Postpartum period

Last updated: August 8, 2023

Summarytoggle arrow icon

The postpartum period refers to the six-to-eight-week period after the birth of a baby in which the body recovers from the changes caused by pregnancy and birth. During this time, the body undergoes several physiological changes, such as uterine involution, discharge of lochia (postpartum vaginal discharge), and the beginning of the lactation process. Women are also susceptible to complications during the postpartum period, such as infection, thrombosis, insufficient postpartum recovery, and postpartum depression. The fundal height measurement and the appearance of lochia provide important clues to possible underlying conditions.

Normal postpartum changestoggle arrow icon

Low‑grade fever, shivering, and leukocytosis are common findings during the first 24 hours postpartum and do not necessarily indicate an infection.

Uterine involution

  • Begins immediately after birth and the delivery of the placenta
  • Afterpains: painful cramps from contractions of the uterus following childbirth
  • The uterus returns to its normal size by the 6th–8th week postpartum.

Lochia (postpartum vaginal discharge)

  • Definition
    • The birthing process and placental detachment lead to uterine lesions, which discharge a special secretion when healing.
    • This secretion, together with the cervical mucus and other components, forms the lochia.
  • Most women pass lochia for about 4 weeks after delivery; in some cases, this lasts for 6–8 weeks.
    • Lochia rubra: blood red; approx. the first 4 days after birth
    • Lochia serosa: brown red; watery consistency, lasts approx. 2–3 weeks
    • Lochia alba: yellow white; lasts approx. 1–2 weeks


Fundal height postpartum Lochia
Right after birth Between the navel and symphysis Blood red
After the 1st day Navel Blood red
3rd day 3 fingerbreadths under the navel (descends 1 fingerbreadth per day) Blood red to brown-red
7th day Between the navel and symphysis Brown-red
10th day Symphysis Brown-red
12th–14th day Symphysis Yellowish
17th–21st day Symphysis Yellow-white

Weight loss


Infant nutrition and weaningtoggle arrow icon

Breastfeeding [6][7][8]

General considerations

  • It is recommended that infants be exclusively breastfed up to the age of 6 months.
  • On-demand feeds are recommended.
  • Breastfeeding plays an important role in mother-child bonding.

Physiology of lactation

Breast milk composition

Breast milk contains all the required nutrients (except vitamin D and vitamin K) for infants up to 6 months of age.

Mature milk (from the 14th day)

g/100 mL

Cow's milk

g/100 mL

Proteins 1 3.4
Carbohydrates 7 4.6
Fat 3.8 3.7
Calories (kcal) 66 65
Unsaturated fatty acids 1.6 1.3
Salts/minerals 0.2


Benefits of breastfeeding [7]

Contraindications to breastfeeding [7][10]

Breastfeeding complications and problems

Formula feeds [12][13][14]

  • Supplementation with formula is only recommended if:
    • Neonate loses > 7% of birth weight during the first 10 days of life
    • Neonatal urine output is decreased
    • Neonatal stool output is decreased (< 3 small stools per day)
    • Maternal breast milk production is inadequate
    • Breastfeeding is contraindicated
  • Lactose protein-based formulas should be fortified with iron to satisfy the infant's iron needs.


Weaning [19][20]

  • Solid foods should be slowly initiated in infants between 4–6 months of age, with continued breast/formula feeding.
  • The recommended initial weaning food is rice cereal fortified with iron.
  • One new food should be introduced per week to allow easy identification of food allergies.
  • Pureed meat, green leafy vegetables, and dried beans are good sources of iron and zinc.
  • Honey should not be given to infants because of the risk of botulism.
  • Cow's milk can be introduced into the diet after 1 year of age.

Postpartum complicationstoggle arrow icon


Postpartum endometritis [21][22][23]

Postpartum sexual dysfunction

Other uterine complications


Septic pelvic thrombophlebitis [24][25][26]

Other thromboembolic complications

Puerperal sepsis [27]


Postpartum urinary retention (PUR) [31][32]



Diastasis recti

Pubic symphysis diastasis [34]

