You have already learned that during pregnancy, hormonal influences will cause changes on the mother's body. These changes, during the postnatal period, will return back to their normal anatomical and physiological state. Now we will try to see these changes one by one.

Uterus

The uterus changes from the pregnant state to the non pregnant state. Or immediately after delivery of the baby the uterus became level of the umbilicus

Lochia

It is a discharge which comes from the placental site and maintains for 4 - 6 weeks. It is classified into three based on its contents.

• Lochia rubra: Red in colour and maintains the first three days.
  
• Lochia serossa: Pink in its colour and stays for two weeks.
• Lochia alba: This is the last, which is white in its color and maintains for 2 - 3 weeks.

Perineum

This is the place which is found between the anus and the vaginal opening; it is made of different muscles which are overlapped one on the other to give it strength. But sometimes when the pushing force of the baby is higher during labor, it may get torn or traumatized. During labor, these muscles will stretch to a remarkable size to allow the passage of the baby. Then after six weeks, it regains its tone and strength. It is necessary to help the mother stretch and relax the muscle repeatedly and daily in order to help it get its strength or tone.

Abdominal wall

The abdominal wall stretches too much throughout the course of pregnancy and can completely lose its normal tone. But after the baby is delivered, it may get back to its normal strength depending on the extent of the exercise the mother performs.

Ovaries

The ovaries normally will gain their functions but the functionality of it depends on the extent of the breastfeeding by the mother. If the mother is capable of breastfeeding exclusively from the start and at least 10 - 12 times a day the ovaries may not produce the ova, this intern will help the mother as a natural family planning method.

After pain

After expulsion of fetus and placenta the uterus contracts to regain its normal size, weight and site, this called involution of uterus. Oxytocin is released from the posterior lobe of the pituitary gland in response to the sucking, which facilitates uterine contraction. The main characteristics of after pain are as follows:

• Occur during the 1st 2-3 days of puerperium.
• Abdominal pains (like cramps) and back pain.
• Strong, regular, and coordinated.
• The intensity, frequency and regularity of contraction decrease after the 1st postpartum day.

Constipation

It is common for the first few days of puerepurium and is due to the factors like:

• The woman's food intake is interrupted.
  
• There may be dehydration during labour.
  
• The abdominal muscles are lax.
  
• Perineal lacerations make defecation painful.
  

Psychological changes

Because this is the period of transition from the non mother state to the mother state, some women may deny this and develop mild to severe forms of mental disorders. For instance:

• Mild degree of depression and emotional liability (normal).
  
• Puerperal psychosis, confusion with disorientation in time, space and a complete loss of interest in the child and it is abnormal. You will see this in detail in the next session.

Systemic changes like:

• Blood volume returns to non-pregnant levels by the tenth days of puerperium
• Cardiac output ↑ (immediately after delivery) → slowly declines→ reach late pregnancy levels 2 days postpartum→ normal 2-6 weeks.

• Hemoglobin concentration increase on the first postpartum days.
• Several clotting factors (fibrinogen) increase on the first days.

• There is diuresis in the first two days of puerepurium.
• Retention of urine(inability to pass urine) may occur either due to the sphincter or reflex from perennial trauma.

Breast:

• Lactation can occur by 16 weeks' gestation.
  
• Lactogenesis (the initiation of milk secretion in the breast) is initially triggered by thedelivery of the placenta.