What is puerperium?
Puerperium is the name given to the postpartum period, also known as quarantine or guard, which lasts around 5 to 6 weeks. It starts right after the baby is born and ends when the woman begins to ovulate again.
The new mother undergoes hormonal, physical and emotional changes. These changes are involuntary and cause serious imbalances in your mood, making you more sensitive and vulnerable.
In the past, I had the idea that mood disorders were part of the female characteristics, leaving the problem undiagnosed and without proper treatment. As a result, the disorder resolved itself or progressed to chronic.
Directly influenced by breastfeeding, the puerperium is divided into three phases:
From the 1st to the 10th postpartum day. It begins shortly after the delivery of the placenta. In the first hour, the uterus continues to contract and vital signs stabilize. Also, in the early hours, it is crucial that the new mom gets up and walks after giving birth. This prevents the appearance of thrombosis , benefits the intestinal flow and contributes to your well-being.
The woman remains under continuous observation during her initial rehabilitation. It is at this time that she tends to have more intense sensations and a major hormonal change.
From the 11th to the 42nd day of postpartum. The female body is still undergoing changes and care must be greater. Both the uterus and the genital region are still undergoing changes to return to their natural state.
From the 43rd day postpartum. Even after the mother starts to breastfeed, she has changes in her body. In the puerperal period, women do not ovulate. However, after the fortieth day, she will be able to reproduce again, and the use of contraceptive methods is recommended if she wishes to prevent a new pregnancy.
The drop in hormone levels is one of the main factors in the transformation of the female body after the birth of the child. Because of this, the woman may feel more fatigued and dejected during this period.
Unlike the gestational period, in which the breasts are more flexible and do not present discomfort, in the puerperal state they are fuller, hotter and more painful due to milk production. The appearance of milk appears between 24 to 72 hours after delivery. The relief of symptoms occurs through breastfeeding.
The abdomen is swollen and its normal size gradually returns, which causes the skin to become flabby. Women over 35 and who give birth to a baby over 4 kg or twins, may have their abdominal wall muscles separated, known as abdominal diastasis.
Involution of the uterus
Right after the placenta is eliminated, uterine contractions continue so that the uterus remains rigid and returns to its normal size, a procedure that lasts an average of 10 days.
It is normal for women to experience colic or abdominal discomfort while breastfeeding. This happens by sucking the baby, which encourages the production of oxytocin, a hormone responsible for promoting uterine muscle contractions. The uterus shrinks approximately 1 cm a day, and colic ceases within 20 days.
Women who have had a normal delivery with an episiotomy (cutting the muscle region between the vagina and anus to help remove the baby) experience pain and discomfort in the region where the incision was made. However, any woman who has a child undergoes changes in her vagina, as it tends to become more dilated and swollen in the first days after delivery.
Similar to menstruation, lochia is a vaginal discharge formed by uterine and vaginal secretions, blood and lining of the uterus. Its duration is about 15 days, and can extend up to 3 months after delivery.
The discharge is more intense in the first 2 to 4 days, blood-colored, and decreases, becoming more pink until it becomes whitish or yellowish after 10 days.
It is the sudden desire to urinate, without being able to completely control the pee, and may pass in the panties. Loss of control is common in women who have had a normal delivery, but it can also appear in those who have had cesarean sections.
This situation lasts about 3 months and can be solved through exercises that tone the muscles of the perineum (region where the genitals and anus are located) or physical therapy.
Hemorrhoids are dilated veins in the anus, which can be internal or external. They cause pain and in some cases even bleeding. They appear during pregnancy or originate from the force exerted during childbirth.
Scar of cesarean section
50% of deliveries in Brazil are cesarean sections – a cut in the woman’s abdomen and uterus to remove the baby, due to complications during pregnancy or with the newborn. The stitches are removed in 8 days and the uterine incision heals in about 6 weeks.
The return of menstruation is subject to breastfeeding. When the woman stimulates milk production, the menstrual cycle returns around 6 months. If she does not breastfeed, menstruation resurfaces within 1 to 2 months.
During guard, sex should be restricted, but not necessarily avoided. Sexual life can be resumed from the first month after delivery with the approval of the obstetrician. However, in this time frame, the woman is not yet ovulating, causing a lack of libido and being subject to infections.
