Given the very close eye kept on the mother's progress during her hospital stay, it is likely that any problem will be identified fairly quickly, but what happens when you return home, would you know if something was just not right?

Normal vaginal bleeding

During the early postnatal weeks the raw area to which the placenta/afterbirth was attached begins to heal. A little blood will seep from this placental site, but the uterus itself stops any heavy bleeding by wrapping and clenching its muscle fibres around the severed ends of the blood vessels leading to the placental site. Together with some of the now unwanted lining of the uterus and the general debris of childbirth, this blood escapes via the vagina and is commonly known as lochia. The colour of normal lochia is bright red for the first few days, gradually turning pink as the bleeding lessens and brown as the blood becomes stale. Over the next week the lochia will become a whitish yellow and indistinguishable from normal vaginal discharge. During the first few days the lochia may contain small shreds of tissue but these should be no bigger than a small fingernail. At no time should the lochia contain blood blots. Normal lochia often possesses a rather pungent odour, but it should not smell offensive. In the first few days after delivery the amount of lochia discharged should be about the same as a rather heavy menstrual period but should quickly reduce thereafter.

Red lochia after the sixth postnatal day is abnormal as this indicates that bleeding is still occurring and the advice of a midwife or doctor should be sought at once. Vaginal bleeding is thought to be excessive if sanitary pads become soaked quickly (i.e. within an hour or so) with fresh blood, particularly if blood clots larger than a thumbnail are also passed. In this event, all the pads and clots should be saved for inspection by a midwife or doctor.

Very rarely the bleeding may be so heavy that the mother feels faint and eventually collapses. Should this occur, encourage urination as a full bladder may adversely affect the power of the uterus to control bleeding. If the bleeding continues, lay her flat and gently massage the area of the abdomen just below the navel until you feel her uterus harden under your hand. If this does occur, then it should be capable of controlling the bleeding which should then diminish. If it does not, and the woman is in danger of collapse, keep massaging and send someone to call for an ambulance as she needs immediate medical attention.

Infection of the uterus

Usually the raw placental site heals without problems, but occasionally infections may occur, particularly if fragments of placenta remain in the uterus. If the placental site becomes infected then healing will be delayed, bleeding will continue, the uterus will feel tender and the lochia will remain red, often with an offensive smell. Blood clots may also be passed, these often containing pieces of placental tissue.

In this case, it will be necessary to remove any placental fragments from the uterus. This is usually achieved through drugs prescribed to make the uterus contract and expel the placental tissue. Alternatively (depending on the severity of the problem), the new mother may be admitted to a gynaecological ward and the fragments manually removed via the vagina. This procedure is termed 'evacuation of retained products of conception', and is likely to necessitate at least an overnight stay in the hospital. Most hospitals have facilities for the baby to stay with the mother, this being particularly valuable if you are breastfeeding.

Infections may also arise even when no placental tissue has been retained, although this is very rare. Because the healing placental site is an environment ideally suited to bacteria, it is very important to follow strict hygiene measures, and so prevent the bacteria spreading up the vagina to the inside of the uterus. For example, pads should be changed frequently and the general area of the vulva and perineum kept clean and dry, as a dirty, moist environment encourages infection.

The perineum, Vagina and Vulva

The perineum is the area between the vagina and the anus. During childbirth the perineum becomes temporarily stretched to several times its normal length and may become bruised, swollen and torn. An episiotomy may have been performed, thus necessitating the stitching of the perineum, and so adding to your discomfort and distress. There may also be minute abrasions, situated in the front part of the vulva which can sting, particularly when passing urine. These do tend to heal quickly,and should not be sore for more than a few days. Bathing the area with warm water immediately after passing urine may aid in easing the discomfort.

If the perineum has been stitched, care needs to be taken to keep the area clean and dry so that healing is encouraged and infection prevented. Warm baths or showers are often soothing (there is no need to add salt or any antiseptic to the water) and the perineum may be patted dry with tissue paper or a soft towel. Drying it with the lowest heat of a hair-dryer may also prove effective. As part of the healing process, one should opt for cotton underwear as this allows for better air circulation, as opposed to that of nylon.

Perineal pain is common among women who gave birth naturally, but there is no longer the need to suffer in silence, as there are many products on the market (including herbal remedies) that can bring relief.
 

• Ice packs:
  Ice packs applied to the area can offer temporary relief. These are best prepared as crushed ice between gauze pads, and applied when you are resting. These should only be used for a few minutes at a time though, as excess cooling and over-constriction of blood to the perineum could delay the healing process.
   

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