What Happens to the Body After Childbirth

After the delivery, the third stage of childbirth begins, and lasts until the placenta is expelled. Excess bleeding at this stage may endanger the mother’s life. The mechanism responsible for the expulsion of the placenta is the same as that for the fetus: contraction of the uterus causes the placenta to detach from the uterine wall. Once the placenta detaches, all the blood vessels that provided it blood remain open and contraction of the uterus is required again to close those vessels and prevent massive bleeding and blood loss.

Excess bleeding in the first 24 hours after childbirth is defined as early postpartum hemorrhage and is one of the main causes of death in women after childbirth in the developing world. The frequency of the phenomenon ranges from 1.2% to 12.5% in different populations. In Israel, the frequency is approximately 0.4%. In undeveloped countries, the death rate may reach 33% for women with postpartum hemorrhage, while in developed countries the rate 13.4% of the mothers with excessive postpartum hemorrhage.

The main cause of bleeding in 80% of cases is failure of the uterus to contract (known as atonia). It may happen after a very lengthy birth or multiple birth, after delivering a high weight fetus and in other circumstances. Additional causes of postpartum hemorrhage are: damage to the birth canal (tears of the uterine cervix, of the uterus itself, or of the vagina), placenta related disorders (such as placenta accreta, improper placental detachment of retained placenta) or blood coagulability disorders.

Risk factors for postpartum hemorrhage:

• Benign tumors in the uterus.
• Postpartum hemorrhage, in a previous delivery.
• Previous operation on the uterus.
• In vitro fertilization.
• Anemia during pregnancy.
• Hypertension during pregnancy.
• Gestational diabetes.
• Polyhydramnios.
• Multiple birth.
• Macrosomia (large newborn).
• Premature childbirth.
• Fever at childbirth.
• Induced labor.
• Vacuum delivery.
• Overweight.
• Mother's age over 35.
• Retained placenta.

However, in most cases of postpartum hemorrhage, the mother has no risk factor, meaning that it may occur in any mother even without risk factors.

Today, most cases of bleeding may be prevented, and most medical centers in the country follow the guidance of the World Health Organization in relation to the third stage of childbirth. In other words, they perform delayed umbilical detachment, administer oxytocin by infusion and promote the extraction of the placenta by uterine massage and with the midwife’s assistance. Some expectant women object to these procedures, and some believe that breastfeeding provides the oxytocin required to prevent hemorrhage. Medically speaking, breastfeeding and nipple stimulation do cause some oxytocin secretion in the body, and help the contraction of the uterus, but do not constitute an alternative to administering oxytocin to prevent the complication of postpartum hemorrhage.

At the end of the pregnancy, you may feel heavy and slow. The uterus has a certain effect on the feeling of heaviness, given that it weighs about a kilogram by the end of pregnancy (for comparison: the uterus weighs just 50 grams or so before pregnancy).

Immediately after the placenta is expelled, the midwife will monitor the contraction of the uterus and the mother herself can feel how the uterus descends to a spot below her umbilicus (navel). Within two weeks, the uterus will usually go back to its normal location inside the pelvis. After 6 weeks, the uterus also returns to its previous size, as was before pregnancy.

The first days of the postpartum period

The area that contained the placenta fills with white blood cells as an inflammatory response, which protects the body from invasion by pathogens (agents that cause diseases).

Immediately after childbirth, there is a bloody discharge that quickly turns brown. The professional name for these discharges is lochia. The discharge will continue to appear for 3 to 4 days after childbirth and sometimes longer.

The first month of the postpartum period

The discharges that you see after childbirth will later become lighter in color than their initial brown. These discharges will have an unpleasant odor. Their name varies: from 22 to 27 days after childbirth, they are known as lochia serosa, and 10 to 15 percent of women will experience them for up to 6 weeks after childbirth. In other women, the discharges will become yellow-white and are known as lochia alba.

How are the discharges treated? There is no need for any special treatment. Most women can cope fine with dressings or pads. It is important to make sure to change the pad frequently, to maintain your hygiene. And what about tampons? It is worth waiting with them because using tampons immediately after birth may increase the risk of infection and interfere with the natural recovery process, particularly in case there are tears in the perineum or sutures in the vagina. It is important to know that in any case, breastfeeding does not affect these discharges.

For 70% of women who are not breastfeeding, menstruation will resume within 12 weeks of childbirth. On average, menstruation is restored 7-9 weeks after childbirth. For women who breastfeed, in contrast, ovulation will be inhibited and menstruation will occur on average after 6 months. For some women, menstruation will only occur after 36 months (three years) after birth. Maybe you already want to know when menstruation will resume? But it cannot always be known. There are a number of factors that affect the phenomenon, such as the time for which you have been breastfeeding, the length of breastfeeding sessions, nutrition and more.

