The puerperium is the period of adjustment after childbirth during which the mother’s reproductive system returns to its normal prepregnant state. It generally lasts six to eight weeks and is characterized by numerous physiological, hormonal and psychological changes

Lochia

Lochia is the genital tract discharge after birth. It is composed of blood, decidual fragments, cervical mucus, vaginal transudate and bacteria.

The lochia changes colour and consistency during puerperium:

  • Lochia rubra (red): consists mainly of blood and decidua. It lasts for 5 days.
  • Lochia serosa (pale): due to relative decrease in RBCs and predominance of leukocytes. It lasts for 5 days.
  • Lochia alba (white): consists mainly of leukocytes and mucus. It lasts for 5 days.

The lochia should gradually decrease in quantity. However, if you notice that the quantity increases or that the lochia has offensive smell, you need to inform your doctor.

Afterpains

The uterus increases markedly in size and weight during pregnancy (approximately 10 times the non-pregnant weight, reaching a crude weight of 1000 g) but involutes rapidly after delivery to the non-pregnant weight of 50–100g. Myometrial contractions, or afterpains, assist in uterine involution. These contractions occur during the first 2–3 days of the puerperium and produce more discomfort in multiparas than in primiparas. Such pains are accentuated during nursing as a result of oxytocin release from the posterior pituitary.

During the first 12 hours postpartum, uterine contractions are regular, strong, and coordinated. The intensity, frequency, and regularity of contractions decrease after the first postpartum day as involutional changes proceed. Uterine involution is nearly complete by 6 weeks, at which time the organ weighs less than 100 g. The increase in the amount of connective tissue, elastin in the myometrium and blood vessels, and the increase in numbers of cells are permanent to some degree, so the uterus is slightly larger after pregnancy.

Incontinence

Pregnancy, labour and a vaginal delivery can stretch or injure your pelvic floor muscles, which support the uterus, bladder and rectum. This might cause you to leak a few drops of urine while sneezing, laughing or coughing. These problems usually improve within weeks but might persist long term.

In the meantime, wear sanitary pads and do pelvic floor muscle exercises (Kegels) to help tone your pelvic floor muscles and control your bladder. To do Kegels, imagine you are sitting on a marble and tighten your pelvic muscles as if you’re lifting the marble. Try it for three seconds at a time, and then relax for a count of three. Work up to doing the exercise 10 to 15 times in a row, at least three times a day.

Weight loss

After you give birth, you might look like you’re still pregnant. This is normal. Most women lose 13 pounds (6 kilograms) during birth, including the weight of the baby, placenta and amniotic fluid. In the days after delivery, you’ll lose additional weight from leftover fluids. After that, a healthy diet and regular exercise can help you gradually return to your pre-pregnancy weight.

Mood changes

Childbirth triggers many powerful emotions. Many new mothers experience a period of feeling down or anxious, sometimes called the baby blues that appear usually 3-4 days after birth and regress within 2-3 weeks. Symptoms include mood swings, crying spells, anxiety and difficulty sleeping. The baby blues typically subside within two weeks. In the meantime, take good care of yourself. Share your feelings, and ask your partner, loved ones or friends for help.

If you experience severe mood swings, loss of appetite, overwhelming fatigue and lack of joy in life after childbirth, you might have postpartum depression.

Approximately 50–85% of postpartum women will experience the “blues” for a few days. Between 10% and 20% may experience postpartum depression, with a higher risk among those women with a history of clinical depression. Early detection and adequate treatment is required. Contact your health care provider if you think you might be depressed, especially if your symptoms don’t fade on their own, you have trouble caring for your baby or completing daily tasks, or you have thoughts of harming yourself or your baby.

The postpartum check-up

The postpartum care is an ongoing process rather than just a single visit after your delivery. It is important to contact your health care provider if there is any concern at any stage after the delivery of your baby.

During the routine postnatal appointment that usually takes place 40 days after delivery, your doctor will check your mood and emotional well-being, discuss contraception and birth spacing, review information about infant care and feeding, talk about your sleep habits and issues related to fatigue, and do a physical exam. This might include a check of your abdomen, vagina, cervix and uterus to make sure you’re healing well. This is a great time to talk about any concerns you might have, including resuming sexual activity and how you’re adjusting to life with a new baby.