A postpartum period or postnatal period is the period beginning immediately after the birth of a

child and extending for about six weeks. Less frequently used are the
terms puerperium or puerperal period.

II. Postpartum Period (for the mother)

A. Body Changes After Childbirth

1) Reproductive Organs

(a) "Shrinking" of uterus: Should be at the level of the navel and firm. If it is above the
navel or feels spongy and soft, there is a much greater risk of increased bleeding. If the
uterus is off to the side, your bladder is probably full. It should move down in the
abdomen about one fingerbreadth/day, approaching nonpregnant size in 4 to 6 weeks.
(b) Lochia (discharge): Should be dark red for 2 to 3 days, pinkish brown for 3 to 10
days, creamy/yellowish for 1 to 2 weeks more. If clot is greater in size than a nickel, or
unusual odor noted, or your bleeding gets heavier and darker, call your OB care
provider.

(c) Cervix: closes slowly after birth

(d) Vagina: May be swollen and bruised. Do not use tampons or douches, because
infection can occur.

(e) Perineum: May appear swollen and bruised. An episiotomy or laceration may be
present with or without sutures. Ice can be used during the first 24 hours. Ask OB care
provider about sitz baths before discharge.

(f) Recurrence of menses/ovulation: You will ovulate and can get pregnant before your
first period occurs; recurrence of period varies person to person.
2) Abdomen
(a) Uterine ligaments and your abdominal wall have been stretched and need time to
recover. Your abdomen may appear flabby for a time, but with exercise (and depending
on your prepregnant condition), tone should return in 2 to 3 months. Consult with OB
provider as to when you may begin to exercise.
 (b) Stretch marks should lighten to silver/white appearance.

(c) If unusual tenderness or pain noted, notify OB provider immediately.

(d) Those delivering by cesarean may experience severe gas pain, which can be
reduced by walking. Peppermint tea has been helpful to many women. OB provider can
also prescribe or recommend remedy.
3) Lactation
(a) Regardless of whether you will be breastfeeding, your breasts have developed, and
will begin to produce milk after birth of baby.

(b) If bottle feeding, breasts may get engorged and sore. To help reduce milk and
promote "drying up," wear a supportive bra that fits well all the time, except for
bathing. If the discomfort of swelling increases, use ice packs on chest and avoid hot
showers hitting directly on breasts to prevent increased swelling.

(d) Breastfeeding provides increased, special immunities to help protect the baby from
infection that only mother can provide when the baby is more vulnerable.

(e) Always consult your clinician or pharmacist before taking any type of medication in
any form if you are breastfeeding. It may affect the baby.
4) Gastrointestinal
(a) Mother is usually very hungry and thirsty after labor and should be able to eat
(unless she has delivered by cesarean, in which oral food will be withheld until bowel
sounds return).

(b) First bowel movement may be delayed. Many mothers will fear tearing their stitches
and wait to have bowel movement, but this will increase chance of constipation and
discomfort; stool softeners may also help.

(c) Flatus is common, especially after cesarean. Flatus results especially after cesarean
because of manipulation of intestines during surgery, resulting in temporary decreased
motility. Early ambulation and "anti-gas" medication will help relieve this.

5) Urinary Tract
(a) May have decreased sensation of need to void, and overfilling of bladder is possible.
Be sure to attempt notify OB care provider if unable to void, there is burning with
urination, blood in the urine, or if urine to void every few hours; is cloudy or foul
smelling.
 (b) May experience slight incontinence when active. This is common because of
decreased tone of voiding muscles. Kegel exercises will help strengthen these muscles
and decrease leaking.
6) Temperature
(a) A temperature up to 100.4 F is normal within the first 24 hours. If fever is present after
that, notify clinician.
7) Weight Loss
(a) Initial loss can be 10 to 12 lbs. after birth.

(b) Five pounds may be lost soon after birth because of increased urination and
excretion of extra fluid.

