A postpartum (or postnatal) period begins immediately after the birth of a child and extends for about six weeks, as the mother's body, including hormone levels and uterus size, returns to a non-pregnant state. Less frequently used are the terms puerperium or puerperal period. The World Health Organization (WHO) describes the postnatal period as the most critical and yet the most neglected phase in the lives of mothers and babies; most deaths occur during the postnatal period. In scientific literature, the term is commonly abbreviated to Px, where x is a number; for example, "day P5" should be read as "the fifth day after birth". This is not to be confused with the medical nomenclature that uses G P to stand for number and outcomes of pregnancy (gravidity and parity).
Upon their entry to the air-breathing world, newborns begin to adjust to life outside the uterus.
Postpartum period in mothers
A woman giving birth in a hospital may leave as soon as she is medically stable, which can be as early as a few hours postpartum, though the average for a vaginal birth is one to two days, and the average caesarean section postnatal stay is three to four days. During this time, the mother is monitored for bleeding, bowel and bladder function, and baby care. The infant's health is also monitored.
After the fourth stage of labor the uterus can be palpated at the level of the navel (belly button). The uterus continues to contract and shrink in size so that two weeks postpartum, it again resides in the pelvis. The tissue lining the uterus begins to regenerate and by day seven postpartum the endometrial glands are restored. By day sixteen, the endrometrial lining has been completely restored except at the site of placental attachment. This site within the uterus undergoes changes that include contractions of vascular smooth muscles and myometrium. This encourages hemostasis.
Immediately after delivery, a large amount of red blood flows from the uterus until the contraction phase occurs. Thereafter, the volume of lochia (postpartum vaginal discharge, containing blood, mucus, and uterine tissue) rapidly decreases. The duration of this discharge, known as lochia rubra, is variable. The red discharge progressively changes to brownish red, with a more watery consistency (lochia serosa). Over a period of weeks, the discharge continues to decrease in amount and color and eventually changes to yellow (lochia alba). The period of time the lochia can last varies, although it averages approximately 5 weeks.
The major focus of postpartum care is ensuring that the mother is healthy and capable of taking care of her newborn, equipped with all the information she needs about breastfeeding, reproductive health and contraception, and the imminent life adjustment.[medical citation needed]
During the postpartum period, a woman may urinate out up to nine pounds of water. The extra fluid that her body has taken on is no longer needed, so the mother may note that her fluid output is disproportionate to her fluid input.
In some cases, this adjustment is not made easily, and women may suffer from postpartum depression, posttraumatic stress disorder or even puerperal psychosis. Postpartum mental illness can affect both mothers and fathers, and is not uncommon. Early detection and adequate treatment is required. Approximately 25% – 85% of postpartum women will experience the "blues" for a few days. Between 7% and 17% may experience clinical depression, with a higher risk among those women with a history of clinical depression.
Postpartum psychosis (also known as puerperal psychosis) is a more severe form of mental illness than postpartum depression. Rarely, in 1 in 1,000 cases, women experience a psychotic episode, again with a higher risk among those women with pre-existing mental illness. Despite the widespread myth of hormonal involvement, repeated studies have not linked hormonal changes with postpartum psychological symptoms. Rather, these are symptoms of a pre-existing mental illness, exacerbated by fatigue, changes in schedule and other common parenting stressors.
Historically, European women were confined to their beds or their homes for extensive periods after giving birth; care was provided either by her female relatives (mother or mother-in-law), or by a temporary attendant known as a monthly nurse. These weeks were called confinement or lying-in, as in the names of maternity hospitals such as the General Lying-In Hospital in London. A 1932 publication refers to lying-in as ranging from 2 weeks to 2 months. It also does not suggest "Getting Up" (getting out of bed post-birth) for at least nine days and ideally for 20 days.
Women received congratulatory visits from friends and family during the period and, among the many traditional customs around the world, the desco da parto was a special form of painted tray presented to the mother in Renaissance Florence. The many scenes after childbirth painted on these show female visitors bringing presents, received by the mother in bed, while other women tend to the baby. No fixed term of lying-in is recommended in Renaissance manuals on family life (unlike in some other cultures), but it appears from documentary records that the mother was rarely present at the baptism, in Italian cities usually held within a week of the birth at the local parish church, normally a few minutes walk from any house. The woman was reintroduced to the community in the Christian ceremony of the churching of women.
