemorrhoids, and anal fissure during the puerperium. The intakes of milk and fish were the benefic factors for protection agains the backache, leg clonus and arthralgia. Intaking more protein, iron and animal splanchna can protect against anemia. Energy intake and lying in bed too long was the risk factors of overweight and obesity. It wasn't found that intakes of vegetables and fruits affected lactation.In the postpartum period, doing exercise can reduce the incidence of anal intestines diseases and breast problems, was beneficial to shorten the duration of ochia rubra, and accelerate uterine involution. Washing perineum usually can decrease the risk of genital system and urinary system infection. It was not found that these behaviors such as bathing, washing hair would increase the chance of infection or backache and leg pain.During postpartum period, doing housework too more was risk factor of the anal intestines diseases, having less time stay in bed was risk factor of genital and urinary system infection and longer time of bloody discharge, and the latter was the one of the signs of uterine subinvolution.Conclusion1 .There are many health problems during the puerperium of women, and we must pay close attention to itMost of the women in HuBei Province had little knowledge about nutrition and health care. The intakes of fresh vegetables, fruits and milk products were very low. During the puerperium, they had some wrong behaviors such as: they stayed in bed most of the day and had no physical activities, and they never had a bath or washed their hair or perineum. Such behaviors leaded to some health problems. We have to payattention to it.2. The nutrition and health education on puerperium dietary and behavior madeprimary effects, the new pattern of convalesce during the puerperium is better for the health of the womenWe combined some health education methods like taking lectures together, consulting and giving advices face to face, and distributing popular health education materials, and suggested new pattern of convalesce such as, having balanced diet, taking more fresh fruits and vegetables, properly reducing the time keeping in bed, doing postpartum gymnastics and paying attention to personal hygiene during the puerperium, which made the nutritional health knowledge levels of the subjects both in the city and rural areas being improved obviously, and had made some effects on changing the dietary behaviors of women and decreasing prevalence during postpartum. All these show that the new pattern of convalesce during the puerperium is better for the health of the women.According to the results of this intervention study and factor analysis, during puerperium the scientific living pattern that being elementarily drawn adapting to different subjects in the city and rural areas are followed:a.Balanced nutrition and increasing the intakes of vegetables, fruits and milk productsDuring pueperium, partartum should intake all variety of food to meet all nutrients requirement, reaching to balanced nutrition. In this investigation, the average daily intakes of VitC and calcium of the city subjects were only about 1/3 of RNI, and the prevalence of constipation, anal fissure and backaches and leg clonus was higher, which was relation to the low intakes of vegetables, fruits and milk products. So the diet structure should be adjusted, i.e. increasing the intakes of vegetables, fruits and milk productsIn the rural areas where the economy condition was poor, the women's nutritional condition before pregnancy and during pregnancy was low, and the physical activity was comparatively more. So it is necessary for the rural subjects to take more animal foods than the city subjects during the puerperium. It not only provides sufficient energy supply, but also corrects some nutritional deficiency diseases like anemia and zinc deficiency. But we have to pay attention to the balanced nutrition of different life phase of a woman, including the nutrition before pregnancy, during pregnancy, during the puerperium and after puerperium.b. Doing postpartum gymnastics to promote recoveryLying in bed too long was the risk factor of overweight and obesity, and doing exercise can reduce the incidence of anal intestines diseases and breast problems, was beneficial to shorten the duration of ochia rubra, and accelerated uterine involution. Therefore, scientific activities and exercises are very essential. Partartum should get up as soon as possible after delivery, and insist in doing postpartum gymnastics under the direction of health providers, to promote recovery and keep healthy bodily form.c.Having sufficient sleeping and restThe results of the logistic regression analysis showed that doing excessive housework during the puerperium was the risk factor of the anal intestines diseases, having less time staying in bed was the risk factor of the reproductory system infection and the duration of ochia rubra prolonging. It showed that paying attention to the physiologic characteristics of the women during the puerperium, doing appropriate housework, having sufficient sleeping and rest, having scientific physical activities and exercises were very important.d.Paying attention to wash perineum, and keeping cleanness and health Because of the discharge, the secretion of vagina increase, and genital system and urinary system infection are subsequent very easily, while washing perineum usually can decrease the risk of genital system and urinary system infection. Thus it is very important to keep perineum cleanness. During puerperium, washing perineum every day, and moderately washing hair and taking bathing are very necessary. 3. We should put the nutritional health education to the job of antenatal and postpartum care.At present, all kinds of medical care organizations only put much more emphasis on the health education of breast-feeding, but ignore the education of nutrition and health care. When taking the postpartum visiting, they pay attention to the visiting rate but ignore the content and quality of it. So the pregnant and lying-in women lack the knowledge of nutritional health care. We recommend the health care agency put the nutritional health education to the antenatal and postpartum health care affairs to improve the quality of health care. This is very significant to ensure the health of mothers as well as their infants.Innovation1. We have made a systematical and comprehensive research on the relationship between the dietary behavior and health of the women during the puerperium in HuBei province. There is no former systematical research in this aspect.2. We have discussed the scientific living pattern of the women during the puerperium in HuBei province, which is suitable for their character and living standard.3. We have designed and compiled a propagandistic material pertinent nutrition and health care during the puerperium for the first time and put up nutritional health education, evaluated the effects and explored the effective nutritional education methods.
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