A Woman’s Body…Six Weeks Postpartum

A woman’s body goes through many changes in postpartum, the six-week period after delivery, as the body attempts to return to its pre-pregnancy state.

Body Image

• After delivery, many women will look 5-6 months pregnant.  Contractions (after pains) will decrease the size of the uterus gradually so that by six weeks postpartum, it will have returned to its position behind the pubic bone.
• By six weeks postpartum, many women will have lost 15-20 pounds.  Approximately 10 pounds of the excess weight is fat the body reserves for breastfeeding.  The body may also rid of extra fluid gained by increasing the amount of urine passed or by having “night sweats.”
• Hair loss is a postpartum symptom which many women experience 2-6 months after baby’s birth.  Including pubic hair, this loss is typically followed quickly by new growth.  It is believed to be caused by hormonal changes.

Discomforts

• Contractions shrink the uterus back to its normal size.  Some women feel these contractions as after pains during the first days following delivery.  These after pains may be more painful for women who have had other children.  Walking, emptying the bladder often, pain medication, breathing and relaxation help lessen the pain.

• A vaginal birth causes stretching and bruising of the perineum and this can be worse for those who have some tearing or an episiotomy.  It is painful when stitches are pulled by swelling so women are encouraged to use ice on the tear or episiotomy throughout the first day following delivery.  Afterward, they may find the moist heat of a sitz bath or tub bath followed by the dry warmth of a blow dryer several times daily, speeds healing.  Sitting on a pillow may be helpful during the early weeks as well.

Bleeding

• Some from a vaginal bleeding or discharge will persist for 4 to 6 weeks after delivery.  This blood loss is called lochia.  During the first few days the lochia is bright red, then it becomes pinky-brown in colour, and by the tenth day the discharge is usually yellowish white.  The amount of lochia decreases daily, but some women notice an increase after being too active or overdoing it.  It’s important for a woman to contact her doctor/midwife if her flow increases to the extent that she is soaking a “pad” within an hour.  A portion of the placenta may have remained in the uterus, which can prevent the uterus from contracting and closing off the blood vessels, leading to hemorrhage.  A woman should also contact her doctor/midwife if the lochia develops a foul odour, if she develops a fever, experiences malaise or abdominal pain, which are signs of infection.

Bladder and Bowel

• Perineal tenderness may make a postpartum woman reluctant to empty her bladder.  Diluting the urine by drinking lots of water may help to reduce the burning.  Spraying water from a squirt bottle over the perineum while urinating, or urinating in the tub or shower may also help.

• Discomfort may lead to reluctance in having a bowel movement (BM).  Often women do not have a BM until several days after delivery because of loose stools during labour, a pre-delivery enema, or little to eat during labour and the days following.  Activity, lots of fluids and high fiber foods will help soften stools.  With stitches, it may be helpful to support them with a wet washcloth when passing that first bowel movement.

Birth Control

• Because it is difficult to predict when ovulation and menstruation will return, birth control is recommended.  Normally a first menstrual period begins 1 to 4 months after baby’s birth, if mother is not breastfeeding.  If breastfeeding, this may be delayed until baby is weaned.   Remember that an egg is released two weeks before menstruation, so another pregnancy could be conceived before a woman’s first postpartum menstrual period.

• At the six-week checkup, discuss birth control options with your doctor.

• Visit the Sexual Health section for more information on birth control options.

Sex

• Sex may be the last thing on the minds of new parents.  The woman is recovering and may have perineal pain and vaginal dryness from altered hormone levels.  She and her partner are adjusting to their new parenting role and may feel tired or overwhelmed with the increased responsibility and change in priorities.
• When you are ready, spend time getting reacquainted.  Chances are you have only talked to each other about the baby.  Becoming intimate may require some mood setting.  You may want to try a water-soluble gel (K-Y jelly) for lubrication.  Experiment with different positions for lovemaking to lessen the discomfort of a tear or episiotomy.  Visit the Sex During and After Pregnancy page for  more information.