Uncomplicated postpartum period (puerperium)

The postpartum period (puerperium) covers the time from the birth of the placenta to the reverse development of the changes in the female organism that occurred in connection with pregnancy. As a result, the body reaches a state close to that before pregnancy. To what extent this condition will recover depends on the age of the woman, the presence and number of previous pregnancies and births. Simultaneously, the lactation process begins. The puerperium usually lasts 6-8 weeks, with the reverse development process being most intense in the first days after birth.

Changes in the genitals

External genital organs: As a result of overstretching and traumatizing them during childbirth, tears, hematomas, abrasions are found on them. Superficial injuries heal in the first days after birth, swelling disappears in 1-2 weeks.

Vagina: After birth, the entrance to the vagina is open and closes after 24 hours. The vagina is overstretched and undergoes reverse development, but does not reach its pre-birth size. His tone is restored in about 1 week.

Cervix: At birth, the cervix is ​​fully shortened, dilated and flattened. In its reverse development, due to the ruptures and stretching, a front and rear lip are formed. The closing of the cervical canal starts from its internal opening. It closes by the end of the second week. The external opening closes by the end of the third week. The external opening of the cervical canal in laborers is slit-like, while in non-laborers it is round and tightly closed.

Uterus: After birth, the uterus weighs about 1000 grams, by the 7-8th day the mass has halved, and at the end of the postpartum period it is 50-100 grams. After birth, the bottom of the uterus (fundus) is felt at or around the level of the navel . The size and weight of the uterus decreases most dramatically during the first two weeks after birth, when it retracts into the pelvis. In the following weeks, the uterus gradually recovers its pre-pregnancy state, but not completely, which is why it remains larger.

According to the day of birth, the bottom of the uterus is searched at different levels:
– 1st day: at the level of the navel.
– 3rd day: 12 cm from the symphysis (the place where the two pubic bones join at the front of the pelvis).
– 5th day: 10 cm from the symphysis.
– 7th day: 8 cm from the symphysis.
– 9th day: 6 cm from the symphysis.
– 10th day: at the level of the symphysis.

Due to the constant contraction of the uterine muscles, the blood vessels are pressed and the blood supply decreases. Due to the impaired supply of nutrients and oxygen, muscle cells atrophy and decrease in volume. After birth, the uterus contains more connective tissue than before birth.

The lining of the uterus (endometrium) quickly regenerates and recovers by the 16-20th day. The place where the placenta separated recovers more slowly.

Lochias :

Lochia is the discharge from the vagina as a result of the “cleaning” of the uterine cavity in the postpartum period. They contain necrotic matter, blood, lymph and mucus. Over time, lochia lightens and decreases in quantity. They change as follows:
– by the 2nd/3rd day after birth – the lochia are bloody, they are called lochia cruenta.
– on the 4th/6th day, necrotic substances are added and the color becomes brown-reddish, the volume decreases – lochia rubra.
– 7th – 10th day – lochia lightens to a yellowish color – lochia alba.
– after the 10th day, the lochia are mucous-whitish and are called lochia serosa.

The period of discharge of lochia has a different duration for different women, but on average it is about 5 weeks, their amount is about 1000-1500 grams. During physical exertion of the woman in labor, the flow may increase and the lochia may become more bloody.

Ovaries: Descend to their usual place. They gradually regain their cyclic function. The time to return to normal ovarian function is very individual and depends to a large extent on breastfeeding. Lactating women have a longer non-menstrual and non-ovulatory period than non-lactating women. About 80% of lactating women develop lactational amenorrhea. Ovulation is suppressed by elevated prolactin levels. Most non-breastfeeding women return to menstruation by 12 weeks postpartum, and breastfeeding women by 36 weeks postpartum.

Extragenital changes

Temperature: After birth, until about the 3rd day, there may be a subfebrile temperature (up to 38 ^o ). The reasons may be the tension of the muscles during childbirth, the processes of cleaning the uterine cavity, the beginning of lactation. A temperature above 38 ^o should be considered pathological , especially in the presence of shaking. If the temperature rises after the 10th day, one should think about a postpartum infection.

Heart rate: The heart rate returns to normal around 24 hours after birth. It is usually labile, affected by emotions, pain, changing body position. It can be accelerated in case of hemorrhage, inflammation, thrombophlebitis (Maller’s symptom – a pulse with a frequency of 100-120 beats per minute, combined with a slightly elevated temperature).

Bladder: After childbirth, urination is difficult due to atony of the bladder from compression or trauma, edema of the external genital organs, psychological reasons. In ½ of women, the first urge to urinate is felt at 15-20 hours after birth. These disturbances are temporary and disappear after a few days.

Gastrointestinal tract: In the first days after birth, there is no defecation. The cause is trauma to the rectum and the relaxed abdominal wall. Intestinal loops are distended with gas (flatulence). If defecation is not restored by the 3rd day, it is induced with an enema or medication.

Abdominal wall: The abdominal wall remains soft and relaxed for a long time. Regaining her pre-pregnancy tone depends largely on the mother’s physical activity. Pigmentation fades.

Metabolism: The basic metabolism is increased. Due to the excretion of calcium with breast milk, its amount may decrease. Sweating is more pronounced. After childbirth, due to blood loss and exhaustion, the appetite may be reduced.

Lactation

Changes in the mammary glands, preparing them for breastfeeding, occur already during pregnancy. Lactogenesis (the production of breast milk) is triggered by the delivery of the placenta, in which there is a drop in estrogen and progesterone levels with high prolactin (the hormone that stimulates the production of breast milk). If the woman does not breastfeed, the prolactin level normalizes in 2-3 weeks.

In the first 2-4 days after birth, colostrum is secreted. It is rich in proteins (immunoglobulins). With the onset of lactation, the breasts enlarge, become tense, the temperature may rise and a feeling of malaise may be experienced.

Early placement of the baby on the breast and regular breastfeeding with full pumping of the breast stimulate lactation. In the first 3-4 months, 0.8-1 liter of breast milk is released daily and then decreases. The composition of breast milk changes to meet the needs of the child’s body.

Breastfeeding is important for both the baby and the mother. Breastfeeding stimulates the reverse development of the genitals during the postpartum period.

Care of the woman in labor in the postpartum period

Normal pregnancies and births with minimal trauma ensure an uncomplicated puerperium. Care for women in the postpartum period aims to:

– prevention of complications (infections) – ensuring good hygiene (2 times a day toilet of the genitals), compliance with the principles of asepsis and antiseptics, observation of the woman in labor;

– stimulation of recovery processes – optimal diet and fluid intake, early exercise, postpartum gymnastics, ensuring rest;

– preparing and instructing the woman about her regimen after discharge. The woman in labor is discharged from the ward when she no longer needs round-the-clock monitoring.