Postpartum (puerperium) - After The Birth

Postpartum: aftercare & care

The puerperium begins immediately after the birth of the child, also known as the puerperium. The puerperium lasts an average of six to eight weeks and is used for physical recovery from pregnancy and birth.

The first ten days after the birth is also known as the "early bed". During this time, mother and child are often still in hospital and are looked after by midwives. Every woman has the right to call in a midwife for care and support, even in the puerperium at home. The health insurance company bears the costs.

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• What are the characteristics of the puerperium?
• Which physical changes take place?
• Which nursing measures are important in the puerperium?
• Whom can I ask?
• How are the costs going to be covered?

What are the characteristics of the puerperium?

In the period of the puerperium, the physical changes that took place during pregnancy and childbirth regress. Any birth injuries can heal and breastfeeding begins. The midwife monitors these regression processes and advises the mother on questions relating to breastfeeding and baby care. Regular check-ups serve to assess the course of the physiological regression and, if necessary, to recognize and treat deviations at an early stage.

The puerperium is also the time when the mother and the newborn can fully recover from the birth. The focus is on getting to know each other between parents, siblings and the new family member. It is important to take enough time and allow yourself some rest.

Which physical changes take place?

Hormonal change

After the birth of the placenta, the mother experiences a rapid drop in estrogen and progesterone levels as well as placental hormones. This also reduces the effects of these hormones. The body volume is reduced and the blood volume decreases again.

More on the subject: Physical changes

during pregnancy The hormone prolactin is already formed during pregnancy, although the high level of placental hormones during pregnancy still strongly inhibits prolactin production. The prolactin is responsible for the flow of milk. After birth, the elimination of pregnancy homones and the suckling stimulus of the child when breastfeeding increases the prolactin production even further. In most cases, the increased prolactin level prevents the onset of ovulation and a menstrual cycle; however, breastfeeding is not a reliable protection against a new pregnancy. Women who are not breastfeeding have their first menstrual bleeding around six weeks after giving birth.

The sucking stimulus of breastfeeding promotes not only prolactin but also oxytocin release. Oxytocin also facilitates the flow of milk and promotes the regression of the uterus. During her visits, the midwife checks the milk flow and gives valuable tips on breast care.

More on the topic: The breastfeeding period

Increase in the risk of thrombosis

Due to the hormonal change, there is a slight change in the woman's blood composition. This can cause the blood to clot more quickly, which increases the risk of thrombosis in the puerperium. Varicose veins, the enlarged uterus, obesity and possibly hereditary factors can further increase the risk of thrombosis. The risk of thrombosis after a caesarean section is higher than after a vaginal birth due to the woman's limited mobility.

As a preventive measure, compression stockings and drug-based thrombosis prophylaxis (“thrombosis injection”) are used in the puerperium.

Regression of the uterus

The uterus increased 20 times in size during pregnancy. At birth, she weighs around 1,000 grams. During the postnatal period, it decreases in size again and the muscle cells return to their original state. At the end of the puerperium, the uterus regains a weight of around 80 grams. There are three main reasons for regression:

• After- pains: These occur in the first few days after the birth and cause the uterus to contract. More on the subject of labor and delivery
• Oxytocin: Breastfeeding increases the release of the hormone oxytocin, which promotes contractions and thus the regression process.
• Decrease in estrogen and progesterone: This breaks down the muscle substance in the uterus.

The course of regression is checked daily by the midwife in the first few days in the postpartum period. To do this, the fundus status (the upper edge of the uterus) is determined by palpating the abdomen. After about six weeks, the uterus has mostly regressed completely.

Weekly river (Lochien)

In the postpartum phase, the placenta separates from the wall of the uterus. This creates a wound surface at this point. The wound secretion that the body excretes in this context is called the weekly flow. The amount, color and smell of the weekly flow show the midwife how the wound is healing. It is bloody at first, then turns brownish and looks yellowish at the end. The regression of the uterus also reduces the wound area and the weekly flow decreases.

Note For reasons of hygiene, the templates should be changed every time you go to the toilet during the week and you should also wear breathable underwear.

Bladder and bowel

Problems with emptying the bladder or bowel can occur, especially in the first few days after the birth. The flushing out of pregnancy-related water retention can often lead to an increased urge to urinate. During her visits, the midwife asks how often the mother empties her bladder or bowel, as an overfilled urinary bladder can prevent the uterus from regressing. This increases the risk of a urinary tract infection.

Regression of the pelvic floor

The pelvic floor and the abdominal wall muscles are heavily stressed by pregnancy and childbirth. The muscles in the pelvic floor can be strengthened through regular exercises. Postnatal gymnastics can be started as early as the puerperium. The midwife shows the first exercises to strengthen the pelvic floor, which also promote the regression of the uterus. This can also reduce possible late effects - such as urinary or fecal incontinence. More on the topic: pelvic floor training.

Which nursing measures are important in the puerperium?

• Since the risk of thrombosis is increased in the puerperium, especially after an operative delivery, the mother should be mobile as early as possible. In addition, she receives anti-thrombosis stockings and drug-based thrombosis prophylaxis.
• Short walks, postpartum gymnastics, circulatory exercises or pelvic floor training are suitable for mobilization. The doctor or midwife will give individual advice on when to start. After a caesarean section or more extensive birth injuries, longer physical restraint may be necessary.
• Full baths and swimming should be avoided during the weekly flow. In addition, no tampons should be used and no sexual intercourse should take place or only with a condom.
• In order to detect infections (e.g. endometritis or mastitis) at an early stage, temperature and pulse are checked regularly in the first few days.
• Perineal or caesarean scars should be specially cared for (e.g. careful cleaning with water, allow to air dry, cooling pads, etc.). The attending doctor and the midwife provide individual advice.
• Eating a high-fiber diet during the puerperium will help prevent constipation. This is also recommended in order not to put additional strain on a perineal incision or perineal tear wound through strong pressure when defecating. More on the topic: carbohydrates & fiber

Whom can I ask?

In the case of a hospital birth, the woman spends two to three days in bed in the hospital. She is looked after by a midwife until she is released. In the case of an outpatient or home birth or after discharge from the hospital, the midwife looks after the mother and child in their own four walls. You can find midwives in your area on the Midwives Council website

How are the costs going to be covered?

Mothers of newborn babies are financially entitled to follow-up care from a midwife. Midwifery care in the hospital for the first few days after the birth is covered by health insurance.

The costs for home visits by a contract midwife in the first five days after the birth are also covered by the health insurance, in the case of caesarean section, premature birth and multiple births in the first six days. If there are symptoms after this time, such as breastfeeding does not work or the uterus does not regress, the health insurance company will cover the costs for a maximum of seven further home visits up to eight weeks after the birth.

Midwives who do not have a contract with the health insurance company must be paid privately. However, there is a right to reimbursement of up to 80 percent of the contract rate (this is usually not the same as the amount that is on the fee note). You can find more information about the costs and the range of services offered by midwives at www.hebammen.at or from the relevant social security agency.