Postpartum: changes, recovery and care after birth

Congratulations, mum! Welcome to the wonderful world of the postpartum period, a time full of changes and adjustments for you and your baby. At Happymami, as midwives, we have created this post especially for you, based on the latest scientific evidence, so that you can get an overview of everything that will happen during your postpartum.

During this postpartum period, your body will go through a series of changes, both physical and emotional, as it recovers from pregnancy and labour. You may also come across cultural practices related to childbirth that are new to you and may raise questions. Our aim is to give you all the information you need to navigate this stage with confidence and peace of mind.

We want you to feel supported in this transition into motherhood, and we are here to answer any questions you may have. Let's get started!

What is the postpartum period in a woman?

The postpartum period is the time that begins after your baby is born. Although the end of this period is not clearly defined, it is considered to last between six and eight weeks after birth, because by then many of the mother's body systems have returned to their pre-pregnancy state. However, not all body systems return to their original state during this period, and recovery is not necessarily linear over time.

For this reason, SEGO (the Spanish Society of Gynaecology and Obstetrics) believes that postpartum care should be extended to 12 weeks after birth. Some experts even consider that women can be in the postpartum period for up to 12 months after their baby is born. In short, the postpartum period is a time of recovery and adjustment for the mother after birth, which can last from a few weeks to several months.

How long does the postpartum period last?

The postpartum period is a phase whose length varies from one woman to another and can last from a few weeks to several months. The postpartum period is considered to begin after your baby is born and to end when the mother's body returns to its pre-pregnancy state.

It is generally considered that the postpartum period lasts around six to eight weeks after birth, since many of the physiological changes that occur during pregnancy return to normal within this period. However, some body systems may take longer to recover completely.

How long do you bleed in the weeks after birth?

What is postpartum lochia?

Postpartum lochia is normal vaginal bleeding that occurs in the postpartum period and lasts about a month. During the first days after birth, the blood is red/brown (lochia rubra) due to the shedding of tissue from the uterus. The discharge then becomes more watery and pinkish-brown (lochia serosa), which lasts two or three weeks. Finally, the discharge becomes whitish-yellow (lochia alba).

The duration of lochia, that postpartum vaginal discharge that includes blood, tissue from the lining of the uterus and mucus, can vary from one woman to another and does not appear to be directly related to factors such as breastfeeding or the use of contraceptives containing oestrogen or progestogen only.

However, it is important to bear in mind that some women with haemorrhagic diathesis, that is, those with a genetic or acquired predisposition to bleeding or clotting disorders, may experience a longer duration of lochia. In these cases, it is crucial to stay in close contact with your doctor to monitor any change or concern about the amount or duration of the flow, and so ensure a safe and healthy postpartum recovery.

How long does postpartum bleeding last?

Postpartum bleeding, known as lochia, is a normal part of the recovery process after birth. This bleeding can last from 4 to 6 weeks, although the exact duration can vary from one woman to another. Here is a more detailed breakdown:

1. First week: During the first days after birth, the bleeding will be heavier and bright red, similar to a heavy period. This is when the body expels the largest amount of blood and tissue from the uterus.
2. Second to third week: The bleeding will begin to decrease in amount and change colour, going from bright red to pink or brown. During this period, the amount of lochia is usually similar to a moderate period.
3. Fourth to sixth week: Towards the end of this period, the bleeding becomes lighter and the colour may change to a yellowish or whitish tone. In some women, lochia may stop before six weeks, while in others it may last a little longer.

It is important to monitor the bleeding and to be alert to any sign of complications. If you experience a sudden increase in the amount of bleeding, large clots, fever, severe abdominal pain or a bad smell in the lochia, it is essential that you contact your doctor, as these could be signs of an infection or other postpartum problems.

Bleeding 15 days after birth

Bleeding 15 days after birth is a normal part of the postpartum recovery process and is known as lochia. Here is what is happening in your body during this time:

After birth, the body begins to shed the uterine lining that supported the pregnancy. This process of cleansing and recovery of the uterus produces the flow of postpartum lochia, which is a mixture of blood, mucus and placental tissue. In the first days after birth, the bleeding is similar to a heavy period and may be bright red.

