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The puerperium is the postpartum period that covers from the day of birth until the return of the 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 day of postpartum;
- Late puerperium: from the 11th to the 42nd day of postpartum;
- Remote puerperium: from the 43rd day postpartum.
During the puerperium the woman goes 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. Better understand what lochia are and what are the important precautions.
What changes in the woman's body
During the puerperium period, the body goes through 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. Tighter breasts
The breasts, which during pregnancy were more malleable and without any discomfort, usually become stiffer because they are full of milk. If the woman is unable to breastfeed, the doctor may indicate a medicine to dry the milk, and the baby will need to take infant formula, with the indication of 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 breastfeeding guide for beginners.
2. Swollen belly
The abdomen still remains swollen due to the uterus not yet being in its normal size, which decreases every day, and is quite flaccid. Some women may also experience a withdrawal of the abdominal wall muscles, a condition called abdominal diastasis, which must be corrected with some exercise. Understand better what is abdominal diastasis and how to treat it.
What to do: breastfeeding and using the abdominal belt help the uterus to 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 gradually come out, which is why there is bleeding similar to menstruation, which is called lochia, which is more intense in the first days but which decreases every day, until it disappears completely.
What to do: it is recommended to use an intimate absorbent of larger size and greater absorption capacity, and always observe the odor and the 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, you should go to the doctor as soon as possible.
4. Colic
When breastfeeding it is normal for women to experience cramping or some abdominal discomfort due to contractions that return the uterus 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 the woman breastfeeds. If it is very uncomfortable the woman can take the baby out of 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 had a normal delivery with an episiotomy, which was closed with stitches. But every woman who has had a normal birth can have changes in the vagina, which also becomes 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 bathe before 1 month. Usually the area heals quickly and in 2 weeks the discomfort should disappear completely.
6. Urinary incontinence
Incontinence is a relatively normal complication in the postpartum period, especially if the woman has had a normal 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 leakage of urine in the panties.
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 from 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 if the bleeding after delivery is looking normal and start using contraception when the doctor or nurse tells you to. The day on which menstruation returns should be noted to indicate to the doctor at the next appointment. Know when to worry 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 birth to:
- Decrease the risk of thrombosis;
- Improve intestinal transit;
- Contribute to the well-being of women.
In addition, the woman should have an appointment with the obstetrician or gynecologist at 6 or 8 weeks after delivery, to check that the uterus is healing properly and that there is no infection.