Postpartum period
During the delayed phase, some changes to the genitourinary system take much longer to resolve and may result in conditions such as urinary incontinence.
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.
However, more recent research shows that routine episiotomy, when a normal delivery without complications or instrumentation is anticipated, does not offer benefits in terms of reducing perineal or vaginal trauma.
[14] The Apgar score is determined by evaluating the newborn baby on five criteria which are summarized using words chosen to form an acronym (Appearance, Pulse, Grimace, Activity, Respiration).
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.
The World Health Organization (WHO) also encourages skin-to-skin contact for the first 24 hours after birth to help regulate the baby's temperature.
[10] In the first few days following childbirth, the risk of a deep vein thrombosis (DVT) is relatively high as hypercoagulability increases during pregnancy and is maximal in the postpartum period,[16] particularly for women with C-section with reduced mobility.
Anti-coagulants or physical methods such as compression may be used in the hospital, particularly if the woman has risk factors, such as obesity, prolonged immobility, recent C-section, or first-degree relative with a history of thrombotic episode.
[21] Discharge from the uterus, called lochia, will gradually decrease and turn from bright red, to brownish, to yellow and cease at around five or six weeks.
[24] If an episiotomy or perineal tear had to be sutured, the use of a donut pillow allows the woman to sit pain-free or at least with reduced pain.
[27] The lactation consultant, health visitor, monthly nurse, postnatal doula, or kraamverzorgster may be of assistance at this time.
[30] Prevalence of PTSD following normal childbirth (excluding stillbirth or major complications) is estimated to be between 2.8% and 5.6% at six weeks postpartum.
The American College of Obstetricians and Gynecologists (ACOG) recognizes the postpartum period (the "fourth trimester") as critical for women and infants.
They recommend that all women have contact (either in person or by phone) with their obstetric provider within the first three weeks postpartum to address acute issues, with subsequent care as needed.
A more comprehensive postpartum visit should be done at four to twelve weeks postpartum to address the mother's mood and emotional well-being, physical recovery after birth, infant feeding, pregnancy spacing and contraception, chronic disease management, and preventive health care and health maintenance.
Recovery from childbirth complications in this period, such as urinary and fecal incontinence, painful intercourse, and pelvic prolapse, are typically very slow and in some cases may not resolve.
[35][36] Many factors figure into the likelihood of post natal problems including the size of the infant; the method of delivery, such as c-section, or of forceps; perineum trauma from either an episiotomy or natural tearing; and the physical condition of the birth mother.
The American College of Obstetricians and Gynecologists (ACOG) recommends women take at least six weeks off work following childbirth.
"[38] The United States is the only country in the Organisation for Economic Co-operation and Development (OECD) that does not provide paid maternity, paternity, and parental leave.
