Overview: What a Big Deal Pregnancy Is#
- First, you need an egg.
(1) Achieving a "Heavenly Egg" in 85 Days
The ovaries are a warehouse, and every girl is born with a stock of 1 to 2 million follicles, which can only be consumed and cannot be restocked. By puberty, the number of follicles dwindles to 200,000 to 400,000. As they mature, girls begin to ovulate, and of course, Aunt Flo comes along as well. From this point on, one egg is generally released each month; accompanying it are over 1,000 follicles that are eliminated due to lack of strength (the essence of survival of the fittest).
Alright, next, girls reach their reproductive age and prepare to make little ones. First, you need an egg, and preferably a high-quality one. In the vast sea of eggs, we find one: "Wow, not bad, we have high hopes for you!" It is destined to become the "Heavenly Egg," and let's call it L.
"Hey, wake up!" The only 30μm big L is awakened. At this time, it is in a sleep state like hundreds of thousands of other follicles, called primordial follicles. "You over 1,000, wake up and come with me!" the warehouse manager shouts. So they sluggishly get up, slowly grow, and after more than 270 days, they reach 120μm. During this process, they grow independently, without interference, quietly coexisting, and transition from primary follicles to secondary follicles.
From the little L (secondary follicle) officially entering the PK mode, it takes 85 days to surpass over 1,000 follicles (becoming the dominant follicle). Now guess, why do people always say that preparing for pregnancy takes 3 months? If you can't answer, go face the wall.
The follicles first need to grow (nutritional growth phase). This phase includes 4 levels, and for each circle of weight gain, they advance a level. Level 1 little L has a great appetite! After 25 days, it earns a Level 2 badge and upgrades its gear—an exclusive big pocket for foodies (follicular cavity), which contains growth factors, steroid hormones, and gonadotropins to supplement nutrition at any time, making meals delicious and the body strong. After another 20 days, L reaches Level 3, and 14 days later, it reaches Level 4. At this point, L has grown from 0.12mm to 2mm, a significant increase!
Next, it enters battle mode. Level 4 L has exceptional food-grabbing abilities, with its pocket (follicular cavity) filled with follicle-stimulating hormone (FSH), and it eats a lot, so it grows impressively, smoothly reaching Level 5 after 10 days. A cruel reality follows: 58% of Level 5 follicles (5mm), 77% of Level 6 follicles (10mm), and 50% of Level 7 follicles (16mm) will starve to death due to lack of food (closing off due to insufficient FSH stimulation). Our L overcomes numerous challenges, is in great shape, stands out from over a thousand follicles, and successfully rises to the glorious Level 8, earning the honorary title: mature follicle (>18mm). From Level 5 to Level 8, it takes 15 days with a 5-day gap between each level.
Here’s a secret about L's undefeated journey: during the growth of this batch of follicles, each one continuously produces estrogen. The more estrogen the follicles produce, the better their ability to digest and absorb food (sensitivity), allowing them to grow even with less food. L is the one with the best constitution and the hardest worker, receiving the most food and absorbing it well, of course, growing the largest.
Finally, ovulation occurs. When the estrogen secreted by the follicles is sufficient (>200pg/ml), the bosses happily distribute more food—follicle-stimulating hormone (FSH) and luteinizing hormone (LH)—encouraging everyone to work, forming positive feedback. As estrogen, FSH, and LH levels peak successively, the peak of LH triggers ovulation, and the egg bursts forth from the follicle: "Hello, world!"
(2) You Are Not Alone in the Battle
Even a powerful L will starve without food supplies. Who provides this food? Let’s welcome the behind-the-scenes bosses: the hypothalamus, the pituitary gland, and the ovaries. Together, they form the hypothalamic-pituitary-ovarian axis (HPOA), which is the core of girls' endocrine system.
Let’s start with the smallest one. The ovaries are a type of gonad responsible for storing, nurturing, and releasing eggs (reproductive function) and producing hormones such as estrogen, progesterone, and testosterone (endocrine function). The pituitary gland, located in the brain, is responsible for secreting gonadotropins (including FSH and LH), targeting the ovaries. The effects have already been witnessed during the follicular growth process. Additionally, the pituitary also secretes prolactin (PRL). The hypothalamus, also in the brain, secretes gonadotropin-releasing hormone to command the pituitary to release FSH and LH. Confused? Read it again, then continue.
