Our baby has already been born, now we have to face a complicated stage, full of changes, mixed feelings and fears.
The puerperium is the period of time that elapses from the end of labor until the moment we have the first menstruation approximately.
In this time our body will undergo a series of physical and psychological transformations until it returns to the state it had before pregnancy, or perhaps we will never be like before pregnancy, but who says this is bad?
Stages of the puerperium
According to all experts, we can distinguish three stages, each with different changes and characteristics.
Immediate puerperium
Time that elapses from delivery to the first 24 hours. It is at this time when the woman who has just given birth needs more vigilance, because it is now when the most serious complications can occur.
The uterus must contract very strongly, to avoid excessive bleedingWhen the placenta comes out, we will notice it as a hard area between the navel and the pubis.
In the first two hours of our baby's life, it is ideal that we start breastfeeding. It will help us both to stimulate milk production and to release hormones necessary for the uterus to soon return to its pre-pregnancy shape and size.
Clinical puerperium
From day 2 to day 10 postpartum.
After the first 24 hours postpartum we will find the uterus at the level of the navel or something above. From that moment on it descends at a rate of approximately one centimeter a day, so that at the end of this stage it is already at the height of the pubis.
It is the period in which hormonal changes are more abrupt. It is also the time when our mood is most vulnerable and the "maternity blues" or puerperal sadness may appear.
It is also the period in which breastfeeding is established. At first there is colostrum in our breasts, but at the end of this period we already have milk. In this link I will tell you everything you need to know to make the start and maintenance of breastfeeding easier and more successful.
Late puerperium
From 10 days postpartum until the structures of the reproductive and genital system return to their previous situation. The famous "quarantine".
It is a time of calmer changes. We begin to understand each other with the baby and every day we feel better. After a few weeks we began to really enjoy motherhood.
Although, in theory, it is a period that ends when you have menstruation, this is not always the case. When we breastfeed, menstruation can take several months to appear.
Postpartum changes
The most striking postpartum changes can be divided into hormonal, physical and psychological changes.
Hormonal changes
Hormonal changes are very abrupt in the postpartum. It is necessary that new hormones appear that stimulate the production and output of milk and that we return to having female hormones in normal quantity so that our menstrual cycle can resume.
Estrogens.
They drop sharply after childbirth, but they increase again at the end of the puerperium, although if we breastfeed they may take longer.
Hormones FSH and LH
They are practically undetectable for the first 10/12 days, after which it depends on breastfeeding.
Placental hormones
They disappear, abruptly, at the time the delivery ends.
Prolactin
It is necessary to stimulate the secretion of milk. It rises after delivery, but needs the stimulation of sucking and emptying of the breast by the baby to maintain its levels and to maintain milk production.
Oxytocin
Needed so much for the uterus to contract and return to its position so that the milk comes out of the breast when the baby sucks. It is also stimulated by the suckling of the baby.
Physical changes
Return of the uterus to its previous situation.
From the moment of delivery the uterus must contract firmly to avoid bleeding and gradually lose size, to go from a weight and length of 1500gr and 32 cm that it measures at the end of pregnancy to the 7/8 cm and 60/80 gr that it usually has.
We can help our bodies to make this great change. Breastfeeding, getting up and walking as soon as possible and periodically emptying the bladder are factors that we can control and help our uterus to return to its place soon, decreasing the risk of bleeding and infection.
The endometrium or inner surface of the uterus
It is a mucous area, which our body makes each month, grow in size and prepare to be the "cradle" of a possible pregnancy. During the first weeks it provides all the nutrients that the future baby needs.
During pregnancy it grows and the placenta is implanted in it, leaving after delivery an area called the "placental bed" that will take longer to heal than the rest of the endometrium.
During the first part of the puerperium it has to disappear that mucosa that has covered the pregnancy, destroying itself and the exterior being expelled in the form of Lochios.
From the 5th day that internal area of the uterus begins to regenerate and from day 25 to 45 postpartum it begins to be stimulated by the usual hormones, causing it to return to its normal cycle, Except in the case of breastfeeding, the stimulation process may not occur due to the action of the lactation hormones.
Afterpains
Who has not heard our mothers and grandmothers talk about the famous wrongs?
The wrongs are nothing other than contractions of the uterus with which it returns to its normal appearance. They are more frequent in mothers who have already had more children or in twin pregnancies.
They are more intense the first days, even painful and at the time of feeding in case of breastfeeding.
lochia
Although many women mistake this bleeding for menstruation, it really has nothing to do with it.
With the lochia, all the remains that have remained in the uterus after delivery are expelled. The remains of the endometrium of pregnancy, remains of blood ... Etc
The first days after delivery are red, because they have more blood.
From the 4th to the 10th day postpartum they have a pink appearance. They have less blood and more bacteria (not pathological) or leukocytes.
From the 10th day to the 3rd or 4th week they have a white or yellowish appearance. Now what we expel are leukocytes and the remains of the healing of the placental wound (area where the placenta was placed) and the healing of the rest of the small wounds in our birth canal.
