What are the physiological changes that happen to the baby during and after birth?

A healthy pregnancy is 40 weeks, and the body continues to evolve for a long time after the baby is born. The postpartum period, sometimes called the “fourth trimester,” refers to the critical time your body needs to recuperate after giving birth.

During pregnancy, the body undergoes an abundance of anatomic and physiologic changes that support both the fetus and the parent’s body. While the body will eventually revert back to “normal,” the process takes some time.

Here are some of the common physical changes you can expect post-pregnancy:

Hair loss

My patients commonly ask me about perceived hair loss during the postpartum period. While pregnant, your hair may grow faster and appear thicker thanks to hormone changes. After delivery, this reverses to a resting phase, which lasts 1-5 months. Normal hair growth patterns typically return 6-15 months after delivery.

Enlarged feet

You can expect your feet to get longer during pregnancy. There are two reasons for this: The laxity of muscles and ligaments, and general weight gain, which can flatten the arch of the foot. Unlike other bodily changes, this one is permanent. Research has shown women’s feet may grow 2-10mm in length during and after pregnancy.

Decreased bladder control

Urinary incontinence is a common problem immediately after delivery, affecting about 1 in 3 women. The decreased bladder control is due to weakness in the pelvic muscles, which stretch out during and after pregnancy. Kegel exercises are useful to strengthen this area and regain urinary control.

Sex drive drop

After delivery, women can expect a temporary decrease in sexual desire. Estrogen and progesterone hormone levels drop after pregnancy, which means the vagina produces less lubrication and can feel dry. Many women experience pain during intercourse because of this, and some women report feeling less satisfied from sex after pregnancy.

Breast fluctuation

Breasts become engorged after delivery as they prepare for breastfeeding. This results in breast fullness and firmness, which can cause pain and tenderness. Breasts will revert back to a smaller size once breastfeeding is over. For women who are not breastfeeding, using a tight bra and avoiding breast stimulation will suppress lactation in a majority of patients.

Skin changes

Stretch marks and varicose veins can appear on the skin due to weight gain during pregnancy. There’s also evidence that family history and genetics are a factor; if your mom had them, you likely will, too. Although there are a variety of creams and lotions meant to reduce the risk for stretch marks, there is no strong evidence to confirm these products actually work. Stretch marks fade over time, and varicose veins typically go away 6-12 months after delivery.

Be aware of serious symptoms

Preeclampsia and peripartum cardiomyopathy (heart muscle weakness) are two of the most dangerous complications that can occur during the postpartum period. After giving birth, do not hesitate to call your doctor or midwife if you experience symptoms such as:

• Chest pain
• Shortness of breath
• Nausea or vomiting
• Headaches
• Visual changes
• Fever
• Swelling in your hands and face

Preeclampsia causes high blood pressure during pregnancy and can be life-threatening to both the mother and her baby. According to the Preeclampsia Foundation, the condition affects 5-8% of births in the United States.

Some patients are surprised to learn they can still develop preeclampsia up to 6 weeks after delivery, even if there were no symptoms during the pregnancy. In fact, approximately 97% of deaths attributed to preeclampsia happen in the postpartum period.

What physical changes can I expect after delivery?

Lochia (vaginal discharge)

Lochia is the vaginal discharge you have after a vaginal delivery. It has a stale, musty odor like menstrual discharge. Lochia for the first 3 days after delivery is dark red in color. A few small blood clots, no larger than a plum, are normal. For the fourth through tenth day after delivery, the lochia will be more watery and pinkish to brownish in color. From about the seventh to tenth day through the fourteenth day after delivery, the lochia is creamy or yellowish in color.

You might notice increased lochia when you get up in the morning, when you are physically active, or while breastfeeding. Moms who have cesarean sections may have less lochia after 24 hours than moms who had vaginal deliveries. The bleeding generally stops within 4 to 6 weeks after delivery. You should wear pads, not tampons, as nothing should go in the vagina for six weeks.

Incision drainage

If you had a C-section or tubal ligation, it is normal to have a small amount of pink, watery drainage from the incision. Keep the incision clean and dry. Wash the incision with soap and warm water. You can bathe or shower as usual. If the drainage doesn’t stop, call your healthcare provider.

Breast discharge

When you are breastfeeding, your breasts may leak fluid. If you are unable to breastfeed, the leaking may occur initially and will stop within 1 to 2 weeks after delivery. Breast pads, worn inside your bra, may help keep you dry.

Breast engorgement

Breast engorgement is breast swelling characterized by a feeling of warmth, hardness, and heaviness in the breasts. Engorgement is caused by increased circulation to the breasts. It can happen as milk comes in or if you miss a feeding (if you are breastfeeding).

If you are bottle-feeding your baby, you can relieve the discomfort of engorgement by taking pain medication as directed by your healthcare provider. You can also apply ice packs. Wearing a supportive bra also helps.