Normally, their cooperation is quite harmonious.
The hypothalamus is the startup center and the source of commands, adjusting orders based on feedback from subordinates; the pituitary is close to the hypothalamus, allowing for quick communication, known as "short feedback"; the ovaries are far from both the pituitary and hypothalamus, known as "long feedback." The pituitary, under the command of the hypothalamus, supplies food to the ovaries. FSH is the most needed thing for follicular growth: it can wake up sleeping small follicles; it can directly stimulate small follicles to grow and develop; it can activate an enzyme (aromatase) in the follicles, giving them the ability to produce estrogen; it can select dominant follicles, eliminating those that are less competitive and cannot obtain enough FSH. Additionally, the pituitary also sends LH to the ovaries, assisting mature follicles in releasing eggs; after ovulation, LH can transform the egg's resting place (follicular wall, follicular membrane) and its companions (granulosa cells, theca cells) into a corpus luteum, maintaining its function to produce and secrete a large amount of progesterone and a certain amount of estrogen to prepare a bed for the fertilized egg.
The ovaries are obedient and well-behaved. In the early stages of follicular growth, the estrogen produced is not that much (<200pg/ml), and the appetite of the follicles is not that big, so the ovaries will report to the bosses: "It’s important to save costs; a little FSH is enough!" (negative feedback) Later, when the follicles are mostly selected, and a dominant follicle that can both work and eat appears, producing a lot of estrogen (≥200pg/ml), the leaders are extremely happy and start distributing large amounts of FSH and LH (positive feedback). When they peak, they help the egg to be released. After ovulation, the leaders only give a little food to the ovaries to protect the possibly fertilized egg, thus limiting the development of small follicles in the warehouse; otherwise, if pregnancy occurs while ovulation is still happening, it would be chaotic!
(1) Meeting on the Magpie Bridge: The Fallopian Tubes#
Ladies, please sit tight and elegantly extend your arms. Take a deep breath and imagine your body as a uterus. Very good, now your arms are the fallopian tubes, from your armpits to your hands, representing the interstitial part, isthmus, ampulla, and fimbriae of the fallopian tubes. The fimbriae and hands look very similar and have fingers (finger-like projections). Not far below your hands, imagine you are controlling a ball with your mind; yes, the ball is the ovary (which is of course fixed in the body by ligaments).
After the egg bursts from the ovary and enters the abdominal cavity, it is pitch black. "What if I can't find my way?!" Just then, a warm hand is felt; this is the fimbriae of the fallopian tube. This international fimbriae is summoned by the egg's "Hello, world!" as it emerges, and it can successfully "pick up the egg" thanks to its many finger-like projections and the contractions of the fallopian tube muscles. This skill is far more powerful than you might think—there is a new method of protecting women's reproductive ability internationally, which involves extracting a portion of ovarian tissue for freezing and then transplanting it back into the body at the right time; the transplant site is often not in the original position of the ovary but in the retroperitoneal space. But did you know that in this case, pregnancy can still occur after ovulation! The diligent fimbriae will find the egg and grab it; it truly is the international fimbriae!
Now, let’s talk about the cross-section of the fallopian tube, which is divided into three layers from outside to inside: the outermost layer is a membrane (serosal layer), the middle is smooth muscle (muscle layer), and the innermost is mainly a layer of cilia (mucosal layer). After the egg enters the fallopian tube from the fimbriae, the muscle layer of the fallopian tube begins to contract rhythmically, and the cilia start to wave toward the uterine cavity. The egg is thus pushed forward, rolling to the ampulla of the fallopian tube and staying there, waiting for the sperm to arrive. Ah, a sperm that has overcome numerous challenges is swimming over! After the two happy beings combine to form a fertilized egg, they continue to roll happily forward with the help of the muscle layer and cilia, taking root and sprouting in the uterus.
(2) This Route Is Blocked, Please Detour
However, the Magpie Bridge may encounter illegal construction, becoming impassable, which accounts for 30% to 40% of infertility causes.
Illegal construction one: pelvic infection. The main culprits are Chlamydia trachomatis and Neisseria gonorrhoeae. After a couple's intimacy or an abortion, pathogens can easily take the opportunity to ascend through the uterus to the fallopian tubes, causing chaos and destruction, and fighting with the body's defenders (white blood cells, phagocytes, etc.) to obstruct their duties. A series of inflammatory responses can lead to ciliary damage, tissue adhesion, or even fallopian tube blockage.
