Puerperium is the postnatal period beginning immediately after the birth of a child and extending for about six weeks. During this period the body tissues, in particular the genital and the pelvic organs, return to the condition in to pre-pregnancy state of the women. This post delivery period of change continues till about 6 weeks (42 days) from delivery to normal, traditionally the concept of 40 days (or ‘sava mahina’) of post-partum confinement was and often still is, the rule in most Indian homes. It gives you time to recover and rest.

Immediate Puerperium

The first 24 hours after birth (immediate Puerperium) is a critical stage. This is the time when your uterus has to contract well, in order to stop the bleeding from the site of placental attachment. It is also the initiation of breastfeeding and bonding. Occasionally, this is the time that most life threatening complications of delivery manifest. These include postpartum excessive bleeding, collapse of the circulation, cardiac failure, etc. These are not common, but even with normal vaginal birth; there is a risk of death of about 1 in 10,000 women. This risk may be more in women with pre-existing medical conditions like anaemia, hypertension or heart diseases. It is also more with operative deliveries. Hence you will be advised to stay in hospital for at least 24 hours following childbirth.

Early Puerperium

This refers to the 2nd to 7th day post-delivery where major changes start in your genital tract. This is probably also the time of maximum adjustment when you come to terms with your new role as ‘mother’. You will also be going home with your baby in this period. There are many relatively minor, yet significant bodily changes you should be aware of. These include:

Lochia / Vaginal discharge

This term refers to the discharge from the vagina, coming mainly from shedding of the inner lining of the uterus. For the first 4 days, there is fresh bleeding, like a heavy menstrual flow. You may need to use 2 pads at a time, changing 3 – 4 times a day. However, if you find it very heavy, or large clots keep coming out, you must inform your doctor. Usually by the 5th day the flow becomes much less, and may now be more of a blood stained yellowish-brown discharge. You may still require sanitary protection, about 2 – 3 pads a day. This discharge usually stops by the end of the second week after which it becomes a plain white discharge. Good hygiene and care of episiotomy will prevent infection. Any foul smell in the discharge should be reported to your doctor.

Urination

The first day you must pass urine at least 2 – 3 hourly, despite pain in the stitches. This is because the bladder may become overfull without your notice, which can cause problems, especially infections later. During the first week, you may notice that you seem to be passing a lot of urine. This is because your body is removing some of the excess water and salt that was retained in pregnancy.

Stools

You may not have a good bowel motion for the first 2 days following delivery, for various reasons. One is that you have not eaten much during labour, you are exhausted and sleepy. Secondly you may be having pain in the stitches of the episiotomy. It is important to take a high fiber diet and plenty of liquids to prevent hard stools. You may need a mild laxative for a few days.

Breasts

The first day you will have only a watery, yellowish discharge, not looking like ‘real’ milk coming from the breasts. This is called colostrum and it is rich in many nutritive factors that are needed by your baby. You must feed your baby at this time. By the third day, the milk flow increases a lot, due to hormonal changes in your body. Regular feeding is important to prevent engorgement.

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