The subacute postpartum starts after the acute postpartum period concludes and can last for two to six weeks. particularly for women with C-section with reduced mobility.
Anti-coagulants or physical methods such as
compression may be used in the hospital, particularly if the woman has risk factors, such as obesity, prolonged immobility, recent C-section, or first-degree relative with a history of
thrombotic episode. For women with a history of thrombotic event in pregnancy or prior to pregnancy, anticoagulation is generally recommended. The increased
vascularity (blood flow) and
edema (swelling) of the woman's vagina gradually resolves in about three weeks. The
cervix gradually narrows and lengths over a few weeks.
Postpartum infections can lead to
sepsis and if untreated, death. Postpartum
urinary incontinence is experienced by about 33% of all women; women who deliver vaginally are about twice as likely to have urinary incontinence as women who give birth via a cesarean. Urinary incontinence in this period increases the risk of long term incontinence. Discharge from the uterus, called
lochia, will gradually decrease and turn from bright red, to brownish, to yellow and cease at around five or six weeks. Women are advised in this period to wear
adult diapers or nappies, disposable maternity briefs, maternity pads or towels, or
sanitary napkins. The use of
tampons or
menstrual cups are contraindicated as they may introduce bacteria and increase the risk of infection. An increase in lochia between 7–14 days postpartum may indicate delayed postpartum
hemorrhage.
Hemorrhoids and
constipation in this period are common, and
stool softeners are routinely given. If an episiotomy or perineal tear had to be sutured, the use of a
donut pillow allows the woman to sit pain-free or at least with reduced pain. Some women feel uterine contractions, called afterpains, during the first few days after delivery. They have been described as similar to menstrual cramps and are more common during breastfeeding, due to the release of
oxytocin. The cramping is the compressing of the blood vessels in the uterus to prevent bleeding.
Infant caring in the subacute period At two to four days postpartum, a woman's
breastmilk will generally come in. Historically, women who were not
breastfeeding (nursing their babies) were given drugs to
suppress lactation, but this is no longer medically indicated. In this period,
difficulties with breastfeeding may arise. Maternal sleep is often disturbed as night waking is normal in the newborn phase, and newborns need to be fed every two to three hours, including during the night. The
lactation consultant,
health visitor,
monthly nurse, postnatal
doula, or
kraamverzorgster may be of assistance at this time.
Psychological disorders During the subacute postpartum period, psychological disorders may emerge. Among these are
postpartum depression,
posttraumatic stress disorder, and in rare cases,
postpartum psychosis. Postpartum mental illness can affect both mothers and fathers, and is not uncommon. Early detection and adequate treatment is required. Approximately 70–80% of postpartum women will experience the "baby blues" for a few days. Between 10 and 20 percent may experience clinical depression, with a higher risk among those women with a history of postpartum depression, clinical depression, anxiety, or other mood disorders. Prevalence of PTSD following normal childbirth (excluding stillbirth or major complications) is estimated to be between 2.8% and 5.6% at six weeks postpartum.
Maternal-infant postpartum evaluation Various organizations across the world recommend routine postpartum evaluation in the postpartum period. The
American College of Obstetricians and Gynecologists (ACOG) recognizes the postpartum period (the "fourth trimester") as critical for women and infants. Instead of the traditional single four- to six-week postpartum visit, ACOG, as of 2018, recommends that
postpartum care be an ongoing process. They recommend that all women have contact (either in person or by phone) with their obstetric provider within the first three weeks postpartum to address acute issues, with subsequent care as needed. A more comprehensive postpartum visit should be done at four to twelve weeks postpartum. It address the mother's mood and emotional well-being, physical recovery after birth, infant feeding, pregnancy spacing and
contraception, chronic disease management, and
preventive health care and health maintenance. Results of a 2023 systematic review of the evidence suggests a relationship between having sufficient health insurance and attendance at follow-up postpartum care visits that may prevent additional needs for preventable care. There are significant health outcome disparities among postpartum individuals of different racial groups in the United States. Therefore, separate data for various population subgroups is essential for decision-makers to evaluate the benefits and risks of postpartum care delivery strategies. This includes individuals at high risk for postpartum complications. At-home blood pressure monitoring may help mitigate race-related disparities in care that occur may during follow-up visits for hypertension management. With early detection of hypertension (high blood pressure), hypertensive disorder complications from the postpartum period can be further prevented. == Delayed postpartum period ==