Menstruation. Although in the ideal course of events, the mother does not menstruate while nursing her baby, that is, for eight to ten months, Dr. Slemons estimates that about one-third of all nursing mothers begin to menstruate about two months after delivery, while according to Dr. Edgar one-half of those who do not nurse their babies begin to menstruate in six weeks after delivery.
Menstruation is more likely to return early in primiparæ than in multiparæ. Patients sometimes wonder whether this early discharge is menstrual or lochial, and though they can not tell, a physician can easily decide by examination, and it is important that he be given the opportunity to do so. A nursing mother may menstruate once and then not again for several months or a year; or she may menstruate regularly and nurse her baby satisfactorily at the same time, though menstruation is usually regarded as unfavorable to lactation.
Lactation. During the first two or three days after the baby is born, the breasts secrete a small amount of yellowish fluid called colostrum, which differs from milk chiefly in that it contains less fat and more salts and serum-albumen than milk and in the fact that it coagulates upon boiling. About the third day after delivery, the meagre amount of colostrum is replaced by milk and as it increases rapidly in amount, the breasts usually become tense and swollen at this juncture, and sometimes very painful; but this turgidity usually subsides after a day or two.
The function of the breasts, that of secreting milk, is definitely stimulated by the baby’s suckling and will not continue for more than a few days without this stimulation, a fact to be remembered if it is desirable for any reason to dry up the breasts.
The ideal condition is for the breasts to secrete a quantity and quality of milk which will adequately nourish the baby for eight or ten months. The reverse of this condition is sometimes found in very young or in elderly women, or in very fat or frail, undernourished women.
Ovulation is usually suspended during lactation, but a mother may become pregnant a few weeks after delivery even while nursing her baby, though the quality of her milk is likely to be unfavorably affected by the pregnancy. But, as has been explained, the return of menstruation does not necessarily exert as unfavorable an influence upon lactation as was formerly believed.
Abdominal Wall. The abdominal wall is usually overstretched during pregnancy, and immediately after labor when the tension is removed, the skin lies in folds and the entire wall is soft and flabby. The normal and desirable course is for the muscles gradually to regain their tone; for the excess of fat to be absorbed and the walls to approach their original state in the course of a few weeks. The striæ usually remain, and the muscles sometimes fail to regain their tone, as for example when pregnancies follow each other in rapid succession or when there has been excessive distension. In such cases there is likely to be the pendulous abdomen so often seen in multiparæ, and a diastasis, or separation of the rectus muscles.
Digestive Tract. During the first day or two after delivery the mother may have very little appetite but she is usually very thirsty. She will almost inevitably be constipated, because of the loss of intra-abdominal pressure; the sluggishness of the intestines acquired during pregnancy; her recumbent position, lack of exercise and the fact that she is taking relatively less food than usual and that her bowels were freely evacuated at the onset of labor.
Temperature. The temperature often rises to about 99° F. immediately after labor but it should drop to normal in a few hours and practically remain so. For various causes, some of which are unexplained, the temperature will not infrequently be slightly above normal at times during the first few days of the puerperium, without the patient’s seeming to suffer any ill effects. But the fairly general agreement among obstetricians seems to be that a temperature of 100.4° F. is the upper limit of normality and that infection is to be suspected if it reaches that point and remains there for twenty-four hours.
Pulse. The normal pulse rate is usually slower during the puerperium, being about 60 or 70 beats to the minute, and is referred to as puerperal bradycardia. It is thought that this is due to the absolute rest in bed and the decreased strain upon the heart after the birth of the baby.