As the days go by, the amount of bleeding should decrease and the colour will change from bright red to pink, then to brown and finally to yellow or white. At around 15 days after birth, it is normal for the bleeding to be lighter and brown, which indicates that the blood is older and that the uterus is continuing to heal.

How much do you bleed in the weeks after birth?

The total volume of lochia discharge after birth is 200 to 500 mL, which is lost over an average of one month. Up to 15 per cent of people are still passing lochia when they have their follow-up visit six to eight weeks after birth. This lochia contains serous exudate, red blood cells, white blood cells, tissue from the uterus, epithelial cells and bacteria.

How can you tell whether it is your period or lochia?

After birth, it is common to have a vaginal discharge called lochia that can last several weeks. It is often difficult to tell lochia and menstruation apart in the first months after birth. However, there are some characteristics that can help you to distinguish between them:

• Lochia is a vaginal discharge that may be red at first, become lighter and finally turn a yellowish or whitish colour. Menstruation begins with a dark red flow of blood and then decreases in intensity and changes colour to brown or reddish.
• Lochia can last from two to six weeks after birth, whereas the length of the menstrual cycle varies from person to person, but usually lasts from three to seven days.
• Lochia can be heavier than menstruation, especially in the first days after birth.

If you have any doubts or concerns about your symptoms, it is important that you talk to your midwife.

How is postpartum haemorrhage identified?

In the postpartum period, it is important that your midwife or the nursing staff check your uterus and vaginal bleeding regularly to make sure that there is no postpartum haemorrhage. Uterine checks assess its tone and are carried out by pressing on the abdomen to feel whether it is firm and well contracted. If the uterus is not firm, a massage can be given to help it contract. In addition, perineal checks assess vaginal bleeding to ensure that it is not excessive. These checks are carried out every hour during the first 2 hours after birth and then every 4 hours during the first 24 hours.

Postpartum lochia: when should you worry?

Although it is normal to notice some changes in your postpartum lochia, there are certain signs that may indicate a problem and require immediate medical attention. Some of these signs include:

• A sudden increase in the volume of lochia
• A strong, foul-smelling odour in the lochia
• Bleeding that does not stop after a few hours of rest with your legs raised
• The presence of large clots (bigger than a golf ball)
• Fever (a temperature of 38 degrees Celsius or more)
• Severe or persistent abdominal or pelvic pain
• Feeling dizzy or faint

If you experience any of these symptoms, seek medical attention immediately. It is always better to consult a healthcare professional if you have any concern or question about your postpartum lochia or any other aspect of your postpartum recovery.

How long does the pain last after birth?

Postpartum pain affects half of all women and may appear 48 hours after birth, whether vaginal or by caesarean section, due to intense uterine contractions. The pain may be intermittent and gets worse during breastfeeding due to the release of oxytocin. Postpartum pain is more common in women who have given birth several times, in women whose uterus was overdistended before birth (for example, due to a multiple pregnancy or polyhydramnios) and in women with a history of dysmenorrhoea. Generally speaking, postpartum pain tends to disappear on its own at the end of the first postpartum week.

How do you relieve postpartum pain?

Mild painkillers, such as paracetamol, ibuprofen and diclofenac suppositories, are effective at relieving postpartum pain. Non-steroidal anti-inflammatory drugs (NSAIDs) are also effective and can be as effective as paracetamol. If a single medicine does not work, both medicines can be combined. Opioids are not necessary and should be avoided. If you experience intense postpartum pain after a vaginal birth, it is uncommon and should be assessed to determine whether there is another cause.

The painkillers that should be avoided or used with caution during breastfeeding are codeine, tramadol, meperidine and aspirin.

Bottle-feeding in the postpartum period

If you need to use a bottle with your baby during the postpartum period, use a made-to-measure Happymami bottle and avoid using generic bottles. The reason is that this stage is the most important one for establishing your breastfeeding. If you use a generic bottle that is different from your breast, your baby may experience nipple confusion, which may make breastfeeding more difficult.

