Puerperium is the period from termination of pregnancy to the involution of the uterus, traditionally 6 weeks.
Involution of reproductive organ
Just after birth: Slightly below umbilicus, weighs about 1000 gm.
Day 2: Uterus begins to shrink.
2 weeks: Uterus descends into pelvic cavity; weighs 300 gm.
6 weeks: Uterus returns to normal nonpregnant state; weighs 50-70 gm.
Placental site involution takes 6 weeks.
Because of rupture of elastic fibers in the skin during pregnancy, abdominal walls remains\ soft and flabby after childbirth.
Exercise helps speed recovery of abdominal walls.
After birth: over-distention and incomplete emptying occurs.
Complete recovery takes 2-8 weeks.
About 7% of women develop stress incontinence after delivery; Kegel exercises are helpful.
Care: immediately after childbirth
Bleeding: Vaginal bleeding should be monitored closely.
Care of perineum:
Mother should be advised to clean the perineum from front to back after bowel movements.
Hot sitz bath can reduce discomfort of perineal area and enhance recovery.
Women can get out of bed several hours after childbirth: An attendant should monitor the first ambulation.
Early ambulation reduces bladder complications and constipation.
Care: puerperal period
Uterine contractions after birth cause pain.
After pains are more common in multiparous women and when the baby suckles.
After pains decrease after 3 days after childbirth.
Lochia is red, due to mixture of blood and tissue, for the first few days.
After 3-4 days, lochia gradually becomes pale in color.
After 10 days lochia, becomes yellowish-white in color.
Physiologic " milk fever" can occur on 3rd or 4th day.
Any fever after childbirth should be monitored. It can indicate an infection.
Any bleeding exceeding 2 times the amount of menstrual blood should be monitored.
Initially after birth, 10-13 lbs is lost due to uterine evacuation and 4.5-6.5 lbs is lost due to diuresis.
Most women approach their prepregnancy weight within 6 months.