Postpartum Period

September 23, 2011

The postpartum period, also known as the puerperium, lasts from the delivery of the infant until about 8 weeks after the delivery. Most of the anatomic and physiologic changes a woman experiences in pregnancy will have returned to the normal state by this 8-week time. The new mother will experience many changes during this postpartum period. The most important changes will be discussed.

The uterus rapidly returns to the normal, nonpregnant size over the first few weeks after delivery. Following delivery, there is a heavy, bloody vaginal flow, known as lochia, for several hours, which transitions into a reddish brown discharge by the fourth day postpartum. This discharge then transitions to a yellowbrown mucous discharge, lochia serosa, which lasts until approximately 25 days after delivery. However, 10-15% of women will still have some lochia serosa at the time of their 6-week postpartum visit with their obstetric provider.

Many women have an episiotomy or spontaneous laceration at the time of their delivery, which will be initially uncomfortable. Such women should delay intercourse for at least 3 weeks to allow healing of the wound and reabsorption of any suture used in the repair. Iced sitz baths appear to assist women by reducing pain and swelling. A woman should initially fill a sitz basin with tepid water, then add the ice cubes, with the episiotomy area remaining submerged in the bath for 20-30 minutes. Topical anesthetic sprays are often started in the hospital or birthing center after delivery. Pain from hemorrhoids, either from swelling or prolapse from the anus, may be managed with topical creams and witch hazel compresses (Tucks pad), and extra dietary fiber to ensure soft bowel movements.

Many couples do not resume sexual activity until after the 6to 8-week postpartum examination by the obstetric provider. Though unnecessary to wait before resuming sexual relations at this time, for some women with minimal birth trauma, the sex drive (libido) is generally diminished for weeks to months due to fatigue and other family adjustments to the newborn infant. The couple interested in spacing pregnancies will want to consider a contraceptive choice before resuming sexual activity. Women who are breast-feeding “on demand,” with the breast milk as the exclusive source of the infant’s nutrition, will generally have several months of suppressed ovulation. The addition of another method of contraception, either hormonal (like the progestin-only contraceptive pill) or a barrier method (like a diaphragm or condom), will provide additional pregnancy protection. When women first become sexually active after a delivery, it is common to experience some vaginal dryness and discomfort. use of additional lubrication (like Astroglide) and open communication with the partner regarding discomfort is essential.

Women are strongly encouraged to breast-feed their newborn infant. Breast milk provides the optimal nutrition for babies and is convenient and affordable. Breast-fed babies have less infectious illness and future problems with obesity. Maintenance of breast-feeding for at least the infant’s first year of life is encouraged. Women returning to work after recovering from delivery can continue to provide breast milk, either by pumping and storing breast milk, or if available and close to the workplace, breast-feeding during work breaks.

The new mother will experience a full range of emotions during the first few weeks after delivery,
including joy and contentment as well as sadness and a sense of being overwhelmed. A very common condition, affecting as many as 85% of new mothers, is a condition known as “postpartum blues” or “baby blues.” The condition typically begins 3 or 4 days after birth and may last several days. Symptoms include mood swings (happy one minute, crying the next), feelings of depression, a hard time concentrating, a poor appetite, and sleeping difficulty. These symptoms will generally resolve by 10 days after the delivery. Some women have worse symptoms of depression, which lasts longer. This condition, known as “postpartum depression,” is much more serious and requires evaluation by a health care professional. Women with postpartum depression will have symptoms that include loss of interest in activities, loss of appetite, low energy, a hard time falling asleep and staying asleep, frequent crying, and feelings of sadness, worthlessness, and hopelessness. A woman may also experience thoughts of harming herself. It is essential that women experiencing these symptoms be promptly evaluated and treated. Fortunately, the newer antidepressant medications, along with counseling, can result in significant improvements. Several of these medications can also be used safely in women who wish to continue breast-feeding.

SEE ALSO: Libido and desire, Postpartum disorders

Suggested Reading

  • Epperson, C. N. (1999). Postpartum major depression: Detection and treatment. American Family Physician, 59 (8), 2259—2260.
  • Johnson, R. V. (Ed.). (1994). Mayo Clinic complete book of pregnancy and baby’s first year. New York: William Morrow.
  • Gabbe, S. G. (Ed.). (2002). Obstetrics: Normal and problem pregnancies (4th ed.). New York: Churchill Livingstone.
  • Morrow, M. H. (2000). Postpartum depression. In R. Rakel (Ed.), Saunders manual of medical practice (pp. 636—639). Philadelphia: W.B. Saunders.

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