Introduction
Puerperium refers to the period of time after the delivery of a baby, during which the mother's body returns to its non-pregnant state. This period is characterized by significant physical and emotional changes and lasts for approximately 6 weeks after delivery. In this article, we will discuss the different stages of puerperium and the common physical and emotional changes that occur during this period.
Stages of Puerperium
The puerperium can be divided into three stages: immediate or initial stage, early puerperium, and late puerperium.
Immediate or Initial Stage
This stage occurs during the first 24 hours after delivery. During this time, the uterus begins to contract, and bleeding from the vagina (lochia) starts. The mother may also experience shivering, sweating, and fatigue.
Early Puerperium
This stage lasts for the first 7 to 10 days after delivery. The mother's uterus continues to contract and gradually returns to its pre-pregnancy size. Lochia discharge is typically heavy during the first few days and then gradually decreases in volume and changes in color from bright red to pink or brown. The mother may also experience breast engorgement, which can be managed with breast massage, warm compresses, and breastfeeding.
Late Puerperium
This stage begins around 10 days after delivery and lasts for up to 6 weeks. By this time, the uterus has returned to its pre-pregnancy size and the lochia discharge has stopped. The mother may still experience some physical changes during this time, such as vaginal dryness, constipation, and fatigue.
Changes During Puerperium
The postpartum period, also known as the puerperium, is a time when the mother's body undergoes significant changes following childbirth. Here are the changes that occur during the puerperium:
Uterus
After delivery, the uterus undergoes involution, a process of returning to its pre-pregnancy size. The rate of involution is influenced by several factors, including breastfeeding, the number of pregnancies, and the presence of complications such as infection or retained placental tissue.
Lochia is the discharge that occurs after delivery and is composed of blood, mucus, and uterine tissue. During the early puerperium, the lochia is typically heavy and bright red, gradually decreasing in volume and changing color to pink or brown. By the late puerperium, the discharge should have stopped.
Read more: What is Lochia?
Breasts
Breastfeeding causes the release of the hormone oxytocin, which stimulates milk production and causes the uterus to contract. Breast engorgement can occur when the milk first comes in, causing the breasts to become swollen, tender, and uncomfortable. Breast massage, warm compresses, and breastfeeding can help relieve breast engorgement.
Vagina
During the puerperium, the vagina undergoes healing and returns to its pre-pregnancy state. This process can be accompanied by dryness, itching, and discomfort. It is important to avoid sexual activity until the doctor confirms that the healing is complete.
Hormonal changes
Hormonal changes occur after the delivery, including a decrease in estrogen and progesterone levels, which can lead to physical and emotional changes, such as mood swings, fatigue, and insomnia. The hormone prolactin increases, which stimulates milk production.
Cardiovascular changes
The mother's cardiovascular system undergoes changes during pregnancy, including increased blood volume and cardiac output. These changes reverse after delivery, which can lead to postpartum anemia, hypotension, and an increased risk of thromboembolic events.
Problems during Puerperium - Postnatal Phase
Puerperium, like any other phase of life, can have various problems. Some of the common problems that may arise during puerperium include:
Postpartum hemorrhage
This is excessive bleeding after delivery, which can occur due to various reasons, including uterine atony (when the uterus fails to contract properly), genital tract trauma, and clotting disorders. It is a medical emergency that requires immediate intervention to prevent maternal morbidity and mortality.
Infections
Postpartum infections can occur in the uterus, vagina, or breast, and can be caused by bacteria, viruses, or fungi. Endometritis is an infection of the inner lining of the uterus, and mastitis is an infection of the breast tissue. Symptoms include fever, abdominal pain, foul-smelling discharge, breast pain, and redness. These infections can lead to sepsis, a life-threatening condition, and require prompt treatment with antibiotics.
Breastfeeding problems
Breastfeeding can be challenging for some women, and problems such as nipple soreness, engorgement, blocked milk ducts, and mastitis can occur. Nipple soreness and engorgement can be managed with proper latch technique, breast massage, and the use of warm and cold compresses. Blocked milk ducts can lead to mastitis, which requires antibiotics and continued breastfeeding or pumping to relieve the blockage.
