• Clinical science

Postpartum period (Puerperal period)

Summary

The postpartum period refers to the six-to-eight-week period after the birth of a baby in which the body recovers from the changes caused by pregnancy and birth. During this time, the body undergoes several physiological changes, such as uterine involution, discharge of lochia, and the beginning of the lactation process. Women are also susceptible to complications during the postpartum period, such as infection, thrombosis, insufficient postpartum recovery, and postpartum depression. The fundal height measurement and the appearance of lochia (postpartum vaginal discharge) provide important clues to possible underlying conditions.

Normal postpartum changes

Low‑grade fever, shivering, and leukocytosis are common findings during the first 24 hours postpartum and do not necessarily indicate an infection.

Uterine involution

Lochia (postpartum vaginal discharge)

  • Definition
    • The birthing process and placental detachment lead to uterine lesions, which discharge a special secretion when healing.
    • This secretion, together with the cervical mucus and other components, forms the lochia.
  • Most women pass lochia for about 4 weeks after delivery; in some cases, this lasts for 6–8 weeks.
    • Lochia rubra: blood red; approx. the first 4 days after birth
    • Lochia serosa: brown red; watery consistency, lasts approx. 2–3 weeks
    • Lochia alba: yellow white; lasts approx. 1–2 weeks

Time

Fundal height postpartum Lochia
Right after birth Between the navel and symphysis Blood red
After the 1st day Navel Blood red
3rd day 3 fingerbreadths under the navel (descends 1 fingerbreadth per day) Blood red to brown-red
7th day Between the navel and symphysis Brown-red
10th day Symphysis Brown-red
12th–14th day Symphysis Yellowish
17th–21st day Symphysis Yellow-white

Weight loss

References:[1][2][3][4][5]

Infant nutrition and weaning

Breastfeeding [6][7][8]

General considerations

  • It is recommended that infants be exclusively breastfed up to the age of 6 months.
  • On-demand feeds are recommended.
  • Breastfeeding plays an important role in mother-child bonding.

Physiology of lactation

Breast milk composition

Breast milk contains all the required nutrients (except vitamin D and vitamin K) for infants up to 6 months of age.

Mature milk (from the 14th day)

g/100 mL

Cow's milk

g/100 mL

Proteins 1 3.4
Carbohydrates 7 4.6
Fat 3.8 3.7
Calories (kcal) 66 65
Unsaturated fatty acids 1.6 1.3
Salts/minerals 0.2

0.8

Benefits of breastfeeding [7]

Contraindications to breastfeeding [7][10]

Complications and problems

Formula feeds [11][12][13]

  • Supplementation with formula is only recommended if:
    • Neonate loses > 7% of birth weight during the first 10 days of life
    • Neonatal urine output is decreased
    • Neonatal stool output is decreased (< 3 small stools per day)
    • Maternal breast milk production is inadequate
    • Breastfeeding is contraindicated
  • Lactose protein-based formulas should be fortified with iron to satisfy the infant's iron needs.

Supplementation

Weaning [18][19]

  • Solid foods should be slowly initiated in infants between 4–6 months of age, with continued breast/formula feeding.
  • The recommended initial weaning food is rice cereal fortified with iron.
  • One new food should be introduced per week to allow easy identification of food allergies.
  • Pureed meat, green leafy vegetables, and dried beans are good sources of iron and zinc.
  • Honey should not be given to infants because of the risk of botulism.
  • Cow's milk can be introduced into the diet after 1 year of age.

Postpartum complications

Uterine complications

Thromboembolic complications

Psychiatric complications

Other complications

  • Urinary insufficiency
  • Urinary retention
  • Pelvic instability
    • Definition: a rare complication of the postpartum period leading to a loosening of the pelvic ring, causing pain when walking and severe tenderness of the symphysis; the patient has difficulty standing on one leg.
    • Diagnostics: may be confirmed with an ultrasound or pelvic x‑ray.
    • Treatment: analgesics and reduced physical activity for 1–2 weeks

The 7 Ws of postpartum fever: Womb (endometritis), Wind (pneumonia), Water (UTI), Walk (DVT, pulmonary embolism), Wound (incision, episiotomy), Weaning (breast abscess, mastitis), Wonder drugs (drug fever)