The Postnatal Period

The Postnatal Period

After the birth of her baby, a woman’s body does not return to normal immediately, It does recover remarkably quickly though, given the enormous changes that have affected it for the previous nine months.

Earlier this century new mothers were advised to keep to their beds for a week or even more. Nowadays although rest is obviously essential, staying in bed all day is not recommended. Not only does activity increase the flow of lochia so that it dries up sooner, it also improves the circulation of the blood. This guards against venous thrombosis (clotting in the veins), a rare but potentially dangerous condition. Thrombosis can now be treated effectively with modern drugs but it is, of course, still better to avoid it.

General changes after childbirth

At first, urine production is increased because the woman has to lose the extra fluid accumulated during pregnancy. Usually, evacuation by the bowels begins slowly and sometimes laxatives are needed, because faeces which remain behind also prevent secretion of debris left in the womb.

Generally, appetite increases several days after delivery, even to the extent that the mother, while nursing the baby, gains weight. It is a mistaken assumption, however, that a nursing mother needs to eat more in order to produce enough milk. Nevertheless, she does have to pay attention to the quality of her diet: care should be taken, for example, that the food contains enough iron, as the woman is more susceptible to anaemia at this time.

Another marked change that occurs is that the mother’s blood circulation must again adjust itself to a body that is no longer pregnant.

During the first days following childbirth and during milk production, the sweat glands secrete more fluid. Also, several hours after childbirth the body temperature will rise slightly for a few days, but should, in a healthy woman, be no higher than 38°C.

Uterine involution

The uterus shrinks rapidly in the immediate postnatal period. Just after delivery, it can still be felt as a hard swelling almost reaching the level of the navel. It feels hard because it is contracting. As it continues to contract it gets smaller, so that by the end of a week or so it can no longer be felt, even by pressing on the abdomen.

The shrinking of the uterus after chilbirth is known as involution. The contractions that accompany it may sometimes be felt as period-like pains or ‘after-pains’. They may be uncomfortable but analgesic tablets, such as paracetamol, and a hot-water bottle placed on the lower abdomen, will help.

Involution continues until about two months after the birth, when the uterus will be back to its pre-pregnant state. One of the purposes of the postnatal examination that takes place about six weeks after the birth, is to make sure that involution is proceeding normally.

Lochia

As the uterus contracts, a blood discharge, called lochia, is lost from the vagina. At first, this will be quite heavy – at least as heavy as a normal menstrual flow – and bright red. Sometimes small blood clots may be noticed in the lochia but these are nothing to worry about. However, if any largish clots appear, it is a good idea to save them for the midwife to examine because although they may be perfectly innocent, they just might be a sign that all is not well. Sometimes, for example, the placenta is not completely expelled at the end of labour and, if parts are retained in the uterus, it may become infected. In the past an infected uterus was highly dangerous, resulting in puerperal fever of which many women died. Today, with modern hygiene and antibiotics, it is rare – and treatable.

The flow of lochia lasts from two to six weeks. It tends to cease earlier in women who are breastfeeding because of the stimulating effect this has on the uterine contractions. The colour will change from bright red to pinkish-brown or yellow, with occasional short episodes of bright red discharge after exercise or breastfeeding.