Illegal construction two: endometriosis. The foreman is endometrial tissue that has migrated to the fallopian tubes. The innate ability of endometrial tissue is to shed and bleed as long as there is no pregnancy, being very self-aware, regardless of whether it is in the uterus. Occasionally, if some endometrial tissue leaves the uterus and wanders into the fallopian tubes, it insists on setting up camp there (proliferating) and dutifully sheds and bleeds regularly, which can cause blood clots and inflammatory responses similar to those of salpingitis.
Additionally, there are other less common illegal constructions, such as benign polyps in the fallopian tubes, small nodules, or issues with the control system of the fallopian tubes causing spasms, which can also lead to blockage or obstruction of the fallopian tubes.
Some ladies may be frightened: how do I know if there is an illegal construction team? Here are a few tricks.
Trick one: pay attention to your body and seek medical attention promptly.
First, let’s talk about prevention; the most common and should be guarded against are infections. Couples should pay attention to hygiene in their daily lives and take contraceptive measures when there is no intention to conceive, as abortions can easily lead to infections. Now, what are the symptoms of an infection? If one day you suddenly have a fever, abnormal discharge, or abdominal pain, you need to see a doctor promptly. After diagnosis, immediate treatment can help drive away the construction team and repair the damage they cause.
Trick two: fallopian tube patency check.
"Construction ahead, please detour." This phrase may bully an inexperienced egg, but dare to be so arrogant with me? Here comes the water, splash! This domineering attitude is essentially the fallopian tube cannulation procedure. Liquid is infused through the uterus into the fallopian tubes; if it flows easily, there are no obstructions; if it gets stuck, there is an obstacle, so apply some pressure and rush! Thus, the previously stubborn roadblock is cleared, and the fallopian tubes gain temporary patency. Therefore, the fallopian tube cannulation procedure has both diagnostic and therapeutic effects, but I say "temporary" because this method is one-time only; after the liquid passes, pathogens may return, and construction can resume. What’s more troubling is that this procedure can disorient and injure the cilia, so even if the path is cleared, the egg may not move, which is why the fallopian tube cannulation procedure has gradually fallen out of favor.
Another more precise diagnostic test, but without therapeutic effect, is hysterosalpingography. First, absorbable LED lights (contrast agents) are placed in every corner of the uterus, fallopian tubes, and even the pelvis, and then a switch is pressed (X-ray imaging), providing a comprehensive view: whether the fallopian tubes are patent, the location and severity of any blockages, the shape of various organs, whether there are fibroids or polyps, etc. Knowing both yourself and your enemy, how can you not deal with it? Moreover, the contrast agents are becoming increasingly advanced; previously, one could only conceive three months after the contrast, but the new types reportedly allow for safe conception within a month.
(3) The Fallopian Tubes Cannot Bear the Weight of Life
Sometimes, the fertilized egg does not roll into the uterus but settles in the fallopian tube, which can be troublesome. When the fertilized egg implants outside the uterine cavity, it is called an ectopic pregnancy (extrauterine pregnancy), with fallopian tube pregnancies being the most common (over 90%). However, it can also end up in some unusual places, such as the cervix, ovary, or even other organs in the abdominal cavity, like the spleen. Yes, that fertilized egg that shocked us not long ago ended up in the spleen.
- The Confused Fertilized Egg
The main reason for fallopian tube pregnancy is that there is a problem with this passage. Salpingitis can cause the lumen to narrow and damage the cilia; peritubal inflammation can lead to adhesion of surrounding tissues, twisting and distorting the fallopian tubes, causing abnormal movement; nodular salpingitis occurs when the muscle wall of the fallopian tube undergoes nodular hyperplasia, growing inward and creating roadblocks; there can also be excessively long fallopian tubes, lack of cilia, and lack of hormonal regulation, or even psychological factors. All these roadblocks can affect the movement of the fertilized egg, but once fertilization occurs, the growth program is initiated, and it must take root.
There is also the phenomenon of the fertilized egg going rogue. After the egg meets the sperm in the fallopian tube, the two combine, but who knows they still need to honeymoon, heading north without turning (not entering the uterine cavity), and as a result, they waste time and can only implant in the fallopian tube, causing trouble for the mother. - The Fallopian Tube Cannot Bear
Life in a foreign land is not easy for the fertilized egg. The fallopian tube's conditions are poor, and it can only make do with a bed because the lumen is narrow, and it cannot provide enough nutrition, often leading to early demise. However, some are resilient and can grow even in harsh conditions. The severity of the consequences is related to the implantation location.
