A postpartum (or postnatal) period begins immediately after the birth
of a child and extends for about six weeks, as the mother's body,
including hormone levels and uterus size, returns to a non-pregnant
state. Less frequently used are the terms puerperium or puerperal
World Health Organization
World Health Organization (WHO) describes the postnatal
period as the most critical and yet the most neglected phase in the
lives of mothers and babies; most maternal and/or newborn deaths occur
during the postnatal period. In scientific literature, the term is
commonly abbreviated to Px, where x is a number; for example, "day P5"
should be read as "the fifth day after birth". This is not to be
confused with the medical nomenclature that uses G P to stand for
number and outcomes of pregnancy (gravidity and parity).
3.2 East Asia
4 See also
6 External links
Main article: Infant
Upon their entry to the air-breathing world, newborns begin to adjust
to life outside the uterus. Within about 10 seconds the infant takes
its first breath and the caregiver places the baby on the mother's
chest. The infant's condition is evaluated using the Apgar scale. The
Apgar score is determined by evaluating the newborn baby on five
criteria which are summarized using words chosen to form a backronym
(Appearance, Pulse, Grimace, Activity, Respiration). Until recently
babies were routinely removed from their mothers following birth,
however beginning around 2000, some authorities began to suggest that
early skin-to-skin contact (placing the naked baby on the mother's
chest) is of benefit to both mother and infant. As of 2014, early
skin-to-skin contact, also called kangaroo care, is endorsed by all
major organizations that are responsible for the well-being of
infants. Thus, to help establish bonding and successful breastfeeding,
the caregiver carries out immediate mother and infant assessments as
the infant lies on the mother's chest and removes the infant for
further observations only after they have had their first breastfeed.
World Health Organization
World Health Organization (WHO) also encourages skin-to-skin
contact for the first 24 hours after birth to help regulate the baby's
A woman giving birth in a hospital may leave as soon as she is
medically stable, which can be as early as a few hours postpartum,
though the average for a vaginal birth is one to two days, and the
average caesarean section postnatal stay is three to four days.
During this time, the mother is monitored for bleeding, bowel and
bladder function, and baby care. The infant's health is also
Early postnatal hospital discharge is typically defined
as discharge of the mother and newborn from the hospital within 48
hours of birth.
Main article: Postpartum physiological changes
The labor process is divided into four stages. During the first and
second stage the cervix opens and shortens and the baby moves down
through the birth canal. The period from just after the baby is born
until just after the placenta is expelled is called the third stage of
labor. The fourth stage of labor, also referred to as postpartum, is
the period beginning immediately after the placenta is expelled and
extending for about six weeks.
Following delivery the area where the placenta was attached to the
uterine wall bleeds, and the uterus must contract to prevent blood
loss. After contraction takes place the fundus (top) of the uterus can
be palpated as a firm mass at the level of the navel. It is important
that the uterus remains firm and the nurse or midwife will make
frequent assessments of both the fundus and the amount of bleeding.
The discharge will gradually decrease and turn from bright red, to
brownish, to yellow and cease at around five or six weeks. According
to the medical site Medscape, "Often, women experience an increase in
the amount of bleeding at 7-14 days secondary to the sloughing of the
eschar on the placental site. This is the classic time for delayed
postpartum hemorrhages to occur."
Following delivery if the mother had an episiotomy or tearing at the
opening of the vagina it is stitched. At one time an episiotomy was
routine, however more recent research shows that a surgical incision
may be more extensive than a natural tear, and is more likely to
contribute to later incontinence and pain during sex than a natural
tear would have. A healthcare professional can recommend comfort
measures to help to ease perineal pain. 
The increased vascularity and edema of the woman's vagina gradually
resolves in about 3 weeks. It regresses but does not completely regain
its previous size. The cervix rapidly returns to a near-nonpregnant
state as well. Postpartum urinary incontinence is experienced by
about 33% of all women; women who deliver vaginally are about twice as
likely to have urinary incontinence as women who give birth via a
See also: Psychiatric disorders of childbirth
In some cases, this adjustment is not made easily, and women may
suffer from postpartum depression, posttraumatic stress disorder or
even puerperal psychosis. Postpartum mental illness can affect both
mothers and fathers, and is not uncommon. Early detection and
adequate treatment is required. Approximately 25% – 85% of
postpartum women will experience the "blues" for a few days. Between
7% and 17% may experience clinical depression, with a higher risk
among those women with a history of clinical depression.
