Physiology
- The puerperium is the 6-week period after delivery when the reproductive tract returns to its non-pregnant state.
- Immediately after delivery, the uterus shrinks down to the level of the umbilicus. By 2 weeks postpartum, it is no longer palpable above the symphysis. By 6 weeks, the uterus has returned to its non-pregnant size.
- Decidual sloughing after delivery results in a physiologic vaginal discharge, known as lochia.
- The abdomen will resume its pre-pregnancy appearance, with the notable exception of abdominal striae (“stretch marks”). These fade with time.
- Most women will experience the return of menstruation by 6–8 weeks postpartum.
Postpartum care
- In the immediate postpartum period, maternal vital signs should be taken frequently, the uterine fundus should be palpated to ensure it is well contracted, and the amount of vaginal bleeding should be noted.
- Early ambulation is encouraged regardless of route of delivery. Adequate pain management is essential.
- Shortly after birth, neonates should receive topical ophthalmic prophylaxis (to prevent ophthalmia neonatorum) and vitamin K (to prevent hemorrhagic disease of the newborn due to a physiologic deficiency of vitamin K-dependent coagulation factors).
- Prior to discharge, skilled nursing staff should be made available to prepare the mother for care of the newborn. The mother should receive anti-D immunoglobulin (if she is rhesus [Rh] negative and her baby Rh positive) and MMR (measles, mumps, rubella) vaccine (if she is rubella non-immune).
- Coitus can be resumed 2–3 weeks after delivery depending on the patient’s desire and comfort. Contraception is necessary to prevent conception.
- A routine visit is recommended 6 weeks postpartum. Contraceptive counseling and breastfeeding should be addressed.
