Puerperium: what is it, phases, physical and emotional changes

Puerperium, quarantine or protection. Both names refer to the postpartum period, in which the woman recovers from the changes suffered during pregnancy.

Erica Mantelli (CRM-SP 124.315), graduated from the Faculty of Medicine of the University of Santo Amaro, with a specialist title in Gynecology and Obstetrics, postgraduate in Legal Medicine and Medical Expertise and Sexology/Human Sexuality from the University of São Paulo (USP ), explains that the puerperium begins soon after the baby is born and lasts approximately six to eight weeks.

Anyone who thinks that changes during the puerperium are just physical in nature is wrong. Learn more about the characteristics of this period and understand what it means for a woman.

puerperium stages

Erica explains how the phases of the puerperium are classified:

Immediate: occurs shortly after delivery of the placenta and lasts up to 2 hours
Mediate: Occurs from 2 hours to approximately 10 days after delivery
Late: from 10 days to 45 days after delivery
Remote puerperium: 45 days to 60 days after delivery

Throughout the puerperium, the woman’s body undergoes a series of transformations that even affect the emotional aspect. Therefore, the watchful eye and support of the family is very important at all stages of the period.

What happens in a woman’s body?

Erica recalls that it is in the puerperium phase that the woman’s body returns to the previous conditions of pregnancy. “All the organs that have undergone changes to make room for the uterus to grow back to their usual location,” she says.

In this sense, see the main transformations that take place during the puerperium and how they reflect on women’s daily lives.

Uterus

Postpartum, estrogen and progesterone levels drop. With this, the uterus begins to return to its normal size, decreasing about an inch per day.

At this stage, the woman may feel some abdominal discomfort, especially when breastfeeding.

bleeds

As the uterus contracts to return to normal, bleeding, called lochia, occurs. And, especially in the first few days, the flow is intense, with red blood, similar to menstruation. But as the days go by, the flow decreases and the blood becomes clearer.

Column

Erica points out that the spine, which was deviated during pregnancy due to uterine growth, and also to compensate for the woman’s center of gravity, goes back to rectify itself during the puerperium.

It is not by chance that many women end up experiencing back pain in this postpartum period. This is usually intensified due to the mother’s care for the baby (holding on her lap, breastfeeding, bathing, changing diapers, etc.).

tits

In the puerperium, the breasts become fuller and more painful, due to the production of milk. But the good news is that the improvement of symptoms occurs exactly through breastfeeding.

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intimate region

After having the baby, regardless of the type of delivery, it is normal for a woman to notice her vagina more dilated and swollen in the first days postpartum.

Women who have had a normal birth with an episiotomy (a cut between the vagina and anus), in particular, often experience pain and discomfort in this region.

Urinary incontinence

Urinary incontinence can occur, although it is not a rule, that is, that sudden desire to urinate without being able to “hold it”.

This condition can last up to three months, but it can also be controlled with the help of exercises that strengthen the muscles of the perineum.

hemorrhoid

There are chances that a woman will develop hemorrhoids (dilation of the veins in the anus) due to the force exerted during childbirth.

This condition can cause pain and even bleeding, but with the proper treatment indicated by the doctor, it does not offer complications.

Stomach

The abdomen does not “decrease overnight”, it gradually returns to normal. And that can make the skin saggy.

Some women may even have diastasis recti, which happens when the muscles in the abdominal wall are pulled apart.

It is worth remembering that, during the puerperium, breastfeeding is a great ally of the mother. Sucking stimulates the release of oxytocin, a hormone that, among other things, helps women get back into their physical shape after childbirth.

What happens to the emotional?

Erica Mantelli highlights that, in the puerperium, many emotional changes occur, mainly due to hormonal changes. “But it is also at this stage that the woman is discovering herself as a mother, and this generates a complex of emotions”, she explains.

Some changes that can occur in the puerperium, from an emotional point of view, are:

Insecurity, fear of “not realizing it” and sadness

In addition to biological changes, resulting from sudden hormonal changes, the very fact of becoming a mother is marked by radical changes. Both psychologically and socially.

There is, then, a real adaptation of the woman to this new role and a need for “reorganization in the routine”. This is much more evident in “first-time mothers”, but women who have already had children are also not immune to all the changes.