There is no hard and fast rule of thumb as to the duration of bleeding after delivery. The important thing is that we see that the quantity decreases progressively and that the smell, although peculiar and strong, is not fetid or unpleasant.
Vagina, vulva and pelvic floor
Little by little they should go back to normality. It is important to begin pelvic floor rehabilitation as soon as possible by performing Kegel exercises.
Consult your gynecologist or midwife in the first days of postpartum to assess the conditions in which your muscles are found and recommend the most appropriate exercises.
Weight loss
This is an issue that usually worries us a lot, return to our figure as soon as possible. Here You can read how to lose weight in a healthy way postpartum.
It is important not to be too demanding, Our body has gone through a pregnancy and childbirth, it is possible that our previous measures are not easy to achieve, but that only means that now our body has another shape and that little by little we will lose weight.
Psychological changes
During pregnancy, most mothers express their fear of childbirth, but idealize the later stage. Many times we dream of a pink and calm baby that gives us a great feeling of tenderness ...
But the baby is a little person who must adapt to many changes, we need time to get to know and understand each other. And time to adapt to the new situation.
Stages that the mother goes through in the postpartum
According to Reva Rubin (if you are interested here you have his theory) in the postpartum the woman goes through three stages
Acceptance stage or period of dependent conduct
On the first day after delivery, the mother tends to have a dependent attitude. You have many doubts and it is difficult for you to make decisions, so it is usually guided by third parties. She constantly talks about childbirth, comparing her expectations with reality.
Stage of support or transition from dependency to independence
In the next two or three days the mother, although she feels insecure, begins to participate actively in the care of the baby, making independent decisions and beginning to assume their responsibilities.
It is a period in which we begin to assume the role of mothers, but we need to be confirmed that we do it well ...
Stage of abandonment or adoption of new responsibilities
There is no set time, it usually happens once we get home and find ourselves alone with the father and the baby.
Now we are in our environment and we feel more protected and empowered to take control. The relationship with our partner and even with our family evolves and changes.
maternity blues
Normally, after childbirth, a feeling of euphoria appears that gradually disappears and we begin to feel that all the fatigue of childbirth falls on us.
To this we must add the tremendous hormonal changes that our body undergoes abruptly, pain, lack of sleep, mixed feelings or fear and anxiety about the responsibility of raising a baby makes the figure of the “maternity blues” or puerperal sadness appear .
It is a normal and physiological phenomenon, which appears in the form of sudden mood swings, dejection, crying, exaggerated sensitivity or decreased appetite.
80% of mothers suffer it. It usually appears on the third or fourth day postpartum and lasts 7 to 10 days.
It is important that the family is aware of the mother. If the condition does not disappear in that time or the symptoms become more intense, it is important to consult a doctor. to prevent it from leading to postpartum depression.
Establish the bond with our baby
The bond is a feeling of togetherness and attachment. To create it, parents need to spend a lot of time with the baby.
Touch, eye contact, voice recognition or smell are essential to stimulate the creation of that bond.
Hug the baby, talk to him, sing to him, hold him as long as possible, Identifying the child's reflexes as voluntary acts (such as when he squeezes our finger), calling him by his name or caressing him is essential for us to begin to recognize ourselves as part of each other.
It is essential that if the baby has siblings let us make them participate in these moments, not denying them to caress the baby or separating them from the new member of the family.
What an interesting post Nati. Look, at the outset I want to highlight this phrase because it seems very important to me: "Or maybe we will never be like before pregnancy, but who says this is bad?" I am also one of those who thinks that there is nothing wrong with not being the same again, but in reality we are not, we have transformed ourselves so much! that instead of seeing it as a slab, we should feel proud and powerful because we have conceived a life and brought into the world a creature, which is no small thing.
Reva Rubin's theory is exciting, the stages we go through, including that Maternity Blues… oh the euphoria! It's as exciting as it is short 🙂, but I loved feeling it and enjoying it.
During my quarantine and with the eldest, something very curious happened to me and it still causes me intense emotion… It was difficult and it was not difficult to establish the link. It cost me because he was born by cesarean section, and it did not cost me because I am very stubborn and until I did not propose it ... But what I am going to: I was so immersed in that new stage of my life that one day I found a friend on the street who was collaborating with me on a work project, and when I saw him I realized that if it hadn't been for that chance encounter, I probably would have gone on for a few more weeks without knowing exactly who I was before <3. I remember it with great affection because I think it is so necessary for mothers and babies to be very close and connect, and I know that many have so many difficulties, it is a shame; fortunately it did not happen to me.
A hug and congratulations for the post.
I recognize that the puerperium stage is the one I like the most to treat women. Many companions prefer pregnancy, but I believe that the most help we need is now, after delivery. Learn to love each other and give ourselves the importance that we have, the evolution from being the daughter to being the mother ... Understanding that we have done something very great and understanding that we are the same and we are not. It is a difficult transition to make.
Thank you very much Macarena and a hug.