Postpartum period (aka postnatal period, puerperium) is the period beginning immediately after the birth of a child, extending for about 6 weeks. It describes the period as the most critical and yet the most neglected phase in the lives of the mothers and babies, most deaths occur during the postnatal period. The term is commonly abbreviated to Px, where x is the number, e.g. day P5 is the 5th day after birth. Do not confuse this with parity.

Source: WA Health

For newborns:

• Breathing and circulation, as the baby is perfusing its body by breathing independently, instead of utilizing placental oxygen delivered via the umbilical cord:
  • At birth, the baby's lungs are filled with lung liquid, which is distinct from amniotic fluid
    • When the newborn is expelled from the birth canal, its CNS reacts to a sudden change in temperature and environment. This triggers it to take the 1st breath, within about 10 seconds after delivery
    • With the 1st breaths, there is a fall in pulmonary vascular resistance, and an increase in the surface area available for gas exchange
    • Over the next 30 seconds, the pulmonary blood flow increases and is oxygenated as it flows through the alveoli of the lungs. Oxygenated blood now reaches the LA and LV, and through the descending aorta reaches the umbilical arteries
    • Oxygenated blood now stimulates constriction of the umbilical arteries resulting in a reduction in placental blood flow. Also, as the pulmonary circulation increases, there is an equivalent reduction in the placental blood flow. Placental blood flow normally ceases completely after about 3 minutes
  • The increase in pulmonary venous return, results in LA pressure being slightly higher than RA pressure, which closes the foramen ovale
  • The flow pattern changes results in a drop in blood flow across the ductus arteriosus, and the higher blood oxygen content of blood within the aorta stimulates the constriction, and ultimately the closure of this fetal circulatory shunt
  • Some types of congenital heart diseases that were not Sx in utero during fetal circulation, will now present with cyanosis or respiratory Sx
  • Following birth, the expression of surfactant (which begins to be produced by the fetus at 20 weeks gestation) is accelerated, to prevent alveolar closure (atelectasis)
  • Rhythmic breathing movements also commence. Caffeine can be given to Tx apnea in premature newborns
  • Neonatal respiratory problems include apnea, TTN, RDS, meconium aspiration, airway obstruction, and pneumonia
• Energy metabolism, as the fetus must convert from a continuous placental suply of glucose to intermittent feeding
  • Glycogen synthesis begin late 2nd trimester, and storage is completed in 3rd trimester. However, the fetus only has enough glycogen to meet energy needs for 8-10 hours, and can be depleted even quicker if demand is high. Newborns will then rely on gluconeogenesis for energy, and is normaly at 2-4 days of life
  • Inadequate glucose substrate can cause hypoglycemia, fetal growth restriction, preterm delivery
  • Excess substrate can cause diabetes, hypothermia, or neonatal sepsis
• Temperature regulation, as newborns come from a warm environment into the cold and fluctuating temperatures. They are naked, wet, and have a large surface area to mass ratio, variable insulation, limited metabolic reserves, and decreased shiver. Physiological responses include vasoconstriction (decreased blood flow to the skin), maintaining the fetal position (decrease surface area exposed to the environment), jittery large muscle activity (generate muscular heat). Techniques include keeping them dry, wrapping them in blankets, giving them hats and clothing, increasing the ambient temperature. More advanced techniques are incubators (at 36.5 degrees C), humidity, heat shields, thermal blankets, double walled incubators, radiant warmers, and use of skin to skin care

For mothers:

• She may leave hospital as soon as she is medically stable and chooses to leave, which can be as soon as a few hours postpartum, though the average for vaginal birth is 1.5 days, and for C section is 3.5 days
• Ensure the mother is capable of taking care of her newborn
• Provide her with information about breastfeeding, reproductive health, contraception
• Baby care and monitoring
• Lochia, is postpartum vaginal discharge, containing blood, mucus, and uterine tissue. It has a stale, musty odor like menstrual discharge. It traverses through lochia rubra, lochia serosa, then lochia alba. Generally it lasts 5 weeks in length
• Incision drainage, that is pink and watery from the incision, if the patient has had C section or tubal ligation
• Breasts, including:
  • Breast discharge, leaking fluid, when breastfeeding. If you are unable to breast feed, the leaking will occur initially, and stop 1-2 weeks after delivery
  • Breast engorgement, where the breasts are swollen, feel warm, hard, and heavy
• Uterus contractions, especially after pains and cramps by uterus contractions that stop bleeding from the area where the placenta was attached
• Reversion to normal, including:
  • Uterus size and weight returns to normal (see McDonald's rule), with the pregnant uterus weighing 1kg, and receding to a weight of 50-100g. Most of the reduction in size and weight occurs in the first 2 weeks
  • Cervix, reverts rapidly to the nonpregnant state, but never returns to the nulli state. By the end of the 1st week, the external os closes such thta a finger can't be easily introduced
  • Hormone levels return to normal
  • Perineum, is stretched and traumatized, sometimes torn or cut. A swollen and engorged vulva rapidly resolves in 1-2 weeks. Most of the muscle tone is regained by 6 weeks
  • Abdominal wall, remains soft and poorly toned for many weeks
  • Menstruation, if you are not breast feeding, 6-12 weeks after delivery. From a woman breastfeeding, ovulatoin is suppressed due to the elevatoin in prolactin
• Perspiration, especially at night, due to adjustments ot new hormone levels
• Perineal pain
• Hair loss
• Stretch marks
• Discomfort during sex

Source: Medscape

• She is assessed for tears, and is sutured if necessary
• Monitored for bowel function, including:
  • Constipation, as stool may be delayed to the 3rd-4th day after delivery
  • Hemorrhoids
• Monitored for bladder function, including:
  • Urinary infection
  • Urinary retention
  • Incontinence of urine, and sometimes bowel
  • Any problems in the muscles
• Monitored for bleeding, PPH
• Monitor for conditions occurring in the postpartum period, e.g. Sheehan's syndrome and peripartum cardiomyopathy
• Assess for psychology, including:
  • Postpartum depression
  • PTSD
  • Puerperal psychosis, even
• Mastitis
• Uterus infection
• C-section infection
• Kidney infection
• Clogged ducts

Source: New Kids Center

• Antenatal care (for the schedule of visits)