With the birth of the baby, the woman feels a sudden increase in responsibility. After all, she becomes the reference of a helpless person, suffers from sleep deprivation, feels tired, notices physical changes, among many other points. All of this associated usually generates that feeling of “I can’t handle it”.

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Not by chance, most women go through a moment of sadness after childbirth, known as “baby blues”. This period usually lasts up to two weeks after the baby is born.

At this stage, she may have crying spells, tantrums, sleepless nights and many difficulties in adapting to the new routine that a baby requires (baths, breastfeeding, identification of crying, etc.). But, this sadness tends to disappear on its own and does not characterize postpartum depression.

sleep deprivation

Erica points out that sleep deprivation, due to the child waking up several times during the night, makes mothers tired and stressed.

Difficulties with breastfeeding

The gynecologist and obstetrician Erica explains that, in general, the breastfeeding process is difficult, especially at the beginning, and this creates anxiety and concern for the mother.

Frustration and Guilt

“Another important factor is the difference between the idealized baby during pregnancy and the real one, which can generate frustration and difficulty in acceptance”, adds Erica.

Such frustration can also generate a feeling of guilt, as a mother expects to be “flooded by feelings of happiness and satisfaction” at such a special moment (which is the arrival of the baby).

So when she can’t feel it, see “all that unconditional love” that people talk so much about, she usually blames herself for it. She still finds it very difficult to talk about the problems and negative feelings she is facing.

Baby blues

Erica remembers that it is common for women to feel sadness from the third postpartum day until two weeks later; this is called the “baby blues”. “During this period, women have mood swings and end up crying more. However, the problem is when these symptoms become more intense and they end up developing depression”, she explains.

In depression, stresses the gynecologist and obstetrician, the mother feels a deep and permanent sadness. “She has no desire to take care of herself and often ends up neglecting the care of the baby. The woman may also have suicidal thoughts,” she adds.

postpartum psychosis

Postpartum depression can progress to postpartum psychosis. This happens when the woman also starts to present, in addition to deep sadness, a mental confusion, with delusions and visions.

Erica points out that there are several changes that happen in the puerperium. “And, therefore, it is important for the entire medical team to contact the woman and the family, to closely monitor all changes and symptoms, so that nothing more than expected occurs”, she explains.

alleviating the symptoms

But, how to go through the puerperium in the best possible way? Although each woman faces the period in a different way, below you can find some tips that make all the difference:

Prepare yourself: “To alleviate symptoms, especially those linked to emotional changes in the postpartum period, it is important for women to prepare themselves from pregnancy. The obstetrician should talk to the patient throughout the pregnancy about how this period will be and prepare her for possible changes”, explains Erica.
Have a support network: in addition to the doctor, points out Erica, the woman should talk to her family and, above all, create a support network. “That is, having a mother, mother-in-law, aunt, neighbor, friend, someone she can count on so she can have a rest period. The woman should not feel ashamed to ask for help”, she guides.
Rest: Erica explains that, postpartum, the mother is also in recovery, so it is important for her to have time to rest. “Many mothers want to do everything, take care of the baby and the house. The ideal is to plan ahead to get everything organized and make everyday things easier, thus preventing her from having more work and stress in this delicate period”, she highlights.
Exercise: Erica explains that the practice of physical activity and some relaxing activity also serves as prevention and helps against depression.
Have a healthy diet and habits: cherish a balanced diet, don’t go too long without eating and drink plenty of water. Do not smoke and do not consume alcoholic beverages. All this contributes to a more stable emotional picture.
Don’t despair: keep in mind that, no matter how difficult the phase is, it will pass. But don’t hesitate to ask for help and talk about your feelings.

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Please remember that medical follow-up is essential both during pregnancy and postpartum.

Postpartum medical consultations

Erica explains that, in the post-pregnancy phase, it is recommended that the woman return to the obstetrician about 7 to 10 days after the birth of the baby, so that the professional can make an assessment, regardless of the type of delivery she underwent.

“In this evaluation, the doctor will guide, will check how the bleeding is, the uterus… And this is also an excellent opportunity to evaluate the emotional aspects. That mother who has been showing some sign of marked melancholy, for example, is already a warning sign for the doctor”, adds the gynecologist and obstetrician.