Most mothers go through a period of sadness after childbirth, an episode known as the baby blues , which affects 15 out of every 100 women. This phase lasts approximately two weeks and disappears on its own. The new mom goes through mood swings, crying attacks, anxiety and sleepless nights.
The most common difficulties encountered by women in transition to the maternal role are bathing, caution with the umbilical stump, breastfeeding, identification of crying, type of delivery and physical frailty.
In addition, during quarantine, the mother undergoes hormonal changes, as mentioned above, making her more sensitive and sentimental.
Postpartum female depression
The arrival of a child is a cause for celebration, but along with it comes responsibilities and changes in routine. Breastfeeding at any time of the day, sleepless nights and apprehension in relation to other children are frequent concerns. However, some women may experience symptoms more intensely and develop postpartum depression .
The mother may feel insecure about the necessary care for the baby and herself at this early stage. Experts are unaware of the exact reason that triggers the disease, but believe that it is the set of hormonal, environmental, psychological and genetic factors.
Without proper treatment, depression can persist for months or even years. The extreme disorder can lead to postpartum psychosis . Therefore, it is essential that the partner and family members are attentive and prepared to help her.
Generally, postpartum psychosis or puerperal psychosis affects women around 2 to 3 weeks after the baby is born. It has all the symptoms of postpartum depression and can progress from this disease. What differs them is that the woman presents, in psychosis, mental confusion, delusions and visions. The number of suicides among women with psychotic disorders is high, as well as the risk of infanticide.
Male postpartum depression
The disease is not exclusively female: one in ten parents has postpartum depression. The challenges of a new lifestyle and of seeing the family grow contribute to the emergence of stress and anxiety.
Questions such as how to be a good father, how to educate the child and the reciprocity of affection lead men to lose the disposition, appetite, pleasure and joy of the new “function”. The chances of developing the disease increase in the baby’s first year and in first-time parents.
To avoid stress or relieve symptoms, here are some instructions for new moms:
Young women or women over the age of 35, recurrent abortions and those with chronic diseases are more likely to have a risky pregnancy, favoring the onset of stress.
Having a balanced diet, drinking plenty of water, performing regular and mild physical activity, not smoking, not consuming alcoholic beverages and not using drugs contributes to a more stable emotional.
Have affective ties
Having emotional ties with family and friends is very important, especially if the pregnancy has not been scheduled or is unwanted. Receiving support and assistance at this time makes the stress lessen.
The bond with the baby should be made while the baby is in the belly. Talk to him, pet him, massage the extremities. If you have other children, try to approach them during pregnancy, as jealousy can become a future problem.
First-time mothers are anxious about the new responsibilities. The key is to follow your instincts and look for information, whether with other mothers, family members, books or specialized websites, about the care needed after the baby is born and changes in the body.
Keep your accounts up to date
Having debts greatly increases stress. Therefore, getting organized and leaving the accounts in days is essential. In addition, saving and having a reserve in case of emergencies will prevent possible inconvenience.
After the baby is born, it is essential that the woman monitor her health with her obstetrician. If the delivery was normal, the first visit should be made between 4 to 6 weeks after giving birth. In the case of cesarean section, the consultation should take place between 8 to 10 weeks after hospital discharge.
The doctor will analyze the physical condition of the mother, breastfeeding and vaginal bleeding, examine the healing and removal of the stitches, in addition to being able to remove possible doubts regarding the puerperal state.
Treatment will depend on the degree of severity the patient is in. Techniques such as psychotropic drugs, psychotherapy, hormonal treatments and electroconvulsive therapy can be used.
Use of medications such as antidepressants, antipsychotics and mood stabilizers.
In this treatment, the psychologist will accompany the patient along with her family members with the intention of seeking an emotional balance in this new reality.
One of the approaches that can be used is cognitive-behavioral therapy, which analyzes and modifies the thoughts and emotions that the person has about himself in a distorted way and that are the cause of his dysfunctional behavioral reactions, restructuring these perceptions.
Psychotherapy can also help to discontinue or reduce the dose of pharmaceutical treatment, reducing the threat of a relapse or the symptoms of postpartum depression. However, in more severe or recurrent cases, it is not recommended to stop pharmacotherapy.
