# Postnatal Care in the Puerperium > Nursing notes on postnatal care in the puerperium: uterine involution, lochia stages, danger signs, lactation support and postpartum mood changes. - Canonical URL: https://prepelephant.com/topics/allied/nursing/postnatal-nursing-care - Exam / course: Allied Health · Subject: Nursing - Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team - First published: 2026-10-02 - Last updated: 2026-10-02 - How to cite: "Postnatal Care in the Puerperium", PrepElephant, https://prepelephant.com/topics/allied/nursing/postnatal-nursing-care ## Direct answer The puerperium is the six weeks after delivery in which the reproductive organs return to the prepregnant state, and postnatal nursing care tracks that involution while guarding the mother-baby pair. The uterine fundus sits at the umbilicus right after birth, descends about a centimetre a day and is no longer palpable above the symphysis by two weeks; lochia passes through rubra, serosa and alba over roughly two weeks. Care covers uterine and perineal assessment, breastfeeding support, nutrition and rest, contraception, immunisation of the baby, recognition of danger signs such as fever, foul-smelling lochia or heavy bleeding, and screening for postpartum mood disorders, which range from self-limiting blues to depression requiring treatment. ## What you must remember - Uterus: fundus at the umbilicus immediately postpartum, involution about 1 cm per day; a soft, boggy fundus above the expected level means atony — massage and empty the bladder before anything else. - A fundus that rises or fails to descend suggests retained products, distended bladder or developing haemorrhage; a tender, subinvoluting uterus with foul lochia points to puerperal sepsis. - Lochia: rubra (red, days 1 to 4), serosa (pinkish-brown, roughly days 5 to 9), alba (pale, about day 10 onward); normal total loss is around 250 to 500 mL and may continue up to three weeks. - Report immediately: soaking more than one pad an hour or passage of clots, lochia becoming foul smelling, fever of 38°C or more, severe pain, breast redness with fever, headache with visual disturbance, and breathlessness. - Postnatal contacts: at least a visit within the first 24 hours after institutional birth, around day 3, day 7 and at six weeks, in line with WHO's four-contact schedule; Indian ASHAs make home visits in the first week. - Postpartum blues peaks around day 3 to 5 and resolves within about two weeks without treatment; depression persists beyond two weeks and impairs function, while postpartum psychosis is a psychiatric emergency. - Continue iron-folic acid, ensure a protein-rich diet, teach front-to-back perineal hygiene and encourage Kegel exercises. - Contraception: the lactational amenorrhoea method works only with exclusive breastfeeding, amenorrhoea and a baby under six months; postpartum intrauterine device insertion is best within 48 hours of delivery. ## A day-by-day read of a normal puerperium Day 1: the fundus is at or a finger below the umbilicus, lochia rubra is moderate, and the perineum is checked for swelling and suture integrity. Day 3: the milk comes in, so engorgement, feeding position and attachment dominate the care plan; the fundus is about 2 to 3 fingers below the umbilicus and the mother walks about to prevent thrombosis. By day 5 lochia is turning serosa-colored, the uterus is halfway to the symphysis and the baby has passed transitional stools. Day 10: lochia alba, fundus barely palpable, and the baby should be regaining birth weight, having lost no more than about a tenth of it in the first days. At six weeks involution is complete and the scheduled visit checks recovery, contraception and mood. Any deviation — a fundus higher than expected for the day, lochia reverting to red, or milk that never established — is the cue to look for a cause, because the examiners test this fixed calendar. ## Where students slip The blues-depression-psychosis ladder is the classic three-column question: blues in up to half of mothers in the first two weeks and self-limiting, depression in roughly one in ten lasting beyond two weeks with impaired function, and psychosis rare but an emergency with delusions about the baby. Students also trade the lochia sequence around, forgetting rubra-serosa-alba in that order, and misread mild afterpains or engorgement as infection. Mastitis differs from engorgement by being localised, hot, painful and feverish, usually affecting one breast, and it needs medical review while feeding continues. Finally, the six-week visit is the designated point for contraception, anaemia reassessment and depression screening — MCQs ask what is scheduled there. ## Frequently asked questions ### How fast does the uterus involute after delivery? About one centimetre per day: at the umbilicus after birth, roughly halfway to the symphysis by day 5 to 6, and non-palpable abdominally by about two weeks. ### What are the three stages of lochia and their timing? Lochia rubra for the first few days, serosa from about day 5 to 9, then alba from about day 10; persistence of red discharge or a foul smell is abnormal. ### Which postpartum mood change is a psychiatric emergency? Postpartum psychosis, with delusions, hallucinations or disorganised behaviour, usually within the first two weeks — it needs urgent psychiatric referral, whereas blues resolve by two weeks. ### When can the lactational amenorrhoea method be relied upon? Only when all three criteria hold: exclusive breastfeeding day and night, no return of menses, and an infant younger than six months. ### What danger signs must a mother report during the puerperium? Heavy bleeding or clots, foul-smelling lochia, fever of 38°C or more, calf pain or breathlessness, headache with blurred vision, and breast pain with redness.