Post-Partum (After Delivery) AKA, Puerperum

December 14, 2007

The Puerperum (Post-partum period)

After the birth of your baby, either by normal vaginal delviery or by C-section, there are many changes that take place to reconstitute you to the non-pregnant state. There are dynamic fluid shifts that can take up to two weeks to equilibrate, resulting in prolonged swelling for some time after delivery. The uterus (womb), within hours of delivery, is already less than half the size it was while pregnant. Lochia, or normal post-partal bleeding, can last up to a month to six weeks. Breastfeeding (see below) will help contract the uterus, decreasing the amount of bleeding from it. Nipple stimulation evokes a response from the pituitary gland in the brain to release oxytocin (the same stuff as pitocin used to induce or augment labor). With each breastfeeding episode, there is an initial "crunch" of the uterus contracting, the so-called "afterbirth pains." Therefore, breastfeeding, and therefrom, afterbirth pains, have an evolutionary survival function, helping to limit blood loss from the uterus after deliveries.

The Best Fed Are Breast-Fed, or...The Mammalian Art of Breastfeeding

Because we're mammals, we have retained several physical characteristics that are pinnacles of evolution. None is as nurturing to our kind, however, as breast-feeding. Besides the obvious nutritional superiority over formula, there are also the bonding, affection, and warmth of the maternal-newborn exchange that snuggling in this way affords.

The infant's face, where most of the nerve sensitivity is centered, is surrounded by motherly bosom--a physical act of love. And from this act of love, life flows, literally. The lactating breast answers the infant's mouth, satisfying the void that the suckling fills.

Indeed, the mother and breast-feeding child constitute a different mammal altogether, a unique unit of togetherness. So with all of this beauty, free for the asking, why do so many women choose to forego it by bottle-feeding?

First of all, few women get proper instruction in the art, either from their own mothers or from their doctors. Everyone is so busy and frantic preparing for the new baby, that no one is preparing for the actual feeding. Instruction is sparse at best, with most advice consisting of nothing more than let the baby latch on and then hope the whole deal takes.

Work is the other enemy of breast-feeding. Employment has expectations, none of which include a twenty to thirty minute break every two to four hours for breast-feeding.

Failure outright is the final disappointment sending new parents to the grocery to anguish over iron, soy, and concentrate. Although true breast-feeding failure can happen, it is rare. Most failure occurs because of pain and impatience with or worry over the amount of flow. There are many hormones and processes necessary for milk let-down, so a new mother and father should expect a grace period after the birth for the process to engage. And nutritional deprivation for the baby need not be a concern, because a full-term infant has a few days of food supply on board, so any success is extra during this time. Within a couple of days of delivery, any concerns can be addressed by a pediatrician.

The precursor of the more dilute milk, colostrum, is an immunological protection for the baby, providing maternal antibodies that are such an important edge in fighting infection. But full milk flow may take three to four days, so the breast-feeding woman should relax while the interaction between infant and breast is fine-tuned.

Each breast can be drained in around ten minutes, the highest fat in the last part. Once a rhythm is established, most breast-feeding schedules are punctuated by feedings every two to four hours. A mother should drink a lot of fluids during this dehydrating action for her, and she can judge the adequacy of hydration and nutrition of her baby by expecting six or seven wet diapers a day. With patience and determination, most breast-feeding attempts end in a satisfying maternal-infant nurturing experience. But just dabbling in it is not enough.

Supplementing with bottles will fail, because a baby will from then on prefer the easier draw of the artificial nipple. Stopping temporarily because of infection of the breast (mastitis) will often cause a permanent end to breast-feeding. It is safe for the baby to continue breast-feeding even then, because the infection probably originated from the normal bacteria in the baby's own mouth.

This is a small article making a small attempt to enthuse mothers-to-be. Whole books have been written on the subject, and they are excellent. Although some espouse their own views of political correctness on the subject, the medical information is usually right on target. Breast-feeding--there really is nothing like it.

Breastfeeding...and subsequent Pregnancy

Q & A: I was wondering if you can get pregnant while breastfeeding if you don't have your period?

Breast-feeding has been the natural contraception relied upon for the entire history of womankind. It's not foolproof, but it has helped make our species prosper so that offspring could be raised properly. Breast-feeding has helped space out children so that parenting could be concentrated on each child one at a time.