The ampulla of the fallopian tube is where the egg and sperm combine, relatively spacious. After the fertilized egg grows into a blastocyst here, it generally experiences miscarriage (yes, what is called miscarriage in the fallopian tube). Sometimes it can completely miscarry, being expelled from the fimbriae into the abdominal cavity (complete miscarriage); but sometimes it can partially miscarry, with some tissue remaining in the fallopian tube wall, these cells thinking they are on a thick bed, insisting on continuing to snuggle (which is actually an erosion), leading to repeated bleeding from the fallopian tube.
If the fertilized egg takes root in the isthmus, which is narrow and has a relatively rich blood supply, it can be dangerous. The blastocyst can penetrate the fallopian tube wall by 6 weeks, leading to a ruptured pregnancy, which is much more dangerous than the aforementioned fallopian tube miscarriage, and can lead to massive internal bleeding in a short time. Most of this blood flows into the abdominal cavity, with only a small portion flowing out through the vagina, making it less detectable. - If Only I Had Known It Was an Ectopic Pregnancy...
Ectopic pregnancy is a nightmare for women. How can one know early on? The typical symptoms of ectopic pregnancy are: missed period, vaginal bleeding, abdominal pain. However, this textbook statement may not apply to everyone; the general situation may be as follows:
If your period is delayed by a week, you must take a pregnancy test. Generally, pregnancies in the ampulla or isthmus will have a 6 to 8-week delay in menstruation. However, 25% of ectopic pregnancies do not have a significant history of missed periods, and may only present as irregular bleeding that seems like a late period. Therefore, if a woman of childbearing age experiences irregular bleeding, with or without abdominal pain, even without a history of missed periods, ectopic pregnancy cannot be ruled out.
If pregnant, whether intrauterine or ectopic, urine HCG (human chorionic gonadotropin) can test positive. Next, continuous monitoring of blood HCG levels can reveal ectopic pregnancy. In normal early intrauterine pregnancies, HCG should double every 1.5 days; ectopic pregnancies do not show such good results, as the implantation site has poor blood supply, leading to lower HCG levels and slower increases, doubling every 3 to 8 days. When you find that HCG is abnormally doubling and barely reaches the threshold (1500 to 1800 IU/L), do a vaginal ultrasound; this time, you can definitely catch it in the act if no pregnancy is found in the uterus.
The above may be too professional, but women need to be vigilant and responsible for themselves. If there are abnormalities in menstruation and a possibility of pregnancy, seek medical attention promptly and leave the professional matters to them.
Dear Aunt Flo.#
- Where Does Aunt Flo Live?
Follicles are stored in the ovaries (not in the uterine wall!). Normally, each month, a batch of small follicles develops, but only one high-quality, vigorous follicle (dominant follicle) grows larger, while the others automatically shrink away.
This big follicle matures (over 18mm, not the egg cell) and breaks through the ovary (the reason for ovulation pain) to be caught by the fimbriae of the fallopian tube. This egg rolls and rolls, lying down in the designated place (ampulla) waiting for sperm to come. If a sperm swims over after overcoming numerous challenges, the two will happily combine to form a fertilized egg, continuing to roll happily forward to take root in the uterus. If no sperm comes, the egg can only wait until it ages and dies, while Aunt Flo will rush over to remove the bedding prepared for the fertilized egg (the endometrium), and prepare for next month. - Who Sends Aunt Flo?
The big boss is the hypothalamus, the second is the pituitary gland, and the third is the ovaries; Aunt Flo is the obedient follower. Taking a 28-day menstrual cycle as an example:
Days 1-4: Aunt Flo's main stage.
Days 5-14: A batch of follicles is summoned. During this joyful growth process, they continuously secrete estrogen, thickening the endometrium. Sufficient estrogen (>200pg/ml) delights the two bosses, who then distribute more FSH and LH to encourage the follicles to work (positive feedback). As estrogen and FSH, LH peak successively, the peak of LH triggers ovulation.