On the other hand, if you use a made-to-measure Happymami bottle designed with the shape of your breast, you prevent this confusion and protect your breastfeeding relationship.

When should you start working on your pelvic floor after giving birth?

It is advisable to start doing pelvic floor muscle exercises during pregnancy to reduce the risk of urinary incontinence in the short term. However, there is no evidence of long-term benefits. After birth, it is important to take into account whether you suffered an injury to the levator ani muscle complex during birth, as pelvic floor exercises can be harmful in the initial phase of healing from the injury. In the case of obstetric anal sphincter injuries, pelvic floor physiotherapy after two weeks has been shown to improve pelvic floor symptoms at 12 weeks postpartum compared with standard care.

How can you recover your pelvic floor after giving birth?

Pelvic floor recovery after birth depends on several factors, such as the type of birth, the extent of the perineal injury and the pelvic floor exercises carried out during pregnancy and after birth.

Pelvic floor muscle exercises (PFME) are very important for postpartum pelvic floor recovery. It is recommended to start with gentle exercises to contract and relax the pelvic floor muscles, and to gradually increase the intensity and duration of the exercises as you recover from the postpartum period.

Pelvic floor physiotherapy is another option to help restore pelvic floor function after birth. Physiotherapists can carry out specific assessments to identify any muscle weakness and design an individualised treatment plan to help strengthen the pelvic floor muscles.

In addition, it is important to avoid lifting heavy objects or doing intense exercise until the pelvic floor muscles are strong enough and have had time to recover. It is also advisable to avoid constipation, as this can increase the pressure on the pelvic floor muscles.

In general, it is important to seek advice from a healthcare professional to determine when it is safe to start exercising and what type of exercises are most suitable for pelvic floor recovery after birth.

How long does it take to recover your pelvic floor after giving birth?

Pelvic floor recovery after birth can vary from person to person and depends on your specific situation. Bear in mind that pelvic floor recovery can take time and may require constant effort and regular practice of the exercises. In addition, the severity of the pelvic floor injury and the care it has received during and after birth can affect how long it takes to recover completely. It is therefore advisable to work with a healthcare professional trained in pelvic floor care to develop a personalised and safe recovery plan.

What activities can you do after giving birth?

There are no data on which to base recommendations about physical activity in the postpartum period. In particular, there are no high-quality data on which to base restrictions such as lifting weights, climbing stairs, bathing, swimming, driving or resuming vaginal sex, exercise or work after birth.

So it seems reasonable to recommend that mums resume "normal" day-to-day activities, such as driving, exercise and sex, when they feel comfortable doing them. They should limit or avoid activities that cause pain or excessive fatigue. If you are taking opioids, avoid activities that require mental alertness (for example, driving).

What happens if I have sex in the postpartum period?

When you feel comfortable, that is the most important thing. On a physical level, most mums can probably safely resume vaginal intercourse from two weeks after birth, as long as the perineum has healed, you have contraception and you feel ready.

But the reality is that most mums will not be ready to resume sex with penetration so soon after birth. Any reason that makes you not want to is valid. These include fatigue, low sex drive, pain, dryness or vaginal discharge, cultural practices, psychological factors or even sadness or postpartum depression.

Bear in mind that ovulation can occur as early as 25 days after birth, so you can become pregnant again, which is an added risk known as a "short interpregnancy interval". It is defined as the period between a birth or caesarean section and the next birth being less than 18 months.

What happens to a woman in the postpartum period?

After giving birth, a woman experiences several physiological changes, which we describe below.

Postpartum shivering

One of them is postpartum shivering or chills, which is seen in 25 to 50 per cent of women after birth. This shivering usually begins between 1 and 30 minutes after birth and lasts between 2 and 60 minutes. The exact cause is unknown, but it is thought that it may be a response to a drop in body temperature after birth, or caused by the separation of the placenta, anaesthesia, bacteraemia or the administration of certain medicines.