Vaginal or perineal trauma
Tears or lacerations in the vagina or perineum during delivery can cause pain, discomfort, and difficulty with daily activities. Perineal pain and discomfort can be managed with pain relievers, sitz baths, and ice packs. More severe tears may require surgical repair.
Bowel Movements
Constipation is a common problem during the puerperium due to the effects of hormonal changes, decreased physical activity, and the use of pain medications. Drinking plenty of fluids, eating a fiber-rich diet, and taking a stool softener can help prevent constipation.
Perineal pain/discomfort
Pain or discomfort in the perineal area, which can occur due to vaginal or perineal trauma during delivery, can make it difficult to sit, walk, or perform daily activities. Pain relievers, sitz baths, and ice packs can provide relief.
Bladder dysfunction
Some women may experience difficulty urinating after delivery due to swelling, trauma, or nerve damage. This can lead to urinary retention, infection, or damage to the bladder. Treatment may include catheterization, medication, or surgery.
Thrombosis/thromboembolism
Puerperium is a high-risk period for thrombosis and thromboembolism, which refers to the formation of blood clots in the veins or arteries. This can occur due to changes in blood clotting factors and reduced mobility after delivery. Symptoms include pain, swelling, and redness in the affected limb, chest pain, and shortness of breath. Treatment may include blood thinners and compression stockings to prevent further clots.
Emotional Changes During Puerperium
The puerperium is a time of significant emotional changes for new mothers. Many women experience mood swings, irritability, anxiety, and sadness during this period, commonly referred to as the "baby blues." These feelings typically resolve within a few days to a week. However, if the symptoms persist or worsen, it may be a sign of postpartum depression, which requires medical attention.
Care for Mothers during the Postnatal Period (Puerperium)
Care during the puerperium, or the postpartum period is critical for the mother's physical and emotional well-being and the newborn's health.
Here are the aspects of postpartum care:
A.) Physical Recovery
After delivery, the mother's body undergoes significant physical changes, and it is essential to monitor for any complications. The healthcare provider will check the mother's vital signs, uterus, perineum, and breasts to ensure proper healing. The mother should rest and avoid strenuous activities, and caregivers should assist with household chores and infant care.
B.) Pain Management
The mother may experience pain and discomfort after delivery due to vaginal or perineal tears, uterine contractions, or breast engorgement. Pain relief measures, such as nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, ice packs, and warm baths, can provide relief.
C.) Breastfeeding Support
Breastfeeding can be challenging for some mothers, and it is essential to provide adequate support and resources. The healthcare provider should assess the baby's latch and feeding patterns and monitor for any breastfeeding complications. A lactation consultant can provide additional support and education.
D.) Emotional Support
Postpartum mood disorders, such as postpartum depression and anxiety, can occur and affect the mother's emotional well-being and ability to care for her baby. Healthcare providers should assess for any signs of mood disorders and provide appropriate interventions and referrals. Family and social support can also be beneficial.
E.) Nutrition
A balanced and nutritious diet is crucial for the mother's physical recovery and breastfeeding. The mother should consume a variety of foods, including fruits, vegetables, whole grains, lean protein, and healthy fats, and drink plenty of fluids.
F.) Contraception
During puerperium, it is important for the mother to consider contraception if she wishes to prevent a subsequent pregnancy.
It is important to discuss contraceptive options with a healthcare provider to determine the best option for the mother's individual needs and preferences. It is also important to note that while breastfeeding can provide some protection against pregnancy, it is not a reliable form of contraception and additional methods should be used to prevent pregnancy.
G.) Follow-up Appointments
The mother should schedule a follow-up appointment with her healthcare provider within a few weeks after delivery to monitor for any complications and address any concerns.
Conclusion
In conclusion, the puerperium is a critical period that requires careful monitoring and attention to physical and emotional changes in the mother. New mothers should be aware of the different stages of the puerperium and the common physical and emotional changes that may occur during this period. Any concerns or questions should be discussed with a healthcare provider to ensure the best possible care for both the mother and baby. With proper care and attention, most women can have a smooth and healthy recovery during the puerperium.