Days 15-28: Ovulation is just the egg's solo journey; the house it leaves behind (follicular membrane and follicular wall) and its companions (granulosa cells, theca cells) together form the corpus luteum. The corpus luteum secretes estrogen and progesterone, which can transition the endometrium from the proliferative phase to the secretory phase, making it thicker, softer, and more nutritious. If the egg does not meet a sperm, the corpus luteum stops functioning, ceasing the production of estrogen and progesterone, leading to a drop in their levels, causing the endometrium to shed, and Aunt Flo arrives. - Is It Normal for Aunt Flo to Be Lazy?
As we can see, Aunt Flo is determined by the changes in the body's sex hormones.
A normal menstrual cycle does not necessarily mean ovulation, but if it hasn’t come for several months, it is likely due to ovulation abnormalities (after hysterectomy or endometrial ablation, these beds are all dismantled, so what bedding can be laid?). Sex hormones fluctuate; checking them every day for a month will yield different results, so it is necessary to assess for abnormalities according to the period. For example, checking hormone levels within 5 days of menstruation reflects the baseline level (ovarian reserve), checking before ovulation can assess follicle quality, and checking between days 21-23 can determine if ovulation has occurred and assess luteal function. For prolonged menstrual cycles or even seasonal menstruation, with ovulation periods being erratic and unpredictable, how can one plan for pregnancy? This depends on the specific situation.
(4) How Is Your Aunt Flo Doing Lately? - Normal Aunt Flo Looks Like This
A normal Aunt Flo should have a cycle of 21-35 days, lasting 2-7 days, with an average blood loss of 20-60ml (according to the latest guidelines from the Chinese Medical Association). I hear you asking how to calculate blood loss. Here’s how: in the lab, measure alkaline hematin; in daily life, based on experience, one medium-sized sanitary pad completely soaked is about 10ml. For those wanting to exhaust the truth, you can refer to the "Menstrual Blood Loss Table" below to score and calculate.
Each sanitary pad's blood-stained area is classified as: mild, blood-stained area ≤ 1/3 of the entire pad area; moderate, blood-stained area occupies 1/3 to 3/5 of the entire pad area; severe, blood-stained area is basically the entire pad. The scores are 1 point, 5 points, and 20 points respectively; the size of lost blood clots, <1 yuan coin is a small clot, counted as 1 point; ≥1 yuan coin is a large clot, counted as 5 points; if the lost blood volume cannot be represented by clots, estimate it as a fraction of the recorded amount. Fill in the scores, quantity, and days for each pad in the menstrual blood loss table. A score ≤ 100 points indicates a blood loss ≥ 80ml.
So, don’t rush to blame Aunt Flo. Anything within the standard is normal, and occasional irregularities shouldn’t cause panic. Hey, who hasn’t had a slip-up? Give it another chance to observe; if it returns to normal, great, no need to tidy up; if it continues to be erratic, then it’s time to discipline it. - Reasons for Aunt Flo's Disobedience
At the age of blooming flowers, if women are generally healthy (no major issues found during check-ups), menstrual irregularities are mostly functional disorders. What does this mean? It means a dysfunction in the reproductive endocrine axis. What does this mean? I’m not repeating it for the third time! Go review the previous text, dear. Yes, it’s the cooperation of the big boss hypothalamus + the second boss pituitary gland + the third boss ovaries + the follower Aunt Flo that has become disharmonious.
Such menstrual irregularities can be divided into anovulatory and ovulatory types based on their causes. The difference between the two is that anovulatory types lose the normal menstrual cycle, while ovulatory types have a normal menstrual cycle. By the way, if Aunt Flo is delayed by a week, you must take a pregnancy test; wishful thinking is not advisable. - It’s Very Important to Determine Whether Ovulation Occurs
Determining whether ovulation occurs is very important! Because it is closely related to the choice of treatment plan, and because women worry about their fertility issues when Aunt Flo is abnormal. Methods of determination include:
Blood tests: Check sex hormones on days 21-23 of the cycle (the first day of menstruation counts as day 1). Alright, I know you can’t stand the crowds at the hospital and are afraid of pain, so this method is not mandatory; let’s move on to the next.
Ovulation test strips: Ovulation test strips are used to detect the LH content in urine, generally starting from day 10 of the cycle, using them correctly for several consecutive days according to the instructions; when the test strip shows a strong positive, have intercourse.
