The puerperium – course, ailments, disturbing symptoms [WE EXPLAIN]

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During the postpartum period, a new mom’s life changes many times. They also happen in her body. So let’s know what to expect. The puerperium, how long does it last, is it exactly what symptoms should you be concerned about?

Puerperium – what is it?

Postpartum puerperium is essentially the fourth stage of labor. It lasts up to six weeks from the moment the baby is born. It is divided into two periods, i.e. early puerperiumfor two weeks, and late puerperiumwhich can last up to six weeks after giving birth. During this time, the body of a woman, a newly-minted mother, is undergoing changes aimed at restoring the state from before becoming pregnant. Thus, processes such as contraction and cleansing of the uterus take place. This, in turn, means that they are excreted paternal faeces. These include uterine discharge such as mucus, blood (often associated with clots), and membrane debris.

Postpartum changes begin almost immediately after delivery and are triggered by a sharp drop in the levels of estrogen and progesterone produced by the placenta during pregnancy. The uterus contracts and slowly returns to its pre-birth size. This usually takes 6 weeks, but can be as long as 8. During this process, called involution, the pregnant uterus’ excess muscle mass is reduced and the uterine lining (endometrium) is restored, usually by the third week of postpartum.

A strongly dilated cervix and lower labor canal also undergo a marked and rapid involution, but rarely return to the antenatal state. While the uterus returns to normal, the breasts begin lactating. Colostrum, a high-protein form of milk, is produced after birth and gradually turns into normal breast milk, which has less protein and more fat.

Read: How to increase lactation?

Postpartum puerperium – ailments

During normal puerperium body temperature is usually normal (although it may be slightly elevated), the heart rate is not elevated. Painful contractions of the uterus occur early in the postpartum period, increasing with breastfeeding due to the release of oxytocin.

For the first 1-3 days after the baby is born, you will likely be light to dark red blood, with clots ranging from the size of a grape to a plum. Between the fourth and seventh day, the blood should turn a brownish color. The clots should get smaller or disappear. Blood should be completely gone within six weeks. If you’ve had a caesarean section, your bleeding is likely to be much less than after having a vaginal delivery. The color of the blood will change from red to brown just like after a vaginal delivery.

Regarding the breast, colostrum is secreted in the first 3 days. Usually, on the third day (natural childbirth) or on the sixth day (caesarean section), there is an invasion of milk – this is a physiological state of overproduction of milk, which is associated with the start of lactation and the baby’s low demand for food. The breasts then become swollen, sore, hard, even overcrowded. Of course, the situation will normalize within a few days.

You may become constipated after giving birth. It is a functional bowel disorder that can reduce the quality of life in the puerperium. Diagnosing postpartum constipation is both subjective and objective. It is characterized by symptoms such as pain or discomfort, straining, hard, uneven stools and a feeling of incomplete emptying of the bowel. Haemorrhoids, pain at the site of the episiotomy, and the action of pregnancy hormones may increase the risk of constipation after delivery. A high fiber diet and increased fluid intake are recommended, consult your midwife or doctor before taking any laxatives.

See also: Food stagnation – how to deal with it?

Puerperium – 1 week of puerperium

You spend the first week of childbirth, or at least part of it, in the hospital. If you gave birth naturally and there were no complications, and everything is fine with your baby, you are discharged home after about 3 days.

In the case of natural childbirth, the first days can be quite tedious, especially if you had an incision in your perineum or if you “cracked” it. There is pain in the perineum, discomfort with the stitches and uterine contractions that increase during breastfeeding. In addition, there is bleeding, which is the natural physiological state of the cleansing uterus after delivery. The blood should be bright red in the first week, but will eventually turn brown, like it is at the end of your period.

In the case of a caesarean section, you will experience soreness in the wound and a feeling of pulling the stitches. It may happen that you feel sore all over and it is very difficult for you to make any movements. Many women have trouble getting out of bed and going back to bed shortly after giving birth to a CC – but it’s important to move around, at least a little, to avoid blood clots.

