Changes after delivering the baby occur in multiple organ systems simultaneously. Below are some of the changes listed, others are listed in links associated with this heading.
Bleeding After Delivery
Physically, when the size of the uterus is compared to the state immediately after delivery, it shrinks back to 1/10-th of the size during pregnancy within only 6 weeks.
There vaginal discharge, which is reddish-brown, (medically called the “lochia”) for 3 to 4 days, which turns into a malodorous, bloody and watery discharge (“lochia serosa”) for 3 weeks after the delivery. After this the discharge often turns yellowish/white (“lochia alba”) for another 1 or 2 weeks Ref. 18, p. 692).
Retained placental tissue
However, in some women retained placenta from the delivery, at least as piece of it, may still be present in the uterine cavity, in which case the uterus has problems contracting completely and new red vaginal bleeding would start about 7 to 14 days after the delivery. This is abnormal and requires an urgent assessment by the physician or obstetrician to prevent the development of a hydatidiform mole or of a choriocarcinoma.
The physician usually orders an ultrasound, which would show whether or not retained tissue is found in the uterus. If there is, a brief daycare procedure in the hospital (uterine evacuation and curettage) would have to be arranged. If the uterine cavity is empty, oxytocin can be given intravenously or methylergonovine (Methergine) intramuscularly. The latter substance cannot be used in patients with heart problems or hypertension.
Cardiovascular System After Delivery
Cardiac output had been significantly elevated during pregnancy and it takes about 6 to 8 weeks for this to normalize following the delivery.
Blood coagulation is in an activated state, likely from vaginal tears, during and until about 1 week following the delivery. By 2 weeks after the delivery the coagulation status is normalized.
This poses a significant risk for women who had an operative procedure such as a cesarean section, forceps delivery, extensive repairs of lacerations or of a large episiotomy (=cut into the perineum to enlarge the outlet birth channel). In these women there is a risk for developing blood clots in the legs or blood clots in the large pelvic veins. These can break off and migrate into the lungs (called “pulmonary emboli”). The physician can order Doppler ultrasound studies to look for clots and if present, can order heparin therapy.
Infections After Delivery
Most infections following a delivery relate directly to the delivery or the associated procedures like a cesarean section, forceps delivery, suturing of an episiotomy or breast feeding. The sutures of the C.section repair can get infected, tears in the vagina from the forceps can get infected as well. This would have to be treated with antibiotics as would infected stitches from an episiotomy.
Ascending bacteria in the uterine cavity can lead to endometritis. Apart from the other vaginal complications, there can be vaginal infections, urinary tract infections and thrombophlebitis with infection (also deep vein thrombosis). If the mother has a vaginal yeast infection, this can be transmitted into the mouth of the baby during the delivery.
Candida vaginitis and mastitis
From there it is only a small step to a yeast infection (Candida vaginitis) and invasive soft tissue infection with a variety of bacteria, such as Staphylococcus aureus, and a massive mastitis of mother’s breast can result from this, which may have to be incised and drained, if oral antibiotics are not effective alone.
Kidney function after delivery
The kidney function, which had increased during the pregnancy by 50%, returns to the baseline function in most of its parameters within 6 to 8 weeks after the delivery. However, because of the manipulation in the vaginal and adjacent urethral area during the course of the delivery there is a higher risk for post delivery UTI’s, which are attended to in a normal fashion.
With the enormous psychological and hormonal adjustments and the sleep deprivation associated with the delivery of a baby it is no wonder that many women experience apart from the great joy that comes with the delivery of a new baby also periods where things appear overwhelming, difficult or draining. This is normal. However, this will need reassurance from the care providers and support from the family and will pass within a few weeks.
1. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 235.
2. B. Sears: “Zone perfect meals in minutes”. Regan Books, Harper Collins, 1997.
3. Ryan: Kistner’s Gynecology & Women’s Health, 7th ed.,1999 Mosby, Inc.
4. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 245.
5. AB Diekman et al. Am J Reprod Immunol 2000 Mar; 43(3): 134-143.
6. V Damianova et al. Akush Ginekol (Sofia) 1999; 38(2): 31-33.
7. Townsend: Sabiston Textbook of Surgery,16th ed.,2001, W. B. Saunders Company
8. Cotran: Robbins Pathologic Basis of Disease, 6th ed., 1999 W. B. Saunders Company
9. Rakel: Conn’s Current Therapy 2001, 53rd ed., W. B. Saunders Co.
10. Ruddy: Kelley’s Textbook of Rheumatology, 6th ed.,2001 W. B. Saunders Company
11. EC Janowsky et al. N Engl J Med Mar-2000; 342(11): 781-790.
12. Wilson: Williams Textbook of Endocrinology, 9th ed.,1998 W. B. Saunders Company
13. KS Pena et al. Am Fam Physician 2001; 63(9): 1763-1770.
14. LM Apantaku Am Fam Physician Aug 2000; 62(3): 596-602.
15. Noble: Textbook of Primary Care Medicine, 3rd ed., 2001 Mosby, Inc.
16. Goroll: Primary Care Medicine, 4th ed.,2000 Lippincott Williams & Wilkins
17. St. Paul’s Hosp. Contin. Educ. Conf. Nov. 2001,Vancouver/BC
18. Gabbe: Obstetrics – Normal and Problem Pregnancies, 3rd ed., 1996 Churchill Livingstone, Inc.
19. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 251.
20. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 250.
21. Ignaz P Semmelweiss: “Die Aetiologie, der Begriff und die Prophylaxis des Kindbettfiebers” (“Etiology, the Understanding and Prophylaxis of Childbed Fever”). Vienna (Austria), 1861.
22. Rosen: Emergency Medicine: Concepts and Clinical Practice, 4th ed., 1998 Mosby-Year Book, Inc.
23. Mandell: Principles and Practice of Infectious Diseases, 5th ed., 2000 Churchill Livingstone, Inc.
24. Horner NK et al. J Am Diet Assoc Nov-2000; 100(11): 1368-1380.
25. Ferri: Ferri’s Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.
26. Rakel: Conn’s Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier