Regression of the cervix (Portio uteri)

The cervix, which has dilated during birth, also recedes during the course of the puerperium. It is already only finger-wide on the 10 day after the birth. The postpartum flow (lochia) starts immediately after birth and lasts for about 4 – 6 weeks.

It represents a wound healing of the endometrium, from which the placenta has detached itself and consists of a composition of blood, dead cells (detritus), lymph, inflammatory cells and inflammatory fluid (serous exudate) that changes during the puerperium. Immediately after birth and in the first week during the postpartum period, the postpartum fluid (lochial secretion) is bloody and is called red postpartum fluid (lochia rubra). At the beginning the wound flow can be around 500 ml.

It decreases during the course of the postpartum period. The proportion of blood in the postpartum flow also decreases, as the vessels of the uterine lining are squeezed (compressed) by the postpartum and the bleeding stops. In the second week during the postpartum period, the postpartum flow looks brown (Lochia fusca), then becomes yellow (Lochia flava) in the third week and is whitish or colorless (Lochia alba) from the fourth week.

Wound Healing

The wound of the episiotomy, or the perineal or vaginal tear that may have occurred, heals well in the puerperium.

Degeneration of the pelvic floor muscles

The pelvic floor muscles, which were stretched during pregnancy, recede within six weeks after birth.

Reduction of pregnancy edema

The fluid stored during pregnancy (edema) recedes within the postpartum period. Depending on how much water is stored, the woman loses about 5 – 10 l of fluid.With the end of pregnancy and the beginning of the puerperium phase, the pregnancy and sex hormones in the body also change. The pregnancy hormones, such as the hormone HCG (Human Chorionic Gonadotropin) produced by the child or the hormone HPL (Human Placental Lactogen) produced by the placenta, which were used to maintain the pregnancy, are no longer produced and existing hormones are broken down, so that the level of these hormones in the blood is soon no longer detectable.

The concentration of the sex hormone progesterone in the blood, which was also produced by the placenta in the second half of the pregnancy and served to maintain the pregnancy, also decreases during the puerperium. The breakdown product of the progesterone Pregnadiol can be detected in urine at most one week after delivery. The decrease in the concentration of the sex hormone progesterone leads to increased production and secretion of the hormone prolactin.

Prolactin is responsible for milk production (lactogenesis). As this hormone increases, milk production also begins. The concentration of the hormone oxytocin is also increased. Oxytocin is responsible for milk flow (milk secretion).