Postpartum naturally occurs in all women after giving birth and lasts for six to eight weeks. Once completed, the normal menstrual cycle will continue, but only if the mother is not breastfeeding. Sometimes it is difficult to know when the postpartum period has ended and normal menstruation has started. However, there are some signs you can look out for.
Part 1 of 3: Knowing the Difference
Step 1. Pay attention to the time
In general, breastfeeding mothers do not experience menstruation for about a year. On the other hand, parturition begins immediately after delivery and lasts between six to eight weeks until it finally subsides.
- Breastfeeding can delay menstruation because it triggers the body to release the hormone prolactin, which keeps levels of the hormones progesterone and estrogen low.
- Even if a woman is not breastfeeding, she will not start getting her period for several weeks after giving birth. About 70% of women experience menstruation again approximately six to twelve weeks after giving birth. Menstruation only lasts for three to six days.
Step 2. Check the color
There is a slight color difference between puerperal and menstrual blood, so you should pay attention to it.
- During the puerperium, the blood looks fresh red in the first three days. Then from day 4 to 10, the color changes from pink to red-brown with various components such as old blood, white cells, and tissue debris.
- After the 10th day, a whitish discharge may appear, which is medically known as lochia. This fluid contains leukocytes (white blood cells), mucus, and epithelial cells. Lokia will be out for eight weeks max.
- Menstrual blood also begins as a fresh red color, but will turn dark red, black, or brown towards the end of menstruation.
Step 3. Watch the blood flow
Puerperal blood is heavier than menstrual blood. In general, puerperal blood will be very large in the first four days, then the quantity will slowly decrease in the following days/weeks.
- If you have to change a thick pad every hour for at least three hours straight, or have a blood clot larger than a golf ball after the first two to three days, call your doctor immediately.
- During menstruation, blood flow is also very heavy for the first three to four days, but the average amount of blood that comes out is only 10 ml to 80 ml.
- An easy way to calculate the amount of blood that comes out is to know that one tampon can absorb about 5 ml of blood. So you can count the number of tampons used and multiply by five to get the amount of blood in milliliters.
Step 4. Recognize the signs of bleeding after delivery
Bleeding can also occur after delivery, which is experienced by 1 to 5 out of 100 women. Bleeding is different from puerperal and requires immediate medical attention. Bleeding can be caused by remnants of the placenta that are still attached, injury to the cervix or other tissues, or abnormalities in blood clotting. If left untreated, bleeding after delivery can cause shock and be fatal. Among the signs of bleeding after delivery are:
- Vaginal bleeding that fills more than one sanitary pad in two hours or is bright red or without clots after the blood has become lighter or has turned brown.
- Decreased blood pressure
- Increased heart rate
- Decrease in the number of red blood cells
- Swelling and pain in and around the vagina.
Part 2 of 3: Postpartum Care
Step 1. Adjust your diet
When you lose blood, you also lose iron. To avoid iron deficiency, increase iron intake through daily diet. There are a number of foods that are naturally high in iron. These foods are:
- Chicken, liver or beef
- Broccoli or asparagus
- Okra, parsley and seaweed
- Mustard leaf or beet leaf
- Raisins, plums, dried peaches or prune juice
- Cane drops
Step 2. Take iron supplements
For normal or moderate parturition, you do not need drugs because puerperal will stop on its own after a maximum of six weeks to two months. However, your doctor may suggest or prescribe iron supplements to treat signs of anemia due to blood loss.
- Most over-the-counter supplements are safe to use, and will be absorbed better with orange juice. Ask your doctor or pharmacist for advice if you are not sure which brand to choose.
- Supplements are usually taken once a day. You should take it after meals to avoid constipation. You may experience stomach problems, such as nausea and vomiting.
Step 3. Seek medical help if needed
Get medical care for bleeding after delivery. If you experience bleeding, you should seek medical attention immediately to avoid shock. The treatments include:
- Blood transfusions to support vital organs such as the brain, heart, kidneys, and liver to prevent organ damage. Blood transfusions will try to compensate for the amount of blood lost.
- Oxytocin will be given through an IV to stimulate uterine contractions and control bleeding.
- The hormone oxytocin plays an important role by stimulating strong uterine contractions by affecting specific receptors present in the lining of the smooth muscles of the uterus. The hormone oxytocin also increases the amount of intracellular calcium to stimulate vasoconstriction.
Part 3 of 3: Understanding the Physiological Process
Step 1. Know what causes the puerperium
Normally, the uterus will continue to contract after delivery to remove any residual debris from the placenta. This residue becomes puerperal blood.
- Postpartum occurs when the uterus enters the involution stage, which is a normal physiological response when the uterus returns to its pre-pregnancy state. This breath is controlled and does not cause adverse side effects.
- Over time, the outer layer of the uterus will slowly shed and come out. This discharge is called lochia.
- This process is perfectly normal and is known to happen. The uterus will heal on its own and the puerperal bleeding/lochia will stop within six weeks.
Step 2. Find out what causes menstruation
During a woman's normal menstrual cycle, the uterus is lined by a nutrient-rich membrane to prepare for the arrival of a fertilized egg.
- If fertilization does not occur, this layer shrinks and sheds before leaving the body, along with the unfertilized egg. Once the old layer is removed, a new layer is formed and the cycle begins again.
- Menstruation lasts for two to seven days and occurs approximately every 28 days, but this cycle varies from woman to woman.
Step 3. Recognize the signs of an abnormal postpartum
In some cases, the puerperal blood that comes out is excessive and poses a health risk. Postpartum is called excessive if you fill one or more pads per hour, pass a blood clot the size of a golf ball or larger, or continue to bleed fresh red after four days. This can happen for a number of reasons, such as:
- Uterine atony. This is the most common cause of excess breath. This condition occurs when the uterus is unable to continue contractions due to a long labor, fatigue, or the use of certain drugs (NSAIDs, nitrates) that make blood leak uncontrollably out of the body.
- Retention of the placenta or retained placenta. Simply put, this condition occurs when the placenta cannot separate completely from the uterus. Retained placenta causes bleeding.
- Trauma to the uterus. Uterine trauma can occur for a number of reasons, such as a difficult delivery, giving birth to twins, trying to remove a retained placenta (manually, with special equipment, or with labor-inducing drugs such as oxytocin). All of these can lead to sores on the genital tract or uterine lining, leading to excessive postpartum.
- Other causes. Other factors that have the potential to cause bleeding after delivery are excessive uterine swelling, preeclampsia, infection, or obesity.