Basal body temperature measurement: The simplest method without suffering. Measure your temperature every morning as soon as you open your eyes; don’t move, don’t go to the bathroom, don’t drink water; that’s your basal body temperature. Record the values and persist in measuring for one cycle, and you will eventually get a temperature curve. Normally, after ovulation, the temperature will rise significantly, lasting 10-14 days, then drop, known as "biphasic temperature." For women with ovulation but abnormal Aunt Flo, count your high-temperature days. If they are too long, it indicates incomplete luteal regression, leading to endometrial shedding, resulting in only a few clean days in a month. If the high-temperature days are too short, it indicates insufficient luteal function, leading to shortened menstrual cycles, possibly with slightly increased flow. If there is bleeding during the ovulation period, it may be related to hormonal fluctuations. If there is no ovulation, the temperature does not fluctuate significantly, known as "monophasic temperature," which is common in adolescence, menopause, and polycystic ovary syndrome, indicating that the reproductive endocrine axis is not functioning well. But don’t worry about fertility issues, okay?! Just because there is no ovulation doesn’t mean there are no eggs! They just need to be summoned; obedient treatment will do! - What to Do About Abnormal Aunt Flo
I want to say, don’t worry too much about treatment; leave it to the doctors! But the body is yours, and here’s what you need to do:
Diet. Don’t be too confident about your dietary structure; in current nutritional assessments, the pass rate is less than 1/3. If the ingredients are insufficient or incorrect, how can the body function well? Also, weight loss should be scientific; don’t overdo it; losing too much weight in a short time can lead to menstrual irregularities or even amenorrhea.
Exercise. Are there still those who don’t work out or exercise? Raise your hands, let me see.
Staying up late. Don’t stay up late too often! Many hormones in the body fluctuate with day and night; if you don’t sleep, they still want to sleep.
Mindset. Don’t be too nervous, especially for women worried about future baby issues, as this is very related to mental factors. We have observed a phenomenon: whenever there is a long holiday or during the New Year, the pregnancy rate in our department skyrockets. Because it’s about to be a holiday, "It’s so hard to treat regularly, and work is so hard; I can’t do it, I want to take a good rest."
(5) Is My Flow Getting Lighter Because I’m Getting Older?
For a long time, there has been a deeply rooted belief that has puzzled us gynecologists: the more menstrual flow, the better! As a result, there are often patients who come to the clinic after bleeding so much that they can’t stand, looking pale, yet heroically managing to smile, which is heartbreaking to see. - Does More Bleeding Mean Youth? Does Less Flow Mean Aging?
I will acknowledge this statement if it meets diagnostic criteria, humph. Let’s look at the latest "Guideline on Diagnosis and Treatment of Abnormal Uterine Bleeding" from 2015 (note: abnormal uterine bleeding refers to any issues with menstrual cycle, duration, or volume).
Normal uterine bleeding (menstruation) and the scope of AUB terminology
You see, the total menstrual volume during the entire period is considered scanty if it is less than 5ml! What does that mean? It means that the total menstrual blood over several days doesn’t even wet half a sanitary pad… Who doesn’t meet this? Raise your hands. For those who didn’t raise their hands, your flow is normal; don’t be paranoid. Moreover, according to the guidelines, the average blood loss per menstruation is 20-60ml, which means that during the entire period, you should fully use 2-6 medium-sized sanitary pads. If you need to use longer night pads, Aunt Flo will be exhausted! - What Affects the Amount of Flow?
We need to talk about the causes of abnormal uterine bleeding. Let me put on a serious tone: teachers overlook this, medical students read along with me, and young ladies can skip this. "PALM-COEIN," this handsome word comes from the initial letters of these terms: endometrial polyps, adenomyosis, uterine fibroids, atypical endometrial hyperplasia, systemic coagulopathy, ovulatory dysfunction, localized endometrial abnormalities, iatrogenic abnormal uterine bleeding, and unclassified abnormal uterine bleeding (polyp, adenomyosis, leiomyoma, malignancy and hyperplasia, coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, not yet classified).
I don’t know if you’ve noticed, but most causes of abnormal uterine bleeding are related to heavy menstruation, and there are very few studies related to scanty flow. Returning to a serious face, the key to judging Aunt Flo is first to see if she comes regularly (cycle, related to ovulation), then how many days she lasts (duration), and finally how much (volume, and the doctor will directly ask how many sanitary pads you used, not how you feel about your flow).