Some young mums may experience the so-called “Baby blues” – postpartum sadness. It appears between days 2 and 5 after giving birth and lasts for about two weeks. In some cases, however, it may persist for a long time, then you should consult your doctor. It occurs in about 80% of all mothers, but is not diagnosed as a disease entity. Postpartum sadness is caused by a sudden change in hormones after delivery, combined with stress, isolation, sleep deprivation and fatigue.

Baby blues is manifested by the fact that a woman’s mood changes very quickly, she is happy in an instant, and after 5 minutes, a huge sadness appears. After doing something related to your newborn baby, you are happy you did it, and then you cry because you think you could have done better. Also, during this period, you don’t feel like eating or taking care of yourself as you feel constantly tired. You are irritable, overwhelmed by the new situation and restless.

Read: Caesarean section simulator – what is it?

Puerperium – 2 week of puerperium

For some women, this week’s bleeding will start to decrease. For others, it may take up to six weeks – both are perfectly normal. At this point, however, the bleeding should not be excessive. You may start to feel your vulva itching, which is caused by cuts or cracks healing. In general, a young mother should not feel any more pain and discomfort in her intimate areas,

If you have a caesarean delivery, you may still feel sore, but it will probably be easier for you to move. The wound may itch as it is healing.

Puerperium – 3-5 weeks of puerperium

During these weeks your uterus continues to contract and you may feel it contracting, especially while you are breastfeeding. Don’t worry, it will be less pain each week. If you cannot bear it, take a painkiller – nursing women can take paracetamol and ibuprofen (of course in the right doses), or ask a midwife or doctor for advice.

Puerperium – 6 week of puerperium

By the 6th week of postpartum, the uterus has usually returned to its original size and bleeding has stopped. After the end of this week, you should visit your attending physician to check that all reproductive organs have returned to their pre-pregnancy state.

Occasionally, it may be so that although bleeding has stopped, it may start suddenly. Usually, this is not a disturbing symptom – it just means that the uterus is not completely clear. Of course, if you are concerned about this, see your doctor.

All this also applies to women after cesarean section. However, they still have to be careful about lifting weights. The scar probably doesn’t hurt anymore, but you may still feel numbness (or even itching) around the incision.

If everything is fine, you can take it already sexual activity – but if you don’t feel ready for it yet, don’t force yourself and explain it to your partner. You can also take up physical exercise, of course, we’re not talking about a marathon here, but gentle fitness.

Read: Postpartum Exercise – When To Start?

The puerperium – disturbing symptoms

There are some symptoms that should be worrisome during the puerperium. It is, for example, a fever above 37,6 degrees Celsius (puerperal fever). Most often it is the result of stagnation of milk in the breasts. This is a big problem if the temperature doesn’t drop even after emptying the breasts. If, in addition, there is pain and swelling, the woman must turn on the red light, because we are probably dealing with puerperal inflammation or an abscess of the breast gland. Endometritis cannot be ruled out either. In addition, high fever in the puerperium is also the result of improper healing of the perineal wound or caesarean section.

You should also pay attention to pain in the lower abdomen. If they are strong and do not come off even after feeding, see a doctor. And it is certainly necessary if, in addition, inappropriate vaginal bleeding or fever or convulsions occur. Consultation with a doctor is also recommended in a situation where we are struggling with pain, especially sudden and strong, later in the postpartum periodwhen theoretically there should be no problems with the uterus.

Another very disturbing symptom that can happen during the puerperium is nsudden stop of bleeding. In a normal puerperium, the bleeding decreases with each passing day, it is not that it stops suddenly. Such a situation may indicate blockage of the internal opening of the cervix with placenta residues or clots, and then intrauterine infection may occur.

