Postpartum Physiological Changes: Details Discussion
Definition of Postpartum Period:
The postpartum period is usually considered the interval extending from the birth of the baby until 6 weeks after. It is the 6 weeks interval between the birth of the newborn and the rectum of the reproductive organs to their normal non-pregnant state.
Postpartum Physiological Changes During Postpartum Period:
1. Reproductive system:
- Involution occurs during postpartum wherein the reproductive organs return to their non-pregnant state.
- The area where the placenta was implanted is sealed off to avoid bleeding.
- The uterus returns to its pre-pregnant size.
- Involution occurs more quickly in women who are well nourished and ambulate early after birth.
- Contraction plays a very important role in the postpartum period for it allows the uterus to return to its former size quickly and also prevents hemorrhage.
- The cervix is soft and malleable immediately after birth, but once contraction of the cervix takes place it also returns to its pre-pregnant state.
- The vagina returns to its pre-pregnant state through contractions after the entire postpartum period but remains slightly distended than before.
- Kegel’s exercise helps return the strength and muscle tone of the vagina.
- The labia minora and majora are still atrophic and soft after birth and would never return to its pre-pregnant state.
- The perineum is edematous and tender immediately after birth.
2. Musculoskeletal system:
Musculoskeletal changes include lower-back pain, leg cramps, and hip pain.
3. Cardiovascular system:
- Blood volume increases by about 50% at the time of delivery. There is an average 500-mL blood loss at vaginal delivery, and a gradual replacement of this with an “auto transfusion'” of 500-750 mL as the uterus contracts.
- Significant changes in every cardiac function parameter: mean arterial pressure, cardiac output, stroke volume, and systemic vascular resistance are all affected.
- Most of the hemodynamic recovery occurs in the first 2 weeks postpartum, with more gradual shifts continuing over the next 4 or 5 months.
4. Vital signs:
- Pulse: Pulse rate is slightly lower than normal, 60-70bpm. By the end of the first week pulse rate will return to normal. Rapid and thready pulse is a sign of hemorrhage.
- Temperature oral or axillary a slightly elevated temperature less than 100.4 degrees is normal. If temperature rises above 100.4 she is considered febrile. If elevated temperature lasts be thinking infection.
- Blood Pressure: Compare pressure to pre-pregnancy pressure. A drop in pressure can indicate bleeding. Elevation above 140 mm Hg systolic or 90 mm Hg diastolic may indicate post-partal pregnancy-induced hypertension.
5. Urinary system:
- Immediately after birth, dieresis sets in to rid the body the excess fluid that has accumulated during pregnancy.
- On the second to fifth day after birth, the urinary output of the woman increases to as much as 3000 mL per day.
- The woman’s abdomen must be assessed frequently during the postpartum period to prevent damage to the bladder due to over distention.
- Urine may contain more nitrogen postpartum because of the increased activity of the woman during labor.
- Lactose levels may be slightly elevated to prepare the body for breastfeeding.
6. Gastrointestinal system:
- The woman will feel hungry and thirsty almost immediately after giving birth,
- Digestion and absorption are active again after birth except for women who underwent a caesarean section.
- Passage of stool may still be slow because of the relaxin that is still present in the bowels.
- Bowel evacuation may still be difficult because of the pain of episiotomy.
7. Nervous system:
Significant nervous system takes place during postpartum period.
8. Integumentary system:
If tearing or episiotomy occurred, sutures may be present. Be alert for any bleeding Tom suture site (do not confuse with lochia), any unusual drainage, odor, separation of skin at injured site, or pressure in that area.
9. Endocrine system:
- As soon as the placenta is no longer present. Pregnancy hormones start to decrease.
- hPL and hCG are insignificant by 24 hours.
- Progestin, estrone, and estradiol return to their pre-pregnancy levels a week after birth.
- FSH remains low for 12 days and then starts to increase to signal the start of a new menstrual cycle.
10. Breast changes:
- Between the third and fourth days after delivery, breasts begin to fill with milk. This can cause breast discomfort and swelling (engorgement).
- During the first days of breastfeeding, nipples will probably become tender or sore. But as breastfeeding becomes more established, the soreness usually goes away.
11. Circulatory System:
- Blood volume returns to its pre-pregnancy level by the first or second week of birth.
- A 4-point decrease in hematocrit and a 1-g decrease in hemoglobin occur with each 250 mL blood loss.
- Hematocrit levels reach its normal pre-pregnancy level 6 weeks after birth.
- An increase in leukocytes and plasma fibrinogen occurs in the first postpartum weeks as a defense mechanism against infection and hemorrhage.
Maria Khatun Mona is a Founder and Editor of Nursing Exercise Blog. She is a Nursing and Midwifery Expert. Currently she is working as a Registered Nurse at Evercare Hospital, Dhaka, Bangladesh. She has great passion in writing different articles on Nursing and Midwifery. Mail her at “[email protected]”