Postpartum period

The postpartum period, also referred to as the postnatal period or puerperium, occurs in females immediately after they have given birth to a child. This period lasts for approximately six weeks. Health professionals consider it a crucial phase in maintaining the mother's physical and mental well-being. During this period, the mother's body undergoes several changes and reverts to a non-pregnant state, with hormone levels changing and uterus size returning to normal. Postpartum mental illness is not uncommon following birth and can include depression and psychosis.

Physical Changes

Immediately after a woman gives birth, her body begins adjusting to not being pregnant. The postpartum period is a time for healing and recovery from the act of childbirth. Each woman experiences the postpartum period differently. Most women experience soreness and exhaustion for several weeks after the birth. For mothers who underwent cesarean section, or the surgical delivery of an infant, the recovery process normally takes longer.

As a woman returns to a non-pregnant state, several physical changes take place within her body. The uterus begins to shrink to a regular size soon after birth, though it will never be as small as before pregnancy. This process usually takes about five weeks and can cause bleeding and some minor pain. Women will often bleed a large amount of blood before the smooth muscle tissue of the uterus begins contracting. Once contraction begins, a different kind of vaginal discharge begins that is brownish red and thinner in consistency. Thereafter, the discharge becomes yellow before dissipating.

The cervix also undergoes recuperation. The cervical opening gradually narrows and eventually closes. The vaginal opening also gets smaller as the weeks progress, though it is never as narrow as before birth. As a woman's estrogen levels rise, the tissues found within the vagina are restored. Additionally, the perineum, the area of skin between the anus and the vagina, may be widely stretched during childbirth. During the postpartum period, this area regains muscle tone and eventually returns to normal.

Normalization of a woman's reproductive functions, which include ovulation and menstruation, depends on the individual and whether or not she chooses to breastfeed. Breastfeeding mothers will not experience ovulation or menstruation while they are lactating (producing breast milk). On average women who breastfeed resume their menstrual cycle within 36 weeks of delivery. Women who do not breastfeed will resume normal menstrual and ovulation cycles sooner.

Postpartum Care

A mother can do several things to ease the discomfort experienced after childbirth. Many women experience soreness in the vaginal area, specifically at the perineum. Mothers are encouraged to perform pelvic floor exercises to strengthen the pelvic muscles and help the perineum heal. Women can also place a cold pack on the area or soak in a warm bath. They should also sit on a pillow if a surface is too hard.

Women also experience afterbirth pains in the uterus as it shrinks back to normal size. Cramping occurs during this period, as the uterus goes from approximately 2.5 pounds to 2 ounces within six weeks. Medical providers suggest taking over-the-counter pain medication to help ease the cramping. Pain medicine can also help ease the discomfort experienced after cesarean births, which involve loss of blood and a sore incision site.

The lactation process can also be painful for mothers. The breasts swell as they fill with milk. The discomfort normally goes away as a woman continues to breastfeed. If swelling continues, a woman can lay warm towels on their breasts or take a warm shower. Supportive bras also help manage soreness. Women sometimes experience pain around their nipples as their breasts adjust. Women should refrain from irritating the nipple region just after birth. If nipple pain continues, mothers can use a special cream to alleviate pain.

Many women experience painful hemorrhoids around their rectum during and after birth. Doctors often recommend over-the-counter creams or sprays to relieve hemorrhoid pain. Women can also eat a diet high in fiber, such as fruits, vegetables, and whole-grain breads and cereals. Doctors also stress the importance of hydration. Drinking lots of water helps bowel movements pass more easily, preventing any unnecessary strain that can aggravate hemorrhoids. Increased hydration also helps relieve constipation and any urinary issues a woman may experience post-pregnancy.

Postpartum Complications

Many women experience loss of sleep and become exhausted by the responsibilities of motherhood. A woman's hormones are also readjusting during the postpartum period, which can affect her mood. Most mothers experience sad emotions up to two weeks after childbirth. These feelings normally go away after this time. Women experiencing these emotions for an extended period are at risk for postpartum depression and should consult a doctor.

Postpartum depression is a serious concern for mothers. This type of depression is triggered by childbirth and can make a woman feel sad, hopeless, and worthless. Other symptoms include insomnia, weight loss, and increased anxiety. This makes it difficult for a mother to bond with her baby. Women with a history of depression are at greater risk of developing postpartum depression.

In rare cases, postpartum depression escalates to postpartum psychosis, a condition that endangers both the mother and her newborn child. Women with postpartum psychosis often have suicidal thoughts. These mothers may experience hallucinations and have thoughts of harming their baby. A family history of bipolar disorder increases a woman's risk of developing postpartum psychosis after birth.

Postpartum depression and psychosis are often treated with counseling and certain medications such as antidepressants. Mothers can also encourage a swift recovery by getting adequate sleep, eating nutritious foods, and engaging in light exercise. Medical professionals also advise women to refrain from drinking alcohol and caffeine after giving birth. Mothers should also avoid smoking or taking drugs.

Cait Caffrey

Bibliography

Kansky, Christine. "Normal and Abnormal Puerperium." Medscape, 22 Dec. 2021, emedicine.medscape.com/article/260187-overview. Accessed 31 Jan. 2025.

Bruce, Debra Fulgum. "Postpartum Depression." WebMD, 10 Nov. 2024, webmd.com/depression/postpartum-depression/postpartum-depression-topic-overview. Accessed 31 Jan. 2025.

"Postpartum." Cleveland Clinic, 27 Feb. 2024, my.clevelandclinic.org/health/articles/postpartum. Accessed 31 Jan. 2025.

Romano, Mattea, et al. "Postpartum Period: Three Distinct but Continuous Phases." Journal of Prenatal Medicine, vol. 4, no. 2, 2010, pp. 22-25. National Center for Biotechnology Information, National Library of Medicine, US Institutes of Health, ncbi.nlm.nih.gov/pmc/articles/PMC3279173/. Accessed 31 Jan. 2025.

"WHO Recommendations on Maternal and Newborn Care for a Positive Postnatal Experience." World Health Organization, 30 Mar. 2022, www.who.int/publications/i/item/9789240045989. Accessed 31 Jan. 2025.

"Your Body After Baby: The First 6 Weeks." March of Dimes, Sept. 2023, marchofdimes.org/pregnancy/your-body-after-baby-the-first-6-weeks.aspx. Accessed 31 Jan. 2025.