Sitting the postpartum confinement period during such a hot summer is mentally taxing. Many young women feel pressured, thinking, "I've got to get through this." During confinement, mothers must carefully monitor their health and be aware of any bodily changes, such as fever. However, it's crucial to first understand the difference between normal and abnormal fever before taking appropriate action.
Normal Fever: During the postpartum period, a mother's temperature is generally normal. However, if labor is prolonged, physical exertion is excessive, or the mother experiences extreme fatigue or mental stress, a slight increase in temperature may occur within the first day postpartum. This typically does not exceed 38°C (100.4°F) and usually returns to normal within 24 hours with adequate rest.
Around days 3–4 postpartum, when lactation begins in earnest, breast vasodilation, lymphatic engorgement, and swelling may cause a slight temperature rise. This typically subsides within hours.
Abnormal Fever: If a mother's temperature reaches or exceeds 38°C on two consecutive occasions between days 2–10 postpartum, this is abnormal and warrants investigation for possible puerperal infection.
Abnormal fever may primarily result from the following conditions:
1. Vulva, vagina, cervix, or perineal incision/tear suture sites are common sites of inflammation. Symptoms often include local redness, swelling, heat, and pain, wound dehiscence, abnormal discharge (sometimes with a foul odor), and occasionally systemic fever with elevated white blood cell count.
2. Endometritis or myometritis typically occurs 3–5 days postpartum. Lochia may be foul-smelling or odorless. Mild cases present with low-grade fever, increased foul-smelling lochia, abdominal distension, lower abdominal pain, and tenderness. Severe cases involve fever, chills, lower abdominal tenderness or pain, and elevated white blood cell count.
3. Pelvic infection typically manifests around day 5 postpartum with chills, high fever, lower abdominal pain, and deep pelvic tenderness.This may progress to pelvic abscesses or persistent high fever. Pelvic peritonitis manifests as chills, high fever, severe generalized abdominal pain, vomiting, abdominal distension, abdominal muscle rigidity, and marked tenderness with rebound tenderness. It can cause intestinal adhesions, diarrhea, tenesmus, and dysuria.
4. Thrombophlebitis commonly occurs 7–10 days postpartum or postoperatively, with increased susceptibility in patients who are bedridden for extended periods, elderly, or obese. Patients present with intermittent fever and persistent abdominal pain that may radiate to the groin, upper abdomen, and costovertebral angle.
Lower limb thrombophlebitis manifests as leg pain. Impaired blood flow may cause lower limb edema and pallor. Cords of tender veins may be palpable, with affected limbs exhibiting higher temperature than contralateral limbs. The course is typically prolonged.
5. Fever caused by acute mastitis may be accompanied by localized breast redness, swelling, tenderness, induration, or even ulceration.
Why does fever occur?
Postpartum infections often result from conditions such as premature rupture of membranes, prolonged labor, birth canal lacerations during delivery, or postpartum hemorrhage. Reduced immune resistance after childbirth allows bacterial infection to develop, causing fever. Therefore, immediate medical attention and prompt treatment are essential upon noticing signs of genital tract infection.
Other causes of fever
1. Upper respiratory infections can cause fever accompanied by headache, nasal congestion, cough, and runny nose. Examination may reveal pharyngeal congestion, enlarged tonsils, and coarse breathing sounds. Treatment involves cold remedies, antibiotics if necessary, or traditional Chinese medicine.
2. Fever accompanied by urinary urgency, dysuria, or other urinary tract irritation symptoms may indicate a urinary system infection. If pyelonephritis is present, examination may reveal tenderness in the renal area and abnormal urine routine test results.
3. Fever may also occur in postpartum women with underlying conditions like hepatitis or tuberculosis, or even due to heatstroke during hot weather. Persistent fever during the puerperium, especially high fever, warrants immediate attention from family members and prompt medical evaluation to prevent complications affecting the mother's recovery.
Treating Postpartum Fever with Targeted Approaches
(1) Fever caused by postpartum colds presents primarily with chills, fever, sweating, joint pain, and sore throat. The fundamental treatment principle is to dispel wind, clear heat, and eliminate toxins.
① Honey-Angelica Tea: Equal parts Angelica dahurica and Schizonepeta tenuifolia, ground into powder and divided into packets (approx. 15g each).Take one packet with 5 grams of fresh tea leaves. Steep in 200 ml boiling water for 15 minutes. Mix the infusion with a small amount of honey and drink warm. Limit to 3 servings daily. Suitable for wind-cold postpartum colds. Contraindicated for wind-heat colds or mothers with pre-existing yin deficiency and blood heat.
② Scallion-Fermented Bean Paste Meat Porridge: 10g fermented black beans, 10g scallions. Simmer both ingredients to extract juice. Combine the juice with minced meat and rice to cook into porridge.
③ Bamboo Leaf and Schisandra Porridge: 30g bamboo leaves, 10g schisandra berries. Simmer both ingredients with sugar to extract juice. Use the juice to cook porridge for consumption.