Occasionally, it may happen that either the perineal wound (natural birth) or the caesarean section wound heals poorly. This is evidenced by redness within it, swelling and throbbing pain. If exudate appears, an immediate visit to the doctor is required. The wound may need to be cleaned and sutured again.

The puerperium – postpartum depression

Postnatal depression (PPD) is a complex mix of physical, emotional and behavioral changes that occur in a woman after giving birth. According to the DSM-5, a textbook for the diagnosis of mental disorders, PPD is a form of major depression that occurs within four weeks after giving birth. Diagnosis of postpartum depression is based not only on the time between delivery and onset, but also on the severity of the depression.

Postnatal depression is associated with the chemical, social and psychological changes associated with having a baby. The term describes a series of physical and emotional changes that many new moms experience. The good news is that postnatal depression can be treated with the right drugs and psychotherapy.

The chemical changes likely include a sudden drop in hormones after childbirth. The real relationship between this relationship is not fully understood. However, it is known that the levels of estrogen and progesterone, the female reproductive hormones, increase tenfold during pregnancy. Their levels then drop sharply after childbirth. Three days after giving birth, these hormone levels return to their previous pre-pregnancy levels.

The symptoms of postnatal depression are similar to what usually happens after childbirth. They include:

1. depressed mood or strong mood swings,
2. excessive crying
3. difficulties in caring for a child,
4. withdrawing from the family, avoiding contacts,
5. loss of appetite or excessive appetite
6. insomnia or increased sleepiness,
7. overwhelming fatigue, loss of energy,
8. reduced interest and pleasure from activities you previously liked,
9. intense irritability and anger,
10. constant guilt that you are not a good mother
11. a sense of hopelessness,
12. feeling of worthlessness, shame or inadequacy,
13. reduced ability to think clearly, concentrate, make decisions,
14. anxiety and panic attacks,
15. thoughts of harming yourself or your child,
16. thoughts of death or suicide repeatedly.

The editorial office also recommends: Postpartum depression after IVF – why is nobody talking about it?

Postpartum coping tips

Each woman goes through the puerperium individually, one is better, the other worse. Here are some tips to help you manage your puerperium:

1. limit visits from family and friends for a few days after giving birth,
2. ask for help – let others know how they can help you,
3. be realistic about your expectations of yourself and your baby,
4. expect good and bad days,
5. take care of your diet – avoid alcohol and caffeine in large amounts,
6. develop relationships with your partner – find time for you,
7. stay in touch with family and friends – do not isolate yourself, but also do not force yourself to meet if you do not want to,
8. sleep or rest while your baby is asleep!

Read: The Birth Belt – How Can It Help You?

Postpartum rehabilitation

Postpartum rehabilitation is very important. Its task is to accelerate the contraction of the uterus. It must also help her return to the correct location. It is also of great importance for the mental condition of a woman who became a mother. It is worth starting gentle exercises in the first days after childbirth. Do not delay because of this time puerperal modifications they happen much faster.

Proper gymnastics, because we are talking about such exercises, improves the functioning of the circulatory system and protects against thrombosis of the veins of the lower extremities. It also stimulates the work of the intestines and regulates excretory processes.

That is why it is good, for example, to tighten and relax the muscles of the legs. Then you need to turn on your side and lower your legs to the ground while leaning on your arms. Then you have to get up, avoiding the sitting position. It seems almost acrobatics? Relax. All you need is patience and regularity (doctors encourage you to do the exercises twice a day and repeat them five times).

Breathing exercises will also bring very good results. It is worth exhaling and pressing the nostrils and the lower part of the chest in parallel. In this way, we support the muscles that are between the ribs, as well as the diaphragm. Of course, if we feel tired, it is better to let go than to lead to the so-called overtraining.

However, you should be aware that not every mother can exercise after childbirth, especially in the first stage of the postpartum period. There is no point in doing this type of physical activity if the perineum is not healing well, there is a puerperal infection or phlebitis.

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