Recovery after birth

After the birth of the placenta, pregnancy hormone levels begin to drop and the uterus begins to retract as the muscle fibers undergo atrophy. Muscle contractions of the uterus cause it to decrease in size also- these contractions increase during breastfeeding when oxytocin secretion increases. The fall in hormone levels is also the first step in the induction of lactation. 

The height of the uterus decreases by about 1 centimetre per day for the first 4-5 days and then by 5mm over the next 10 days. It is usually not palpable by 2 weeks postpartum. Have you seen the postpartum uterine fundus being checked on your postnatal rounds with your teams?

Blood loss also decreases after birth. The vaginal loss after delivery is called "lochia" and it is made up of erythrocytes, leucocytes, remnants of decidua, and fibrin. In the first 4-5 days it is red in colour and looks like blood. Then it turns pink and then it becomes serous in appearance. If this does not occur and a woman continues to bleed fresh red lochia, we need to consider whether there may be a problem such as infection or retained products. 

The puerperium is also the crucial time for mothers to bond with their babies. We encourage a policy of "skin-to-skin" time as soon as possible after the birth of a baby, regardless of the mode of birth, as this is beneficial for mothers and babies. Babies have a smoother transition from fetal to newborn life, cry less, and have better stability of blood sugars, breathing, and temperature regulation. Mothers breastfeed for longer durations and are more confident to care for their babies. This bonding time is supported by health professionals both in hospital and at home. 

As the body returns to the non-pregnant state, it is important to look out for complications that may occur. Regular postnatal assessments are important, and include aspects of history and examination to ensure things are going smoothly. 

Pelvic floor exercises are also recommended for postpartum women to aid in recovery of continence and strengthen muscles that may have been weakened by childbirth. 

Women will usually remain in a postnatal facility (hosptial or primary unit) for 1-3 days after an uncomplicated vaginal birth and 3-5 days after an uncomplicated Caesarean section. Longer stays may be needed if there are complications. After discharge home, a postnatal midwive will visit within 24-48 hours of birth and then 5-6 times over the first four weeks after birth. 

At 6 weeks postpartum, a "six week check" is recommended with the GP to ensure they have recovered well from birth and are settling in to motherhood. This is often scheduled at the same time as the 6 week baby check and 6 week vaccinations.