Puerperium: what it is, care and what changes in a woman’s body

The puerperium is the postpartum period that spans from the day of birth to the return of a woman’s menstruation, after pregnancy, which can take up to 45 days, depending on how breastfeeding is done.

The puerperium is divided into three stages:

• Immediate puerperium: from the 1st to the 10th postpartum day;
• late puerperium :dthe 11th to the 42nd postpartum day;
• Remote puerperium: from the 43rd day postpartum.

During the puerperium, women go through many hormonal, physical and emotional changes. During this period, it is normal for a type of “menstruation” to appear, which is actually a normal bleeding caused by childbirth, called lochia, which starts abundantly, but gradually decreases. Understand better what lochia are and what care is important.

What changes in a woman’s body

During the puerperium period, the body undergoes many other changes, not only because the woman is no longer pregnant, but also because she needs to breastfeed the baby. Some of the most important changes include:

1. Tougher breasts

The breasts, which during pregnancy were more malleable and without any discomfort, are usually harder because they are full of milk. If the woman cannot breastfeed, the doctor may recommend a medicine to dry the milk, and the baby will need to take infant formula, as indicated by the pediatrician.

What to do: To relieve the discomfort of a full breast, you can put a warm compress on the breasts and breastfeed every 3 hours or whenever the baby wants. Check out a complete guide to breastfeeding for beginners.

2. Swollen belly

The abdomen still remains swollen because the uterus is not yet at its normal size, which shrinks every day, and becomes quite flaccid. Some women may still have a pullout of the abdominal wall muscles, a condition called abdominal diastasis, which must be corrected with some exercises. Understand better what abdominal diastasis is and how to treat it.

What to do: Breastfeeding and using the abdominal belt help the uterus return to its normal size, and doing the correct abdominal exercises helps to strengthen the abdomen, fighting belly flaccidity. See some exercises to do after childbirth and strengthen the abdomen, in this video:

3. Appearance of vaginal bleeding

The secretions from the uterus come out little by little, and that is why there is bleeding similar to menstruation called lochia, which is more intense in the first few days but decreases every day, until it disappears completely.

What to do: It is recommended to use a sanitary pad of larger size and greater absorption capacity, and always observe the odor and color of the blood, to quickly identify the signs of infection such as: bad smell and bright red color for more than 4 days. If these symptoms are present, see a doctor as soon as possible.

4. Colic

When breastfeeding, it is normal for a woman to experience cramps or some abdominal discomfort due to contractions that make the uterus return to its normal size and which are often stimulated by the breastfeeding process. The uterus shrinks by about 1 cm per day, so this discomfort should not last more than 20 days.

What to do: Placing a warm compress on the abdomen can bring more comfort while a woman is breastfeeding. If it’s bothering you a lot, the woman can take the baby off the breast for a few minutes and then resume breastfeeding when the discomfort eases a little.

5. Discomfort in the intimate region

This type of discomfort is more common in women who have had a normal birth with an episiotomy, which was closed with stitches. But every woman who has had a normal birth can have changes in her vagina, which is also more dilated and swollen in the first few days after giving birth.

What to do: wash the area with soap and water up to 3 times a day, but do not use a sitz bath before 1 month. Normally the area heals quickly and within 2 weeks the discomfort should disappear completely.

6. Urinary incontinence

Incontinence is a relatively normal postpartum complication, especially if the woman had a vaginal delivery, but it can also happen in cases of cesarean section. Incontinence can be felt as a sudden urge to urinate, which is difficult to control, with urine leaking into your underwear.

What to do: Doing Kegel exercises is an excellent way to control your urine normally. See how these exercises against urinary incontinence are performed.

7. Return of menstruation

The return of menstruation depends on whether the woman breastfeeds or not. When breastfeeding exclusively, menstruation tends to return in approximately 6 months, but it is always recommended to use extra contraceptive methods to avoid becoming pregnant during this period. If the woman does not breastfeed, menstruation returns in approximately 1 or 2 months.

What to do: check that postpartum bleeding looks normal and start using birth control when your doctor or nurse tells you to. The day when menstruation returns should be noted to inform the doctor at the next appointment. Know when to be concerned about Postpartum Bleeding.

Necessary care during the puerperium

In the immediate postpartum period, it is important to get up and walk in the first hours after delivery to:

• Decrease the risk of thrombosis;
• Improve intestinal transit;
• Contribute to women’s well-being.

Also, a woman should have an appointment with her obstetrician or gynecologist at 6 or 8 weeks postpartum to check that the uterus is healing properly and there is no infection.