![]() Menstruation does not typically return until 12 weeks or later. Mothers often refer to this as having their milk “come in.” ![]() Prolactin initiates milk production, and the breasts become engorged, as well as warm and tender, between postpartum days 3 and 4. Vaginal dryness and painful intercourse, known as dyspareunia, may be noted during the postpartum period due to decreased estrogen levels.Īfter delivery there is a significant decrease in estrogen and progesterone levels. The vaginal walls are smooth after delivery, and the vaginal folds, known as rugae, do not return until approximately 3 weeks postpartum. The internal os closes almost completely within three to four months of delivery. The shedding endometrium is known as lochia.Īs with all other reproductive organs and structures, the cervix also changes as the body returns to a prepregnancy state. The fundus continues to descend into the pelvis at the rate of approximately one centimeter (finger-breadth) per day and should be nonpalpable by two weeks postpartum.Īfterpains, or intermittent uterine contractions, are a normal occurrence during the postpartum period.Īfter delivery, the endometrial surface of the uterus is shed via the vagina. By approximately one hour post delivery, the fundus is firm and at the level of the umbilicus. Immediately after delivery, the upper portion of the uterus, known as the fundus, is midline and palpable halfway between the symphysis pubis and the umbilicus. The uterus continues to contract after delivery, and its size decreases rapidly as estrogen and progesterone levels diminish. Exfoliation is the sloughing off of dead tissue at the site where the placenta is attached to the uterine wall. Large vessels at the site of placental attachment thrombose to control bleeding.Įxfoliation also occurs at this time. The uterus, with the assistance of the uterine muscles, contracts the uterine vessels and impedes blood flow. The uterus begins a process known as involution immediately after the delivery of the placenta. Some of the physiologic adaptations to the reproductive system are described below: Immediately after delivering, women experience massive shifting as the body returns to its pre-pregnant state.
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