Does breastfeeding prevent conception? No, it does not. Unlike common popular belief, you cannot depend on breastfeeding as a reliable birth control method. A woman who feeds her baby by breastfeeding alone (without infant formula supplementation) can experience ovulation in the first six months after birth. The odds of this happening may be low, at 1-5%, but they exist nonetheless. If you are not interested in another pregnancy, use contraceptive methods. It is advised to ask a physician what birth control means suit you.

During pregnancy, your breasts develop and reach the stage in which they secret the initial milk, known as colostrum. After the placenta is expelled, progesterone levels drop and the second stage of milk formation occurs, lasting 2-4 days after delivery. During this time, after childbirth, milk fills the breasts, which become congested and full of milk. To prevent side effects such as pain and excessive congestion, it is advised to breastfeed the baby often.

Read more about breastfeeding

The newborn, the placenta, blood and amniotic fluid together weigh about 4.5-5.5 kg. Usually, you will not be able to see weight loss immediately because in the first few days after birth there is still accumulation of fluids that occurs for several reasons, the main ones being the stress of childbirth, which causes hormonal change. The use of epidural anesthesia, with concomitant fluid administration, also contributes to edema. You should know that this is not a worrisome phenomenon and is indeed transient. The edema should resolve after about two weeks (the excess fluid is excreted in the urine), but it varies from one woman to the next.

Weight loss after pregnancy is also gradual and only 28% of women return to their pre-pregnancy weight, 6 weeks after birth. Later, for about 6 months after childbirth, weight gradually decreases to the one at which you became pregnant.

You should know that women who gain more than 15 kg during pregnancy may remain with an excess of about 5 kg. The common belief that breastfeeding causes weight loss is wrong: breastfeeding has no particular effect on weight loss during the postpartum period or later. Studies show that women who return to their pre-pregnancy weight are at lower risk for being overweight in the ensuing 5-10 years. The postpartum period is an important one for establishing healthy habits for the mother and the newborn, particularly given the fact that today it is known that excess weight is a disease and children are at risk of being overweight if their parents are overweight.

During pregnancy, the thyroid gland functions at a higher level than before (approximately 30% more). If your physical condition is normal, for 12 weeks after childbirth, your thyroid gland functioning will return to the levels preceding childbirth. Today it is known that women in the postpartum period are at greater risk of excess autoimmune activity of the thyroid gland, which may become a chronic disease called postpartum thyroiditis (PPT), which occurs in 2-17% of women. Excess frequency of thyroid dysfunction will resolve up to a year from childbirth.

If you take medication for the thyroid: it is advised that you ask your family physician for a referral for thyroid hormone level testing in the 6 weeks after childbirth and continue treatment for a year, and only then repeat the test and assess the need for further care.

Women with type 1 gestational diabetes are at increased risk of disease: the risk stands at 25%. 5%-30% of women who contract the disease will develop hypothyroidism later in life. The recommendation for treatment is only for women with clinical symptoms.

Immediately after childbirth, you may experience slower hair growth, which will last 3 months on average. Slower hair growth is a well-known phenomenon after childbirth, which results in hair loss and is called telogen effluvium. New mothers sometimes refer to it as postnatal hair loss. If the appearance of lots of hair on your brush bothers you, it is completely natural, but it is important for you to know that usually there is no reason for concern and your hair growth will go back to normal in a few months.

If there were no birth complications, you can resume all physical activity, including moderate weightlifting, cycling, running and more, almost immediately. Physical activity does not adversely affect breastfeeding. On the contrary, physical exercise should help relieve stress and anxiety and reduce the risk of postpartum depression. However, you should remember that this period often involves a feeling of fatigue, so you should adapt the activities to your physical condition: shorter activities of lower intensity. It is worth choosing exercises that strengthen core muscles and the pelvic floor concurrently.

When the state of the perineum and decrease in bleeding permit it, you can resume sexual activity. On average, women can resume sexual activity 6-7 weeks after childbirth, but it is important to note that half of them report pain during sexual intercourse. Some women report that the pain persists a year after childbirth and even longer.

Breastfeeding increases fourfold pain in sexual intercourse (known as dyspareunia). If you breastfeed and suffer from pain, you should know that the reason for the pain may be vaginal dryness, which occurs during breastfeeding and is increased due to hormonal changes and suppressed estrogen secretion. Low estrogen levels in this period cause a decrease in vaginal discharge, which increases dryness. To relieve these phenomena, specific vaginal lubricants may be used.