Postpartum is the name given to the process in which the changes that occur during pregnancy return to the mother's body after birth. It is also referred to as the postpartum period or the puerperium period. It is generally thought that this process is largely completed in 6 weeks.
To briefly mention the changes in the uterus, vagina, perineum, abdominal wall and breasts during the postpartum period;
Uterus (Womb)
During pregnancy , the uterus (excluding the baby, including placenta, fluids, etc.) weighs approximately 1000 grams. Within 6 weeks after birth, the uterus shrinks to a weight of 50-100 grams.
Immediately after birth, the uterine fundus (the uppermost part of the uterus) can be felt clearly by touch at or near the level of the mother's navel. In the first 2 weeks after birth, the uterus decreases in size and weight, and in most puerperal women, it returns to the true pelvis, the intra-abdominal region, shrinking to a level where it cannot be felt clearly by hand.
In the following few weeks, although the uterus size usually remains larger than before pregnancy, the uterus gradually returns to its pre-pregnancy state. The endometrial layer is the inner wall layer of the uterus and is rapidly renewed after birth and the endometrial glands have already formed on the 7th day after birth. On the 16th day after birth, the endometrium is completely renewed except for the part where the placenta is located. The surface of the endometrium where the placenta is located undergoes many changes during the puerperium. Immediately after birth, the smooth muscle cells in the uterine arteries contract and the uterine muscles called myoma etrium contract and the uterine veins are compressed (this event is called physiological attachment) and the bleeding in the uterus is controlled. Vaginal discharge called lochia occurs during the renewal of the placental bed. The placental bed decreases by half after birth and the changes in the placental bed cause changes in the amount and quality of lochia.
Immediately after birth, there is a large amount of bleeding until the uterus contracts and the bleeding is brought under control. After the bleeding is brought under control, a red vaginal discharge called lochia rubra is first seen. This discharge changes during the healing and renewal process, first becoming brownish watery lochia serosa and then, after a few weeks, a yellowish white vaginal discharge called lochia alba, which gradually decreases in amount. The time for lochia to end varies, but is approximately 5 weeks on average. It can last up to 6 weeks or more in 15% of puerperal women. An increase in the amount of vaginal bleeding can usually be seen between the 7th and 14th days after birth, due to the separation of the scab from the wound in the placental area. This is the classical time for delayed postpartum bleeding (postpartum hemorrhage).
Cervix (mouth of the womb)
The cervix returns to its pre-pregnancy state shortly after birth, but it will not be the same as it was before. The outer part of the cervix closes to the point where a finger cannot easily enter within a week after birth.
Vagina (Chamber)
During the healing and reshaping process of the vagina, there is a reduction in size, but it does not return to its pre-birth size. In non-breastfeeding puerperal women, it takes up to 3 weeks for the increased vaginal vascularity to decrease and for the edema to resolve, and for the folds called rugae to re-form in the vagina. In breastfeeding puerperal women, this process takes up to 6-10 weeks, depending on the decreased estrogen hormone levels.
Perineum (crotch area)
The perineum may have been stretched, traumatized, torn, or cut during delivery. The swollen and enlarged external genitalia regenerate in 1-2 weeks. Muscle tone in this area may return in up to 6 weeks, with further recovery taking several months. If there is extensive damage to the muscles, nerves, and connective tissue in these areas, muscle tone may not return to normal.
Abdominal wall
The abdominal wall may continue to be soft and poorly toned for weeks. Returning the abdominal wall to its prenatal state depends largely on the mother's exercises.
Ovaries
The return of the ovaries to normal function varies greatly depending on whether the postpartum woman is breastfeeding or not. Breastfeeding mothers have a longer amenorrhea (absence of menstruation) and anovulation (absence of ovulation) period than non-breastfeeding mothers. In non-breastfeeding mothers, ovulation occurs as early as 27 days after birth. In most women, the menstrual cycle begins approximately 12 weeks after birth, and the average first menstrual period is 7-9 weeks.
In breastfeeding mothers, the return of menstruation varies greatly depending on many factors, such as how often and how much the baby is breastfed, and whether or not supplemental formula is used. The return of the ovaries to normal function in breastfeeding mothers is due to high levels of the hormone prolactin, which causes milk to be secreted from the breasts. In 3 out of 4 breastfeeding mothers, normal menstrual cycles return around 36 weeks after birth.
Nipples
There are changes in the breasts throughout pregnancy that are necessary for postpartum milk secretion. The earliest week of postpartum milk production is around the 16th week of pregnancy. Lactogenesis (milk production) begins after the baby is born, thanks to the prolactin hormone, which remains high compared to the estrogen and progesterone that decrease following the birth of the placenta. If the mother does not breastfeed, the prolactin level decreases within 2-3 weeks.
The first breast milk that comes in the first 2-4 days after birth is called claustrum. It has a high protein content and is protective for the baby. Breastfeeding increases milk secretion. During the first week, milk matures and contains all the nutrients that meet the baby's needs. The nutrients contained in milk vary according to the baby's needs.
Is There a Difference in the Postpartum Process After Normal Birth or Caesarean Section?
Although there is not much difference between normal birth and cesarean section in terms of postpartum, those who have cesarean section may experience difficulty healing the wound and moving. It is obvious that the incision made in the vaginal area may also cause difficulty in walking in those who have normal birth.
Comments