Your Body During the Puerperium, the Postpartum Period

The “puerperium” refers to both the period of time and the process that your body goes through after the birth of your baby. Technically, it begins with the delivery of the placenta. With the loss of that organ, so vital to your baby’s intrauterine survival, you lose one of the largest hormone-producing glands your body will ever know. The sudden withdrawal of all those hormones initiates a cascade of profound bodily events.

The slow inflation of your body to accomodate a growing pregnancy is now replaced by a process of deflation……that is, for every part of your body except your breasts. They’re going to grow significantly if properly stimulated….that is, when you put the baby to breast to feed. Whether or not you breastfeed, your uterus begins its “involution” from the pregnant to the non-pregnant state. This will take about 4-6 weeks. The lining of the uterine cavity which helped nourish the placenta will slough off in the first few days after birth. The uterus, about the size of a large grapefruit in the hours after birth, will decrease to the size of a lime within the next 6 weeks.

The fluid that your body stored up in the last months of pregnancy will find its way back into your bloodstream. There the kidneys will remove the amount not needed. For most women, that means they will urinate huge amounts in the days after delivery. In fact, a complication of the puerperium, is the overdistention of a weakened bladder by the large volume of urine which is produced. If the bladder becomes significantly overdistended it may keep the uterus from contracting in the early postpartum period. This can result in the uterus filling up with blood, which most new mothers cannot afford to lose. If this happens, your bladder may need to be emptied with a catheter placed up through the urethra.

Your breasts will produce the first milk, colostrum, if they are not already doing so. The real milk will not come in until the second, third or fourth postpartum day. Sometimes the breasts fill so suddenly and with so much milk that the milk glands become “engorged”. Engorgement can cause significant pain and discomfort. But it will pass. Engorgement can be managed with a proper fitting bra, ice (yes, ice), some pain medication, and expressing out some of the extra milk produced.

If you decide not to breastfeed, you may still notice some milk production. To decrease the chance of engorgement, wear a tight-fitting bra or sports bra as soon after delivery as possible. Try not to stimulate your breasts in any way (avoid direct spray from hot showers). Regardless of what some women have heard, there is no “shot” or medication which can “dry up” the breasts. Many medications have been tried, but none are adequately successful and most have potentially significant side effects.

If you had an episiotomy, expect to have a tremendously sore bottom for 2-10 days. You may need pain medication and special care to get through this period…..especially with all the other demands of this period of time. If you had a small- to medium-sized tear, it will not hurt like an episiotomy, but care for the wound just the same. Even if you had a large episiotomy or tear, rest assured that the tissue of the vulva and vagina usually heal extremely well. With the right care and attention, there is actually little chance for these wounds to become infected. Ice in the first 24-hours keeps swelling to a minimum. But after the first 24-hours, heat in the form of sitz bathes and hot compresses will draw blood to the area and promote more rapid healing.

Often the pain associated with an episiotomy or laceration will be intense enough to limit a woman’s movement. Years of experience with surgical patients has shown that early physical activity promotes blood circulation and peristalsis of the intestines. When pain is well-controlled with appropriate levels of pain-relief drugs (and there is a tendency to under-utilize them), people heal more quickly. One unfortunate side effect of the narcotic pain relievers is constipation. So, make certain that your intake of fiber and fluids is adequate, and that you maintain a reasonable level of physical activity.

If you gave birth by c-section, expect a significantly longer recovery period. Although the recovery experience is vastly different person to person, the fact that your body has had a major abdominal surgery is worthy of respect for the natural healing process. If you are able to move around, do so early but sparingly. If you are unable to move because of pain, ask for more pain relief. Generally, those women who are up and moving earlier and more often are the ones who recover sooner. Surgery often temporarily paralyzes the intestines. This is not a good thing if there is still food in the intestines which has not found its way all the way through the system. Generally, the earlier “the gut” starts moving and shaking, the better. Rumblings in the stomach and intestines are a good sign…..and the first gas is golden. A few hours after surgery, attempt to swallow some sips of a liquid (water is a good start). When you tolerate liquids without significant nausea or vomiting, move to a semi-solid. Broths and Jello are the classics. When all that stays down easily move on to soft, solid foods.

A new mother may not have a bowel movement for several days. Most do, but it is not unusual not to have one until the third or fourth day postpartum. Constipation is common, however, and many factors in the immediate postpartum period feed this monster (bedrest, inactivity, narcotics, fluid restrictions, iron supplements). If you have had problems with constipation, start to think 24 to 72 hours ahead. Laxatives which work faster than this produce an exaggerated effect on the bowel which produces (as the book says) “a watery evacuation”.

Three factors are associated with regular, soft bowel movements- fiber, fluids and physical activity. If you are on a narcotic or iron supplement, be especially attentive to the potential for constipation. You may need a stool softener, mild laxative or senna/psyllium product (which adds a water-absorbing form of fiber to the intestines). Senna products generally work faster, but produce a stool with a higher water content. Psyllium products work over a day or two (or three) but produce a more normal stool. Once the immediate problem is corrected, always be thinking 2-3 days into the future, and make certain that appropriate amounts of fluid, fiber and exercise are incorporated into your lifestyle.

Many new mothers try to do too much, too fast…..especially if there are older siblings involved…..and especially if those older siblings are toddlers. For the first week postpartum, try to care only for yourself and your baby’s immediate needs. Let someone else cook, clean, shop and attend to those other parts of your life. Call up all those people who offered to help and ask each to provide your family’s evening meal one day for the first week. Do not answer the phone or front door….have your “significant other” do this, and tell all those well-meaning friends and family that you and the baby are sleeping. When they say that they just want to “peek at the baby” and that they will “only stay for a minute”, it often ends up to be 30 minutes while your breasts are leaking and your pad needs changing…….put your man to work; he finally has a job that will come naturally to him; to protect you and the baby (if only from Aunt Tilly and that nosey neighbor next door).