Referencestoggle arrow icon

  1. Chen KT. Postpartum endometritis. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. Last updated: September 9, 2016. Accessed: April 27, 2017.
  2. Antibiotic regimens for postpartum endometritis. Updated: February 2, 2015. Accessed: April 27, 2017.
  3. Rivlin ME. Endometritis. Endometritis. New York, NY: WebMD. Updated: March 20, 2016. Accessed: April 27, 2017.
  4. Chellman-Jeffers MR. Ovarian Vein Thrombosis. In: Lin EC, Ovarian Vein Thrombosis. New York, NY: WebMD. Updated: January 9, 2016. Accessed: October 30, 2017.
  5. Chen KT. Septic Pelvic Thrombophlebitis. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. Last updated: February 24, 2016. Accessed: October 30, 2017.
  6. Septic thrombophlebitis. Updated: September 5, 2018. Accessed: June 1, 2019.
  7. Organization WH. WHO Recommendations for Prevention and Treatment of Maternal Peripartum Infections. World Health Organization ; 2016
  8. Bacterial Sepsis following Pregnancy. Updated: April 1, 2012. Accessed: October 26, 2021.
  9. Majangara R, Gidiri MF, Chirenje ZM. Microbiology and clinical outcomes of puerperal sepsis: a prospective cohort study. J Obstet Gynaecol (Lahore). 2018; 38 (5): p.635-641.doi: 10.1080/01443615.2017.1399112 . | Open in Read by QxMD
  10. Manning-Geist B, Rimawi BH. Severe Infections in Obstetrics and Gynecology: How Early Surgical Intervention Saves Lives. Journal of Clinical Gynecology and Obstetrics. 2016; 5 (1): p.1-16.doi: 10.14740/jcgo368w . | Open in Read by QxMD
  11. Yip SK, Sahota D, Pang MW, Chang A. Postpartum urinary retention.. Acta obstetricia et gynecologica Scandinavica. 2004; 83 (10): p.881-91.doi: 10.1111/j.0001-6349.2004.00460.x . | Open in Read by QxMD
  12. Yip SK, Brieger G, Hin LY, Chung T. Urinary retention in the post-partum period. The relationship between obstetric factors and the post-partum post-void residual bladder volume.. Acta obstetricia et gynecologica Scandinavica. 1997; 76 (7): p.667-72.doi: 10.3109/00016349709024608 . | Open in Read by QxMD
  13. Cavkaytar S, Kokanalı MK, Baylas A, Topçu HO, Laleli B, Taşçı Y. Postpartum urinary retention after vaginal delivery: Assessment of risk factors in a case-control study.. Journal of the Turkish German Gynecological Association. 2014; 15 (3): p.140-3.doi: 10.5152/jtgga.2014.13102 . | Open in Read by QxMD
  14. Stolarczyk A, Stępiński P, Sasinowski Ł, Czarnocki T, Dębiński M, Maciąg B. Peripartum Pubic Symphysis Diastasis-Practical Guidelines.. Journal of clinical medicine. 2021; 10 (11).doi: 10.3390/jcm10112443 . | Open in Read by QxMD
  15. Berens P. Overview of postpartum care. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. Last updated: March 3, 2017. Accessed: April 27, 2017.
  16. Mangesi L, Dowswell T. Treatments for breast engorgement during lactation.. Cochrane Database Syst Rev.. 2010; 8 (9).doi: 10.1002/14651858.CD006946.pub2. . | Open in Read by QxMD
  17. What Are Significant Contraindications for Breastfeeding?. Updated: September 13, 2010. Accessed: April 27, 2017.
  18. Dudenhausen JW, Obladen M. Practical Obstetrics. Walter de Gruyter GmbH & Co KG ; 2014
  19. Wagner CL. Human Milk and Lactation. In: Rosenkrantz T, Human Milk and Lactation. New York, NY: WebMD. Updated: February 2, 2015. Accessed: October 30, 2017.
  20. Binns C, Lee MK, Low WY. The long-term public health benefits of breastfeeding. Asia Pac J Public Health. 2016; 28 (1): p.7-14.doi: 10.1177/1010539515624964 . | Open in Read by QxMD
  21. Breastfeeding . Updated: April 12, 2017. Accessed: June 30, 2017.
  22. Moore ML. Current research continues to support breastfeeding benefits. J Perinat Educ. 2001; 10 (3): p.38–41.doi: 10.1624/105812401X88327 . | Open in Read by QxMD
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  24. AAP Section on Breastfeeding. Breastfeeding and the Use of Human Milk. Pediatrics. 2012; 129 (3): p.e827-e841.doi: 10.1542/peds.2011-3552 . | Open in Read by QxMD
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  26. Acceptable medical Reasons for Use of Breast-Milk Substitutes. Updated: January 1, 2009. Accessed: June 30, 2017.
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  28. Formula Feeding. Updated: November 1, 2016. Accessed: June 30, 2017.
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  30. við Streym S, Højskov CS, Møller UK, et al. Vitamin D content in human breast milk: a 9-mo follow-up study. Am J Clin Nutr. 2015; 103 (1): p.107-114.doi: 10.3945/ajcn.115.115105 . | Open in Read by QxMD
  31. WHO. Guideline Daily Iron Supplementation in Infants and Children. World Health Organization ; 2016
  32. Vitamin B12 Fact Sheet for Health Professionals. Updated: March 30, 2020. Accessed: September 4, 2020.
  33. Solid Foods in Infancy. Updated: November 1, 2016. Accessed: June 30, 2017.
  34. Schanler RJ, Potak DC, Abrams SA, Duryea TK, Hoppin AG. Initiation of Breastfeeding. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. Last updated: March 28, 2017. Accessed: June 30, 2017.

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