(c) After 5 to 6 weeks, you should be near prepregnant weight if you gained 25 to 30
lbs. and maintain an appropriate diet.
8) Postpartum chill
(a) Women sometimes experience a "shaking chill" shortly after delivery. This is normal
and fine, as long as it is not accompanied by continued fever (a warm beverage and
blankets often help).
9) Postpartum sweating
(a) Increased sweating after birth occurs to eliminate extra water and waste products
from the body (and often occurs at night).
10) Afterpains
(a) Caused by intermittent uterine contraction

(b) Increased in women who have had more than one child

(c) May cause little to severe discomfort 2 to 3 days after birth

(d) If Pitocin given after birth to help with uterine firmness, this will increase discomfort.

(e) Breastfeeding often stimulates afterpains.

(f) Rocking in a chair, or propping a pillow under abdomen while lying on your side may
assist with discomfort.
11) Breasts
(a) Often enlarged and sore, often leak breast milk, but if a reddened area noted, notify
clinician.
(b) If breastfeeding, watch breasts for cracking and open sores; increased chance of
infection
 (c) Interventions for common breast discomforts, in Family Information Handouts,
Section V, E.
12) Skin
(a) If tearing or episiotomy occurred, sutures may be present. Be alert for any bleeding from
suture site (do not confuse with lochia), any unusual drainage, odor, separation of skin at
injured site, or pressure in that area. If so, notify clinician.
13) Extremities
(a) If swelling of legs or ankles occurred during pregnancy, it should resolve. If new
swelling, tenderness, or redness noted in legs (especially if just one), let clinician know.
14) Postpartum guidelines for mothers.

B. Psychological changes after childbirth

1) Adjustment to all the new changes, new roles the family will play; this may cause many
different emotions.

2) Postpartum blues: Occurs in some women in different degrees, as a temporary depression

lasting usually 1 to 2 weeks after birth, and may be experienced in many different ways (being
cranky, crying at commercials). Do not be afraid to talk out your feelings with someone,
family, friend, or clinician. It often helps.

3) Cultural influences: Different cultures have different rituals they follow after mother has the
baby.

4) Attachment: The process of interaction and bonding between mother and baby

Involution of the Uterus

During the pregnancy, the uterus enlarges due to growth and stretching of the uterine muscles. The muscles not only increase
in size but also in number.

Immediately after the delivery of the baby, the uterus has two main aims - the first is to control bleeding and the next is to
revert back to its former state.

Bleeding is controlled by contraction of the muscles. The uterine muscles are arranged in criss-cross layers - so that
contraction of the muscles constricts the blood vessels between them, causing less blood flow. This is the early stage of
involution.

At this time, it forms a firm, ball-like structure just below the bellybutton. It is tender and pressing on it can cause pain.
Involution starts by autolysis and phagocytosis. Autolysis, more commonly known as self-digestion, refers to the destruction of
a cell through the action of its own enzymes. During involution, the muscles undergo some amount of autolysis to reduce in
size.

Autolysis occurs in response to the withdrawal of placental hormones after the childbirth. During pregnancy, hormones like
estrogen and progesterone help the uterine muscles to enlarge and grow rapidly. Blood vessels too increase in number and
size.

The gradual decrease in size of the uterus during involution occurs due to a decrease in size but not a decrease in the number
of uterine muscles. This causes the uterus to remain somewhat larger in size than the pre-pregnant state. The size of a uterus
which has once undergone pregnancy is larger than a uterus which has never gone through pregnancy.

After involution is complete at around 6 weeks postpartum, the uterus is more or less its normal size but the endometrial cavity
remains larger than in the virgin state. The blood vessels are also more tortuous, and its muscular layers are more defined.

The uterus, which weighs about 900 grams at the end of labour, weighs only about 40-60 grams at the end of the postpartum
period, 6 weeks after childbirth.

Rate of Involution of the Uterus

Immediately after the delivery, the upper margin of the uterus lies about 5 inches above the pubic symphysis (upper margin of
the pubic bones). In an average sized woman, this will be at the level of the umbilicus.

The rate of involution is maximum in the first five days (about 1 cm per day) of the postpartum period and then gradually slows
down. By the 7th day, the uterus becomes much smaller and only its upper border can just be felt at the level of the symphysis.
It regains its pre-pregnancy size at the end of 6 weeks.

Involution is accompanied by the flow of Lochia - a thick vaginal discharge consisting mainly of the thick endometrium formed
to help support the pregnancy.