Postpartum psychosis (also known as puerperal psychosis) is a more
severe form of mental illness than postpartum depression. Rarely, in 1
in 1,000 cases, women experience a psychotic episode, again with a
higher risk among those women with pre-existing mental illness.
Despite the widespread myth of hormonal involvement, repeated studies
have not linked hormonal changes with postpartum psychological
symptoms. Rather, these are symptoms of a pre-existing mental illness,
exacerbated by fatigue, changes in schedule and other common parenting
A mother in
Florence lying-in, from a painted desco da parto or birth
tray of c. 1410. As women tend to the child, expensively dressed
female guests are already arriving.
Main article: Lying-in
Historically, European women were confined to their beds or their
homes for extensive periods after giving birth; care was provided
either by her female relatives (mother or mother-in-law), or by a
temporary attendant known as a monthly nurse. These weeks were called
confinement or lying-in, as in the names of maternity hospitals such
General Lying-In Hospital
General Lying-In Hospital in London. A 1932 publication refers
to lying-in as ranging from 2 weeks to 2 months. It also does not
suggest "Getting Up" (getting out of bed post-birth) for at least nine
days and ideally for 20 days.
Women received congratulatory visits from friends and family during
the period and, among the many traditional customs around the world,
the desco da parto was a special form of painted tray presented to the
Renaissance Florence. The many scenes after childbirth
painted on these show female visitors bringing presents, received by
the mother in bed, while other women tend to the baby. No fixed term
of lying-in is recommended in
Renaissance manuals on family life
(unlike in some other cultures), but it appears from documentary
records that the mother was rarely present at the baptism, in Italian
cities usually held within a week of the birth at the local parish
church, normally a few minutes walk from any house. The woman was
reintroduced to the community in the Christian ceremony of the
churching of women.
A modern version of this rest period has evolved, to give maximum
support to the new mother, especially if she is recovering from a
difficult labour and delivery.
Main article: Postpartum confinement
East Asian cultures, such as Chinese, South Korean, and
Vietnamese, there is a traditional custom of postpartum confinement
known in English as doing the month or sitting the month (Mandarin
zuò yuèzi 坐月子). Confinement traditionally lasts 30 days.
This tradition combines prescribed foods with a number of restrictions
on activities considered to be harmful. The new mother is also given
special postnatal foods, such as seaweed soup in Korea and "Pork
Knuckles and Ginger Stew" in China. It is widely believed in many East
Asian societies that this custom helps heal injuries to the perineum,
promote the contraction of the uterus, and promote
lactation. In Thailand "yu-fai (lie down by a fire)
treatment is traditional postpartum healing. Performed in an open
area, it involves using smokeless tamarind wood, local herbs and
Most traditional Indians follow the 40-day confinement and
recuperation period also known as the 'Jaappa' (in Hindi). A special
diet to facilitate milk production and increase hemoglobin levels is
followed. Sex is not allowed during this time. In Hindu culture, the
puerperium was traditionally considered a period of relative impurity
(asaucham) due to the processes of childbirth, and a period of
confinement of 10–40 days (known as purudu) was recommended for the
mother and the baby. During this period, she was exempted from usual
household chores and religious rites. The father was purified by a
ritual bath before visiting the mother in confinement. In the event of
a stillbirth, the period of impurity for both parents was 24
hours. Many Indian sub cultures have their own traditions after
birth. This birth period is called Virdi (Marathi), which lasts for 10
days after birth and includes complete abstinence from puja or temple
Pelvic girdle pain
Sex after pregnancy
Early postnatal hospital discharge
^ a b "Normal and Abnormal Puerperium: Overview, Routine Postpartum
Care, Hemorrhage". Medscape. 2017-08-04.
^ WHO. "WHO recommendations on postnatal care of the mother and
newborn". WHO. Retrieved 22 December 2014.
^ Phillips, Raylene. "Uninterrupted Skin-to-Skin Contact Immediately
After Birth". Medscape. Retrieved 21 December 2014.