The uterus during the postpartum period

Immediately after birth, your uterus begins to return to its non-pregnant state, which is known as uterine involution. The contractions of the interlaced myometrial muscle constrict the intramyometrial vessels and stop the blood flow, which is the main mechanism for preventing haemorrhage at the placental site. Inadequate myometrial contraction will lead to atony (that is, a soft, boggy uterus), which is the most common cause of early postpartum haemorrhage.

After birth, the uterine fundus is normally firm, not painful, globular and located halfway between the pubis and the navel. In the following 12 hours, it rises to just above or below the navel, then moves back down by about 1 cm per day until it is once again halfway between the pubis and the navel at the end of the first postpartum week. It cannot be felt through the abdomen at two weeks postpartum and reaches its normal non-pregnant size between six and eight weeks postpartum.

The cervix is soft and loose after birth, and may have small lacerations on the margins of the external os. The cervix remains dilated 2 to 3 cm during the first postpartum days and less than 1 cm dilated at one week.

The vagina in the postpartum period

The vagina is roomy and soft immediately after birth, and contracts slowly, but it does not return to its pre-pregnancy size. The folds are restored in the third postpartum week as oedema and vascularity decrease.

Fascial stretching and trauma during birth can lead to relaxation of the pelvic muscles, which cannot return to their pre-pregnancy state. The abdominal wall becomes lax after birth, but regains most, if not all, of its normal muscle tone within several weeks. However, the separation (diastasis) of the rectus abdominis muscles may persist.

The abdomen after birth

After birth, the abdominal wall may be lax, but within several weeks it regains most of its normal muscle tone. However, a separation of the rectus abdominis muscles (diastasis) may persist, which can cause abdominal discomfort and long-term cosmetic problems. These problems can be treated conservatively or surgically.

Postpartum hormones:

After birth, it is normal for hormone levels to fluctuate. Human chorionic gonadotropin (hCG) disappears after an average of two to four weeks after a full-term birth, but it can take longer. However, if hCG levels are high after birth, this may be a sign of gestational trophoblastic disease. In addition, some people may experience hot flushes in the postpartum period due to a thermoregulatory dysfunction, triggered at the level of the hypothalamus by the withdrawal of oestrogen after the expulsion of the placenta.

Return of postpartum ovulation.

Gonadotropins and sex steroids are at low levels during the first two or three weeks postpartum. On average, the return of menstruation after birth ranges between 45 and 64 days, and ovulation can occur between 45 and 94 days after birth. However, exclusive breastfeeding can delay the return of ovulation and menstruation. The intensity of breastfeeding and the mother's nutritional status and body mass can affect the extent to which breastfeeding suppresses the secretion of gonadotropin-releasing hormone (GnRH). Therefore, amenorrhoea during breastfeeding may be related to higher levels of prolactin, which inhibit the pulsatile release of GnRH from the hypothalamus.

Postpartum warning signs

It is important to be alert to any possible complications after birth and to seek medical help if you experience any of these warning signs:

• Excessive postpartum bleeding (for example, a sanitary towel soaked in less than an hour).
• Fever.
• New or worsening perineal or uterine pain.
• Difficulty passing urine.
• Breastfeeding problems
• Difficulty breathing, chest pain or swelling in the legs
• Significant changes in mood that affect relationships or daily activity
• Severe pain in any part of the body (for example, head, chest, abdomen) is also a cause for concern and should be reported to your doctor.

How do you say post parto or posparto?

Both forms are correct and widely used in Spanish: "postparto" and "posparto". The most common form is "postparto", but in some places the shortened form "posparto" is used more. In any case, both forms refer to the period after birth.

Postpartum conclusion

The postpartum period is a stage of changes in which we have to bear in mind that every experience will be individual to each mother. Bear in mind that eating well will be essential because your body is very receptive to recovery but will need the right nutrients. And, above all, lots of patience: it is a new stage with new challenges and you will manage to adapt to each one perfectly.

Postpartum bibliography

Berens P. Overview of the postpartum period: Normal physiology and routine maternal care . Uptodate.com. . Available here.