When breastfeeding, you can prevent engorgement by frequently feeding your baby or pumping your breasts. To relieve the discomfort: Apply warm compresses or take a warm shower to help the milk let down (but then feed your baby or pump immediately after). Do not repeat this if you don’t get relief, as it may increase swelling and prevent the milk from flowing.

If you still have discomfort, you may try the following:

• Apply ice packs.
• Express some milk before feeding your baby.
• Use an anti-inflammatory such as ibuprofen, as directed by your healthcare provider, to reduce swelling.
• Wear a supportive bra.

Seek help from your healthcare provider, lactation consultant, attend a lactation support group, or call the lactation hotline if this continues to be a problem for you. If there is one area that is red and wedge-shaped and toward the nipple, it could be an infection. Call your healthcare provider if you suspect an infection.

Discomfort in the perineal area

If you had an episiotomy, the area of skin between the vagina and anus (called the perineum) might be very sore and sensitive. To relieve discomfort, try warm sitz baths. Sit in a tub filled with a few inches of water. (To prevent infection, do not add bubble bath or other products.) You can also buy a small basin that fits on the toilet. You may also use this treatment for discomfort associated with hemorrhoids.

Perineal care

Keeping the perineum clean will increase comfort and prevent the risk of infection. After each time you use the bathroom and/or change your pads, fill the peri bottle (given to you in the hospital) with warm water. Squirt the water over the area between your vagina and rectum in a front-to-back motion. Pat the area dry with toilet tissue. Do not rub the area. Apply a clean pad often to maintain cleanliness. Continue to do the perineal care for 1 week after delivery.

Uterine contractions

Within a few hours after birth, the upper portion of your uterus (fundus) is at about the level of your navel. It remains there for about a day then gradually descends each day. If you are breastfeeding, this may occur more rapidly. Without complications, your uterus will return to its approximate non-pregnant size (the size of a pear) in about six weeks.

After-pains, or cramps, are caused by uterine contractions that stop the bleeding from the area where the placenta was attached. These pains are more common in women who have had more than one pregnancy. The discomfort can be intense – especially if you are breastfeeding –for about 5 minutes, but will gradually subside.

To relieve discomfort, you may try these methods:

• Lie on your stomach with a pillow under your lower abdomen.
• Take a walk.
• Take pain medication as recommended by your healthcare provider.
• Take a sitz bath.
• Use a heating pad on your stomach.

Urination contractions

You may feel discomfort when urinating. Discomfort is common, but be sure to tell your healthcare provider if you feel pain or if urinating is difficult.

Incontinence

The stretching of your muscles during delivery can cause temporary loss of urinary and sometimes bowel control. Urinary incontinence may occur more frequently when you laugh, cough, or strain. Practice your Kegel exercises to improve urinary incontinence. It will improve a few weeks after delivery. If incontinence continues to be a problem after your first postpartum check-up, talk to your healthcare provider.

Constipation

The first bowel movement after delivery may be delayed to the third or fourth day after delivery. Your healthcare provider may prescribe or recommend an over-the-counter stool softener to soften the stool and make bowel movements less uncomfortable. Increase fruits, vegetables, and whole grains in your diet to keep your bowel movements regular. Also make sure you are drinking at least 10 to 12 glasses of fluid per day. Narcotic pain relievers may worsen the situation, so minimize their use. Over-the-counter creams can help hemorrhoid discomfort, as can sitz baths. If constipation continues to be a problem, call your healthcare provider.

Perspiration

Increased perspiration, especially at night, is common after delivery as your body adjusts to new hormone levels after delivery. Protect yourself from getting the chills by showering and changing your clothes and change bed linens. Also, increase fluids to quench your thirst during this time.

Menstruation

If you are breastfeeding, you may not get your period (menstruate) until after your baby weans from the breast. Please be aware that although you may not get your period while breastfeeding, you can still get pregnant. If you are bottle-feeding, you will usually menstruate 6 to 12 weeks after delivery. The first few periods after delivery may be irregular.

When should I call my healthcare provider after delivery?

Call your healthcare provider if you have:

• A fever over 100.4 degrees Fahrenheit or severe chills.
• Foul-smelling vaginal discharge.
• Bright red bleeding that continues beyond the third day.
• Passing of large blood clots (larger than a plum).
• Pain, burning or trouble urinating.
• Severe cramping or abdominal pain that is not relieved by pain medication.
• Increased redness, swelling, bruising or pain on your perineum, or separation of your stitches.
• Increase in the amount of vaginal discharge or bleeding in which you need to use more than one sanitary pad per hour.
• Blurred vision.
• Severe headaches or fainting.
• Increased pain, redness, drainage or separation of abdominal incision (cesarean delivery)
• Severe pain, swelling, or redness, of one extremity more than the other.
• Warm, red painful areas on your breast.
• Difficulty breathing.
• Any signs of postpartum depression such as: being unable to cope with everyday situations, thoughts of harming yourself or your baby, feeling anxious, panicked or scared most of the day.

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