^ "Recovering from a caesarean section". NHS Choices. Retrieved 16
^ "With Women, Midwives Experiences: from Shiftwork to Continuity of
Care, David Vernon, Australian College of Midwives, Canberra, 2007
ISBN 978-0-9751674-5-8, p17f
^ Gjerdingen, D.K.; Froberg, D.G. (1991). "The fourth stage of labor:
The health of birth mothers and adoptive mothers at six-weeks
postpartum". Family medicine. 23 (1): 29–35.
^ Mayo Clinic staff (30 July 2015). "Labor and delivery, postpartum
care". Mayo Clinic. Retrieved 15 August 2015.
^ WHO (2013). "WHO recommendations on postnatal care of the mother and
newborn". World Health Organization. Archived from the original on 22
December 2014. Retrieved 22 December 2014.
^ Thom, DH; Rortveit, G (December 2010). "Prevalence of postpartum
urinary incontinence: a systematic review". Acta Obstetricia et
Gynecologica Scandinavica. 89 (12): 1511–22.
doi:10.3109/00016349.2010.526188. PMID 21050146.
^ "Postpartum Depression". Canadian Mental Health Association.
Retrieved July 9, 2014.
^ Dobson, V.; Sales, B. (2000). "The Science of Infanticide and Mental
Illness". Psychology, Public Policy and Law. 6 (4): 1098–1112.
^ a b Lying in by Jan Nusche quoting The Bride's Book — A Perpetual
Guide for the Montreal Bride, published in 1932
^ Jenstad, Janelle Day,
Lying-in Like a Countess: The Lisle Letters,
the Cecil Family, and A Chaste Maid in Cheapside, Journal of Medieval
and Early Modern Studies - Volume 34, Number 2, Spring 2004, pp.
Renaissance childbirth - Victoria and Albert Museum". Vam.ac.uk.
^ "Effect of Alcohol consumption on Maternal lactation characteristics
during 'doing-the-month' ritual". Retrieved 2014-02-02.
^ "Ayuvedic Postpartum Healing Tips". Ayurveda.iloveindia.com.
^ "Ayurvedic diet for de-stressing postpartum mothers".
Thefreelibrary.com. 2001-12-22. Retrieved 2014-02-02.
^ Jacobson, Hilary. "Lactogenic Foods and Herbs". Mobimotherhood.org.
Archived from the original on 2014-01-26. Retrieved 2014-02-02.
^ "Lie down by a fire". Bangkok Post.
^ John Marshall / Jaya Tirtha Charan Dasa. "GUIDE TO RITUAL IMPURITY -
What to do at the junctions of birth and death". Hknet.org.nz.
eMedicine: Normal and Abnormal Puerperium
Patient UK: Postnatal Care (Puerperium)
NHS Choices Birth to Five Planner: Postnatal post-traumatic stress
Postpartum care of mother and newborn: WHO
Pregnancy and childbirth
Natural family planning
Assisted reproductive technology
In vitro fertilisation
Maternal physiological changes
Postpartum physiological changes
Sexual activity during pregnancy
Chorionic villus sampling
Adaptation to extrauterine life
Pelvimetry / Bishop score
Rupture of membranes
Sex after pregnancy
Human physiology of sexual reproduction
Germ cell (gonocyte
Human sexual behavior
Mechanics of sex
Prenatal development/Sexual dimorphism/Sexual differentiation
Maternal age / Paternal age
Pathology of pregnancy, childbirth and the puerperium (O, 630–679)
Oedema, proteinuria and
related to pregnancy
Acute fatty liver of pregnancy
Intrahepatic cholestasis of pregnancy
Integumentary system /
dermatoses of pregnancy
Intrahepatic cholestasis of pregnancy
Pruritic folliculitis of pregnancy
Pruritic urticarial papules and plaques of pregnancy
Pruritic urticarial papules and plaques of pregnancy (PUPPP)
Maternal care related to the
fetus and amniotic cavity
Braxton Hicks contractions
chorion / amnion
Amniotic band syndrome
Premature rupture of membranes
Twin-to-twin transfusion syndrome
Amniotic fluid embolism
Pain management during childbirth
Umbilical cord prolapse
Low milk supply
Diastasis symphysis pubis
Systemic lupus erythematosus
Sexual activity during pregnancy