Puerperal Phase
Puerperal Phase
The puerperal phase is the period from childbirth to 4-6 weeks after birth, during which the wounds incurred during childbirth are completely healed and the reproductive organs and surrounding areas return to their pre-pregnancy state.
Uterine restoration
It takes 5 to 6 weeks after giving birth for the body to return to its original state. This happens faster in first-time mothers than in multiparous women, and in lactating women than in non-lactating women.
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Size of the uterus
The placenta shrinks to the size of an adult's head after it is expelled during childbirth, and to the size an adult’s fist one week after that.
By approximately 4 to 6 weeks after giving birth, it becomes the same size as an egg early in pregnancy. -
Location of the uterus
It is located near the navel immediately after birth. After two weeks postpartum, it moves into the pelvis and cannot be felt from the outside.
Postpartum pain (afterpains)
Postpartum pain (afterpains) is pain caused by uterine contractions and is more severe in multiparous women than in first-time mothers. Breastfeeding can accelerate uterine contractions and make the pain stronger (because the hormone that secretes milk has the effect of uterine contractions). It usually gets better in 3 days after birth.
Cervix and vagina
- The cervix is almost closed by one week after birth.
- The vagina gradually narrows but does not return to its pre-partum state. The vaginal rugae (folds) reform usually from the third week.
Reproductive function
- When ovulation resumes after birth depends on breastfeeding. If you are not breastfeeding, you may ovulate as early as 27 days after giving birth, but on average, ovulation occurs six weeks later. If you are breastfeeding, ovulation occurs 6 months on average after birth, but when ovulation resumes may depend on the frequency of breastfeeding, the length of time it takes for each feeding, and the degree of mixed feeding.
- The return of your menstrual cycle also varies depending on whether or not you are breastfeeding. If you are not breastfeeding, even though there are personal differences, it may start after 6-8 weeks. However, if you are breastfeeding, it may start within 2-18 months.
Vaginal discharge (lochia)
- During the recovery process of the uterus after childbirth, secretions from wounds in the birth canal, blood, mucus, and fallen cells from the uterus or vagina are excreted through the vagina for a period lasting about 4-6 weeks.
- Red discharge called lochia appears for several days after giving birth, and the color gradually fades and the amount decreases, changing from red to brown, yellow, and pale white.
- If you suddenly have a large amount of blood-like discharge, you should see a doctor.
Breast pain
Breast engorgement is a painful swelling and fever of the breasts due to accumulated milk in the mammary glands. If your breasts feel tight, painful, and have difficulty producing milk three days after giving birth, you should suspect breast engorgement. This occurs when milk does not come out or the baby does not suckle well, causing the milk to accumulate in the mammary glands. However, if your milk engorgement worsens, it can develop into mastitis, so caution is required. To prevent this, you should massage your breasts or actively breastfeed to ensure that no milk remains.
Weight
Approximately 5-6 kg of the weight gained during pregnancy (12-16 kg on average) is lost upon giving birth. As swelling goes down, your body weight will decrease by approximately 2 to 3 kg. After, your weight will gradually decrease and return to a similar state as before pregnancy around 6 months after birth. However, your weight will have increased slightly compared to before pregnancy. Sagging belly fat occurs when the rectus abdominis muscles spread left and right during pregnancy and lose elasticity. However, regular postpartum exercise can help restore the abdominal area to its original state.
Blood flow and cardiac output
The increased blood flow during pregnancy decreases by about one liter due to blood loss immediately after delivery. It takes about a week to return to the pre-pregnancy blood flow. The increased cardiac output during pregnancy usually returns to pre-pregnancy levels 8 to 10 weeks after birth.
Urine and sweat
During the first few days after giving birth, a lot of the water that has accumulated in the subcutaneous tissue during pregnancy is excreted through sweat and urine. If the woman is unable to urinate within 4 hours immediately after giving birth, a urinary catheter may be inserted during hospitalization, but in most cases, urinary function is restored.
Broken capillaries in the eyes
During childbirth, the broken capillaries in the eyes due to strong force may cause the eyes to temporarily turn red, but this will heal after 2-3 weeks.
Skin
Brown spots caused by pregnancy usually disappear after childbirth, but hyperpigmentation of the areola and the pregnancy line (linea nigra) on the abdomen may persist until after delivery. Vascular abnormalities such as palmar erythema and epulis gravidarum usually disappear after childbirth due to the decline in estrogen hormones.
Changes in emotions
Between 8-20%of new mothers may experience postpartum depression (PPD, or sometimes called the “baby blues”. It can occur at any time from immediately after birth to 1 year later, and symptoms usually begin 4 to 6 weeks after birth. If PPD persists for more than two weeks, you should consult a doctor.