Estrogen-based drugs (hormone responsible for controlling ovulation and the development of female characteristics) can be prescribed sublingually and transdermally (applied to the skin). The treatment balances the amount of hormone, which reduces mood swings and consequently helps in the woman’s psychic disorders.
Electroconvulsive therapy (ECT)
Women with some types of depression, suicidal thoughts or psychotic outbreaks may need to be hospitalized. Electroconvulsive therapy is used when the patient does not respond to the medication or when it exceeds the side effects of the medication.
The treatment has nothing to do with the electroshock applied in the past for torture purposes. Self-limited brain cadence shots are made, which makes neurotransmitters (responsible for disseminating nerve impulses in the brain and preserving well-being) stable.
The patient receives anesthesia, muscle relaxant and oxygenation, in addition to being checked by cardiac, brain and blood pressure monitors.
The drugs commonly used in the treatment are:
- Citalopram bromide ;
- Carbamazepine ;
- Clonazepam (Rivotril).
- Cloridrato de Amitriptilina;
- Fluoxetine Hydrochloride ( Prozac );
- Nortriptyline Hydrochloride ( Pamelor );
- Sertraline Hydrochloride ( Zoloft , Tolrest );
- Risperidone .
NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained in this website is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.
In the puerperium phase, the woman must adopt some measures to assist in her recovery. Are they:
- Have a good diet. Eat vegetables, fruits and vegetables, as well as foods that contain iron and calcium, such as red meat, milk and its derivatives. Another tip is to drink a lot of water, as it contributes to maternal intestinal function and milk production;
- Do not take weight or practice intense physical activity for 45 days. In the case of cesarean section, the time must be up to 3 months;
- Do not drive in the first month, as it may hinder the healing of the perineum, if it is a normal delivery, and the abdominal seam if it is a cesarean;
- Maintain good personal hygiene. If there was an episiotomy or a caesarean section, the area should be kept clean by washing with soap during the bath and drying it well.
Shaving, climbing stairs and using tampon in this period have no contraindications.
The discomfort is due to the appearance of puerperal mastitis, inflammation of the mammary glands during the puerperal phase, caused by the sucking of the baby when nibbling and moisture on the outside of the breasts, which facilitates the appearance of cracks in the nipples.
In puerperal mastitis, the woman feels pain, swelling and increased temperature in the inflamed breast. The doctor must be contacted and indicate the best treatment, and antibiotics may be prescribed in case of infection, or healing ointments. During the healing period, direct breastfeeding should be avoided.
In 10% of the occurrences, puerperal mastitis develops into a breast abscess , which is a collection of pus formed in the breast. In these cases, breastfeeding should be stopped.
Such problems can be avoided by following some recommendations:
- The baby needs to suck properly at the time of breastfeeding and deplete breast milk;
- Wear comfortable but supportive bras, avoiding those with a half-cup with a ferrule;
- Too much rest;
- Have a good diet.
Hemorrhages are frequent in the puerperium and arise from both normal and cesarean delivery. They occur during the first hours after delivery and are usually external, due to rupture in the birth canal or uterus, containment of fragments of the placenta, sparse uterine contraction or changes in blood clotting.
In specific cases, internal bleeding can occur, caused by the rupture of a blood vessel generated by the force made by the baby’s head when crossing the birth canal. The blood is concentrated below the superficial tissues, causing pain in the area and hematoma.
Unusually, hemorrhages also originate in the developed puerperium, caused by remains of the placenta not removed from the uterus, due to a failure in detection at the end of delivery.
Normally, the bleeding will go away on its own within a few days, but the woman can undergo medical treatment as symptoms show.
It is the second most common complication in the puerperal period. However, occurrences have drastically reduced due to the procedures used in childbirth to prevent the entry of disease-causing germs into the body, techniques dominated by asepsis.
Infections arise in circumstances such as rupture of the bag, extensive labor or during cesarean section. Fever above 38 ° C, chills and sweat are indicators of infection.
The problem is seen in the first hours of delivery, therefore, the patient is treated at the hospital. However, if the woman identifies the symptoms at home, she should contact the doctor immediately.
The puerperium is a phase that all women who have given birth are subject to. They are not just feminine traits, the symptoms must be evaluated and treated.
So, new mother, stay tuned and share this information with family and friends!