The 3 Postpartum Phases Explained (Everything You Need To Know)

There are at least 3 distinct postpartum phases that you go through after delivering your baby.

  • The first phase is the immediate 6-12 hours after birth.
  • The second phase is the following 6 weeks after delivery.
  • And the third phase is from week 6 to six months.

Let’s go into more details!

postpartum-phases

Disclaimer

***READ FIRST***

Although I am a doctor, I am not your doctor. This information is for informational purposes only and should not substitute the advice from your healthcare professional. All kinds of exercise and dietary changes are potentially dangerous, and those who do not seek counsel from the appropriate health care authority assume the liability of any injury which may occur. Please read my full Disclaimer for more information. Also, this post may contain affiliate links: meaning I may receive a commission if you use them.

Ok, moving on.

How Long Is The Postpartum Period?

The postpartum period lasts from the time you deliver to approximately 6 months.

We divide it up into three distinct phases.

What Are The Phases Of Postpartum?

There are three postpartum phases that most women will experience.

Each phase is unique in that your body will begin to experience new and exciting changes as it begins to transition back to a non-pregnant state.

Let’s describe each phase in more detail.

Phase 1

Phase 1 starts 6 hours after delivery.

This is a critical time for you and your baby.

You may still be on the labor and delivery unit, or you may have been transferred to the postpartum unit.

During this time we will monitor you closely as there are several postpartum complications we want to avoid.

Some of the things we will be monitoring include your:

1. Heart rate

Your heart rate is the number of times your heart beats in one minute.

During pregnancy, it is normal to have a slightly increased heart rate due to all the physiologic changes that have occurred.

Postpartum, however, a fast heartbeat can be more concerning. Tachycardia is the term we use to describe a rapid heartbeat.

This can occur in the postpartum period due to:

  • Excitement over your new baby
  • Pain
  • Anemia, or excessive blood loss after your delivery
  • Pulmonary embolism, which is a blood clot in your lungs

We will do a thorough examination if we are concerned about any of these things.

The next thing we will be measuring is your blood pressure.

2. Blood pressure

Blood pressure monitoring is especially important to ensure you are not developing postpartum preeclampsia or high blood pressure.

Preeclampsia is diagnosed when you have elevated blood pressure of at least 140mmHg systolic or 90mmHg diastolic plus proteinuria (protein in your urine).

Preeclampsia can also present with headache, blurry vision, epigastric pain as well as right upper quadrant abdominal pain without protein in the urine.

postpartum-preeclampsia

Be sure to speak with your doctor if you are experiencing any of those symptoms.

3. Oxygen saturation

A deep venous thromboembolism (DVT) is a blood clot that most commonly occurs in the lower legs.

If these blood clots break off and travel to your lungs, it is known as a pulmonary embolus or PE for short. A PE is especially dangerous because it can impair the amount of oxygen your lungs receive and cause severe respiratory distress.

Signs of a PE include low oxygen saturation, difficulty breathing, tachycardia, and chest pain.

This is a medical emergency that requires immediate treatment.

All postpartum and pregnant women are at increased risk of DVT and PE due to the increase in estrogen that is circulating during pregnancy.

Pregnant and postpartum women are 4x more likely than the general population to develop a blood clot, with postpartum having the highest risk.

If you had a cesarean delivery, you are at risk as you may not be as quick to ambulate as those who had a vaginal birth. Because of this, you may have compression devices on your lower extremities while you are in bed, and may even be receiving blood thinners like heparin or lovenox.

4. Vaginal bleeding

Next, we will be checking your pad, to ensure that your postpartum bleeding is not too heavy.

A moderate amount of lochia, or vaginal bleeding after delivery, is normal but anything excessive should be evaluated as it could be a sign of a postpartum hemorrhage or PPH for short.

lochia

Postpartum hemorrhage remains one of the leading causes of maternal morbidity and mortality.

A primary PPH occurs up to 24 hours postpartum.

A secondary or delayed PPH can occur up to 24 hours postpartum!

Risk factors include:

  • Being multiparous or have had at least 1 baby in the past,
  • Long labor,
  • Having delivered a macrosomic infant (aka big baby),
  • Twin delivery

Ok, so now that you know all about phase 1 and what to look out for, let’s move on to phase 2.

Phase 2

The second phase of postpartum lasts until week 6.

It is during this phase that your body will undergo many physiologic changes.

The systems affected are your vascular, endocrine, genitourinary, and gastrointestinal systems.

  1. Your blood volume will begin to decrease,
  2. Your pregnancy hormones like bHCG, estrogen, and progesterone decrease back to pre- pregnancy levels.
  3. You may experience urinary incontinence
  4. Your appetite may change.

You may also experience feelings of sadness, guilt, loss of interest, and decreased energy, during this time.

These symptoms could be a sign of postpartum depression (or baby blues) which is typically diagnosed during this phase.

If you feel like you may be depressed or are experiencing any of these symptoms, please speak with your health care provider immediately so that you can get the care you need.

Phase 2, is also the time at which you should have your postpartum appointment.

postpartum-appointment
  • If you had a cesarean section this appointment will occur 1-2 weeks after the surgery and again at postpartum week 6.
  • If you had a vaginal delivery your postpartum appointment will occur at ~ week 6.

During your postpartum appointment, your vital signs will be checked and you will have a full physical examination to check your uterine size, any lacerations you had repaired after delivery, vaginal bleeding, etc.

You will also be checked for resolution of gestational diabetes if necessary.