A modern version of this rest period has evolved, to give maximum support to the new mother, especially if she is recovering from a difficult labour and delivery.
In some East Asian cultures, such as Chinese, South Korean, and Vietnamese, there is a traditional custom of postpartum confinement known in English as doing the month or sitting the month (Mandarin zuò yuèzi 坐月子). Confinement traditionally lasts 30 days. This tradition combines prescribed foods with a number of restrictions on activities considered to be harmful. The new mother is also given special postnatal foods, such as seaweed soup in Korea and "Pork Knuckles and Ginger Stew" in China. It is widely believed in many East Asian societies that this custom helps heal injuries to the perineum, promote the contraction of the uterus, and promote lactation. In Thailand "yu-fai (lie down by a fire) treatment is traditional postpartum healing. Performed in an open area, it involves using smokeless tamarind wood, local herbs and massage.
Most traditional Indians follow the 40-day confinement and recuperation period also known as the 'Jaappa' (in Hindi). A special diet to facilitate milk production and increase hemoglobin levels is followed. Sex is not allowed during this time. In Hindu culture, the puerperium was traditionally considered a period of relative impurity (asaucham) due to the processes of childbirth, and a period of confinement of 10–40 days (known as purudu) was recommended for the mother and the baby. During this period, she was exempted from usual household chores and religious rites. The father was purified by a ritual bath before visiting the mother in confinement. In the event of a stillbirth, the period of impurity for both parents was 24 hours. Many Indian sub cultures have own traditions after birth, birth period is called as Virdi(Marathi) starting from birth till 10 days where complete abstinence from puja or temple visit.
- "Normal and Abnormal Puerperium: Overview, Routine Postpartum Care, Hemorrhage". Medscape. 2017-08-04.
- WHO. "WHO recommendations on postnatal care of the mother and newborn". WHO. Retrieved 22 December 2014.
- "Recovering from a caesarean section". NHS Choices. Retrieved 16 December 2016.
- "With Women, Midwives Experiences: from Shiftwork to Continuity of Care, David Vernon, Australian College of Midwives, Canberra, 2007 ISBN 978-0-9751674-5-8, p17f
- Thom, DH; Rortveit, G (December 2010). "Prevalence of postpartum urinary incontinence: a systematic review". Acta Obstetricia et Gynecologica Scandinavica. 89 (12): 1511–22. doi:10.3109/00016349.2010.526188. PMID 21050146.
- "Postpartum Depression". Canadian Mental Health Association. Retrieved July 9, 2014.
- Dobson, V.; Sales, B. (2000). "The Science of Infanticide and Mental Illness". Psychology, Public Policy and Law. 6 (4): 1098–1112. doi:10.1037/1076-89184.108.40.2068.
- Lying in by Jan Nusche quoting The Bride's Book — A Perpetual Guide for the Montreal Bride, published in 1932
- Jenstad, Janelle Day, Lying-in Like a Countess: The Lisle Letters, the Cecil Family, and A Chaste Maid in Cheapside, Journal of Medieval and Early Modern Studies - Volume 34, Number 2, Spring 2004, pp. 373-403
- "Renaissance childbirth - Victoria and Albert Museum". Vam.ac.uk. Retrieved 2016-09-10.
- "Effect of Alcohol consumption on Maternal lactation characteristics during 'doing-the-month' ritual". Retrieved 2014-02-02.
- "Ayuvedic Postpartum Healing Tips". Ayurveda.iloveindia.com. Retrieved 2014-02-02.
- "Ayurvedic diet for de-stressing postpartum mothers". Thefreelibrary.com. 2001-12-22. Retrieved 2014-02-02.
- Jacobson, Hilary. "Lactogenic Foods and Herbs". Mobimotherhood.org. Retrieved 2014-02-02.
- "Lie down by a fire". Bangkok Post.
- John Marshall / Jaya Tirtha Charan Dasa. "GUIDE TO RITUAL IMPURITY - What to do at the junctions of birth and death". Hknet.org.nz. Retrieved 2014-02-02.