Think about this. If women had babies every nine months, what type of child-rearing would our species have had to rely on to advance? Babies are not born with a lot of animal instincts--they have to be raised, trained, and educated.

Breast-feeding has also made it possible for women to get older. Childbearing was a risky proposition before the availability of modern life-saving medical technology. A woman who had more babies had more risk of dying than a woman having fewer pregnancies. Breastfeeding, with its natural contraceptive tendencies, allowed more women to survive thanks to less total risk. In the human race, the matriarch--the older woman who would teach the younger ones how to raise children--was indispensable to our survival. We would probably not be here were it not for women being able to survive into an age where their wisdom could be passed down.

Prolactin, the milk "let-down" hormone, causes the other components of the menstrual cycle to be suspended. In fact, an elevated prolactin, in some tumors, can be a cause of infertility. In previous generations, women with these types of tumors would continue to make milk for years and would "rent themselves out" for babies of working mothers. This was actually an honorable profession and these women were called Wet Nurses.

Since prolactin causes the components of the cycle to be suspended, this is why periods are irregular or even non-existent in breastfeeding women. Usually.

Usually?

Yes, some women's bodies rise above breastfeeding and begin cycling normally. This usually means that they're ovulating normally, and these are the women who can get pregnant while breastfeeding.

So after ruminating over the evolutionary, social, and humanistic importance of breastfeeding, the answer to your question is this: If you're having normal periods while breastfeeding, beware, because you're probably having regular ovulations and can conceive. If your periods are erratic, then your ovulations are too, and pregnancy is less likely, but still not impossible.

(As an extra aside, let me mention that at times women come to me pregnant while still breastfeeding the last baby. Unfortunately this must stop, because suckling can stimulate powerful uterine contractions, perhaps initiating premature labor. The release of the contraction-causing oxytocin hormone also has a survival value, because when a baby would breastfeed immediately after a delivery, the resulting strong uterine contractions would diminish the blood loss.

But strong uterine contractions, as you might guess, does a premature baby no good at all.)

Circumcision Is Usually a Personal Preference

When the new baby is a boy, parents are offered a procedure called circumcision. It is a word that is really self-explanatory, "-cision" meaning incision, or cut, and "circum-" meaning around. The top of the foreskin, that part that slides over the top of the penis, or "glans," is removed surgically, effectively exposing the area previously covered. In the newborn, it is usually done by the obstetrician or the pediatrician in a quick, simple manner. A benefit readily offered is the ease of hygiene.

Smegma, the thick secretion which is seen to accumulate under the foreskin, is considered undesirable. In fact, smegma is thought to be a possible carcinogen, even though cancer in this area is extremely rare. Covering an area wherein urine can be trapped can be a theoretical concern for urinary tract infections and other inflammatory conditions. Also, phimosis, the condition in which the foreskin is stuck tightly around the penis once it's been forced down around it, can cause very painful episodes in a young boy's life. So circumcision, a practice as old as antiquity itself, is touted as the solution to uncleanliness, cancer, and pain, all of which may be hogwash.

What is worth noting is that most parents make a decision for or against circumcisions for cosmetic reasons.

They feel this is reason enough, because all of the above cautions are either easily avoided or extremely unlikely. The parents wonder whether most of the boys in the school gym shower will be just like their son--or more importantly, what can be done to make their son just like most of the other boys around. They don't want their son to be different-- especially "there," in that part of the anatomy that has more than anatomical importance when someone falls for the myths of masculinity along with the realities.

It is strange that I can talk about circumcision as if it were just another usual expectation of medical care. Actually, it's really unusual, most of the world choosing not to circumcise their young sons. Except for North America and Israel, the practice may be looked at as deforming. In fact, many here feel the same. They say that because it really is only a cosmetic procedure, it shouldn't be forced upon infants. They say it is a breach, an uninvited altering within one's privacy. They feel that it may forever diminish full sexual sensitivity. Additionally, they speak of the pain, even in an infant, which must go somewhere--even if it's not remembered.

On the other hand, proponents for circumcision argue that it just may not be that important, that no one who's had it regrets or remembers it. One thing is true--that it's easier done earlier than later, as demonstrated by the baby who sleeps untroubled in his mother's arms a moment after. Like most philosophical exercises, there can be no morally absolute, political, or obviously logical answer. It is a personal decision, and it is one of the first decisions parents will make in raising their son.

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