Now let’s talk about phase 3.

Phase 3

The final phase is the third phase.

This is the delayed period which lasts up to 6 months.

Physiologic changes that are occurring in your body are more gradual during this time, and it is rare for you to have a problem related to your pregnancy.

It is really not until this point that your physiology is that of a non-pregnant patient.

During phase 3, the connective tissues and muscles are undergoing restoration and repair.

Lastly, just so that you are aware- the changes that are occurring in your genitourinary system may take a longer time to resolve and may actually never fully resolve to that of a non-pregnant patient.

Ok, moving on.

How Long Does It Take For A Woman’s Body To Go Back To Normal After Pregnancy?

Every woman recovers from pregnancy at a different rate. On average, some women may go back to “feeling normal” 6 weeks after delivery while others can take at least 6 months to get back to pre-pregnancy feel.

With that said, try not to compare yourself to others. The entire first year of postpartum recovery can be full of surprises.

We are all different and our bodies are unique.

Give your body the time, love, and attention it deserves!

What Are The Physiological Changes During The Postpartum Period?

There are many physiological changes that occur in the postpartum period.

Some of those changes include:

1. Involution of the uterus

Involution of the uterus occurs when the uterus begins to return to its pre pregnancy size.

Let’s think about this.

The uterus starts out as the size of a small lemon.

To accommodate your full term baby, the uterus grew to the size of a watermelon!

The uterus will begin to contract down to return to a normal size right after the delivery of the placenta, but it takes time.

In fact, breastfeeding can help this process.

You ever wonder why your uterus starts contracting as you breastfeed? 😉 It is helping the process.

2. HCG, estrogen and progesterone decrease 

The hormone beta human chorionic gonadotropin, or bHCG for short, as well as estrogen and progesterone begin to decrease in the postpartum period.

HCG, progesterone and estrogen are 3 important key players throughout the pregnancy and keep the pregnancy viable.

Once the baby is delivered these hormone levels begin to drop, which can contribute to the mood and psychological changes many new mothers experience postpartum.

Thyroid hormone levels will also begin to normalize.

hormone-level-postpartum

3. Blood volume begins to decrease

Your blood volume also begins to decrease as you no longer have a fetus or placenta to deliver oxygen and nutrients to.

As a result, you will be peeing out a lot of this extra fluid in the first couple of weeks postpartum.

4. Your body prepares for breast milk production

The secretion of colostrum from your breasts begins to increase as the breasts begin to respond to the hormone prolactin.

High levels of estrogen and progesterone are what prevent your body from secreting breast milk while you’re pregnant.

5. Appetite changes

Lastly, you can experience changes in your appetite due to the varying levels of hormones circulating in your body that regulate your hunger.

I discuss the appetite changes you could expect to experience postpartum, here.

To see a more detailed summary of all the major changes that happen postpartum, check out this resource.

What Is The Peripartum Period?

The peripartum period includes the time right before birth, during birth, and the immediate postpartum period.

Other Related Questions

How long does it take your cervix to close after giving birth?

Your cervix should close around 6 weeks postpartum.

Because your cervix is open for several weeks after giving birth, there are a few things you must avoid during this time period.

What should you not do after giving birth?

After delivery and for the 6 weeks following, you should not:

no-swimming-postpartum

The reason you should not do any of these things is that microorganisms and other virulent pathogens can enter the vagina, travel to the cervix and cause an infection in the uterus.

This uterine infection can present with fever, abdominal pain, and vaginal discharge.

If you are experiencing any of these symptoms please see your OBGYN physician.

What is the difference between postnatal and postpartum?

Postnatal refers to things concerning the baby and postpartum refers to things concerning the mother. However, we generally use these terms interchangeably.

Finals Words On Postpartum Phases

The postpartum period is just as important as your 9 month pregnancy.

This is a time of rapid change and it is beneficial for you to know what those changes are.

Now I want to hear from you.

What was your postpartum experience like?

When did your body go back to normal?

Comment below and let me know


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brittany-robles

Brittany N Robles, MD, MPH, CPT

Brittany Robles is a full-time OBGYN, a NASM certified personal trainer, and health & fitness, expert. She holds a Masters of Public Health degree in maternal health with a special interest in exercise and nutrition. She is also the co-author of The White Coat Trainer. Learn more about her here.



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References:

  1. Heit JA, Kobbervig CE, James AH, Petterson TM, Bailey KR, Melton LJ 3rd. Trends in the incidence of venous thromboembolism during pregnancy or postpartum: a 30-year population-based study. Ann Intern Med. 2005 Nov 15;143(10):697-706. doi: 10.7326/0003-4819-143-10-200511150-00006. PMID: 16287790.
  2. Haeri S, Dildy GA 3rd. Maternal mortality from hemorrhage. Semin Perinatol. 2012 Feb;36(1):48-55. doi: 10.1053/j.semperi.2011.09.010. PMID: 22280866.
  3. Buckwalter JG, Stanczyk FZ, McCleary CA, Bluestein BW, Buckwalter DK, Rankin KP, Chang L, Goodwin TM. Pregnancy, the postpartum, and steroid hormones: effects on cognition and mood. Psychoneuroendocrinology. 1999 Jan;24(1):69-84. doi: 10.1016/s0306-4530(98)00044-4. Erratum in: Psychoneuroendocrinology 1999 Jul;24(5):581. PMID: 10098220.
  4. Chauhan G, Tadi P. Physiology, Postpartum Changes. [Updated 2020 Dec 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK555904/

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