- [Voiceover] You know,
they say that a woman is never the same after she has a baby, but your body works pretty hard, and it starts working right
after the baby is born, to get the body back into
its pre-pregnancy state. It usually takes somewhere
along six to eight weeks to occur, for most of the
organ systems to go back to working the way they
did before pregnancy. What happens right after delivery occurs? For some women, something like twenty-five to fifty percent of women,
so almost half of all women, start shivering. These postpartum shivers, they usually start within
thirty minutes of delivery, and they last anywhere
from two minutes long, to being an entire hour long. We're not exactly sure why they occur. We think that it might be related to sudden thermal imbalances from the separation of the placenta. Maybe it's related to certain
medications or anesthesia that's used during the delivery, or, perhaps, even, due
to bacteria in the blood. We're not exactly sure why they occur, but, in any case, there's
no real treatment for them, other than to give the
woman a warm blanket. They tend to resolve on their own, so, maybe not as clinically significant, but it's important to
know so that you're not startled when you see them
or you experience them for the very first time. Starting with the uterus,
let's talk about what happens after the baby and the
placenta are delivered. Immediately after delivery,
the uterus starts to contract. I mean, baby's out, placenta's out, the uterus immediately starts to contract. After a few of those
successive contractions, the uterine muscle starts to shorten. Those contractions also help
to constrict the blood vessels that are running through
the uterine muscle. That helps to control any
bleeding that might be going on. When you palpate the uterus,
when you feel for the uterus, the uterus should feel more
firm and feel more globular than it did in the pregnancy. Within about twenty four
hours after delivery, the uterus shrinks down,
so you can feel the fundus, which is the top of the
uterus, kind of, at the level of the umbilicus, so at the
level of the belly button. By one week postpartum,
the fundus can be felt halfway between the umbilicus
and the pubic symphysis, so, pretty rapid reduction. Then, by two weeks, you can't
feel the fundus anymore. Within six to eight weeks, it's
returned to its normal size, so, pretty quick reduction
back down to its normal size. The shrinking of the uterus
back down to its normal size, is affected by a couple
of different things. In women who had multiple
babies in the past, and in women in whom
the delivery of the baby occurred by C-section, rather
than by vaginal delivery, the uterus tends to be larger. Compare that with breast-feeding. Breastfeeding tends to cause a quicker reduction in the size of the uterus. A lot of that has to do with
a hormone called oxytocin. So there's hormone called oxytocin that's released from the brain. The primary function of oxytocin has nothing to do with the uterus. The primary function of
oxytocin is to contract the ducts of the breast,
to help release milk. One of the side effects, I
guess you could say, of it, is that it also causes
the uterus to contract, causing it to shrink at a faster rate. That's why women who breastfeed have a quicker shrinking rate,
essentially, of the uterus than women who do not breastfeed. With regards with what's going on on the inside of the uterus,
remember that the placenta attaches itself to the decidua basalis. The placenta is attached
to the decidua basalis of the uterus. That decidua basalis,
that lining of the uterus, is left behind after
the placenta separates. It's left behind, and what it does is, it splits up into two different layers. There will be the superficial
layer, which is shed, and the deeper layer, which sticks around, and it regenerates a new endometrium. When the bloody desidua
sheds, it does so for the first few days following delivery. The woman observes that, she sees it. It's referred to as lochia rubra. The lochia rubra, rubra
meaning red, right, so it's red lochia. After that, the vaginal
delivery becomes very watery. That's called called lochia serosa. That lochia serosa lasts for
about two to three weeks. Ultimately, that vaginal
discharge turns more yellow, yellow-white color. Then it's referred to as lochia alba, with alba meaning white. You can see that vaginal discharge, a significant amount of vaginal discharge lasts for about a month
following delivery. It's not just the uterus which
contracts to become smaller, the cervix and the vagina
do the exact same thing. After delivery, the cervix,
which is the opening of the uterus through which
the baby passes through, as you can probably imagine,
is pretty soft and floppy. After delivery, the
cervix starts to contract. By one week postpartum, you'll see that it's somewhere less than one inch dilated. The external os, or the
external opening of the cervix, actually, never returns to the same shape that it had before pregnancy. Instead of being this small, smooth, circular opening, it becomes a large, sort of, horizontal
slit, after childbirth. Similarly, the vagina is very smooth and dilated after delivery. It slowly, very slowly, contracts to shrink down, but, usually, it doesn't reach its pre-pregnancy size. As the swelling reduces,
the rugae of the vagina come back, usually
within three weeks or so, so the smooth surface is
replaced by the typical rugated surface of the vagina. Normally, it's safe to resume sex about three to four weeks postpartum. Finally, with regards to
the return of ovulation and the return of menses,
that usually occurs within six to eight weeks after delivery in women who don't breastfeed, so that's an important distinction. In women who do not breastfeed,
menses and ovulation usually return within six to eight weeks. In women who do breastfeed, however, ovulation and menses don't
return for up to six months, during the time the
woman is breastfeeding. That's because in order
to sustain breastfeeding, the hypothalamus, which is in the brain, has to produce a hormone called prolactin. So the hypothalamus produces
this hormone called prolactin, which is really important
for stimulating lactation. However, prolactin also inhibits,
I guess you can say again, this is one of the side
effects of this hormone, prolactin also inhibits
sex hormone production, which prevents ovulation from occurring. In fact, in some
under-developing countries, breastfeeding is used as a
main method of contraception after delivery, after
the woman gives birth. Those are some of the changes that occur after the baby is delivered.