Furthermore, it’s not just a thick endometrium that leads to heavy flow; if the endometrium is too thin, exposing blood vessels can also cause heavy bleeding. - Does Less Flow Mean Aging?
The thickening of the endometrium relies on estrogen, so if the flow is heavy, it means I have a lot of estrogen! Women with high estrogen are delicate like flowers! But don’t forget that progesterone also plays a role in menstruation. After ovulation, the house where the egg is left in the ovary forms a corpus luteum, which begins to produce progesterone and estrogen. Progesterone switches the endometrium from a proliferative phase to a gentle and soft phase. If there is no pregnancy, the levels of estrogen and progesterone drop sharply, causing the endometrium to collapse and shed, leading to Aunt Flo’s arrival. You see, there are so many steps in between; it can’t be said that if the endometrium grows 1cm, it must shed 1cm.
That said, ovarian function decline essentially means that the reserve of follicles is tight, so they are reluctant to ovulate; if there is no ovulation, Aunt Flo will be irregular, and she may not come for several months or even amenorrhea. But conversely, this doesn’t necessarily hold true; women who haven’t had their periods for several months shouldn’t panic. As long as women with normal ovulation, the estrogen produced during the follicular growth process is sufficient; otherwise, they wouldn’t release them if they haven’t done enough work or grown enough. Moreover, the estrogen produced can’t all be used on the endometrium; all organs in the body need it, so it’s not necessarily that some areas get more while others get less.
So, are you feeling a bit happier now?
(6) Is Aunt Flo Irritable, Is It My Fault? - Cold Water and Dysmenorrhea
Everyone already knows that dysmenorrhea is divided into primary and secondary types. Friends, if a disease is called "primary," it mostly means "the cause is unknown." So, could cold water be the cause of dysmenorrhea? It’s unclear, and I haven’t found any related research literature. But just because there’s no evidence doesn’t mean I’ll say, "Come on, girl, go ahead, eat cold food, ice cream, and your stomach won’t hurt! Don’t want to? Why are you so delicate? Western girls are fine!" I would definitely slap that person because I also shiver when my fingers touch cold water during my period; drinking cold water makes me hold my stomach.
No theoretical basis doesn’t mean we should ignore the phenomenon. My viewpoint is that ladies should "listen" to their bodies because the reactions during menstruation vary from person to person. If there are girls who can drink ice water without any reaction, then keep drinking; if someone feels cold with water below body temperature, they must keep warm. If you feel weak and powerless, don’t exercise; rest more. I’ve also seen girls who run on the playground when they have dysmenorrhea, and it works wonders. If you feel nauseous at the sight of food, eat less and drink more hot water. But there are also people like me, who can only squat by the cabinet with my stomach covered, eating all the snacks I can reach to alleviate dysmenorrhea (including the forbidden chocolate). - Causes and Treatments of Primary Dysmenorrhea
In exploring the causes, ancient medicine and modern medicine are completely different paths, and mutual verification is meaningless. If you don’t understand traditional Chinese medicine, don’t say too much, but "blood flows when it meets heat, and coagulates when it meets cold" may have some truth.
Ahem, let’s talk about what I know. Although the mechanism is still under research, it has been found that prostaglandins (especially PGF2α), leukotrienes, and angiotensin can cause contractions of the uterine smooth muscle and vascular spasms, leading to uterine ischemia, thus causing dysmenorrhea, which is known as the "hypothesis of dysmenorrhea caused by excessive uterine contractions." Additionally, dysmenorrhea is also related to women’s pain thresholds (tolerance to pain) and psychological factors.
You see, modern medicine’s focus is entirely different; it must study molecules, hormones, nerves, feedback axes, etc. Perhaps cold water affects a certain link in this chain, but as far as I know, there hasn’t been any large-scale research on it.
If hot water, blankets, snacks, etc., don’t relieve the pain, or if it hurts so much you feel like dying, it’s best to take painkillers. I recommend ibuprofen and diclofenac (Voltaren tablets), and be sure to follow the instructions; don’t exceed the maximum daily dosage. Many girls have dysmenorrhea and excessive menstrual flow, and some have not ruled out adenomyosis, so don’t take aspirin casually! - About Taboos
Chinese women live too hard under various "taboos." I searched and was shocked; the taboos listed in the encyclopedia include coffee, chocolate, sugar, alcohol, milk, cold drinks, singing loudly, sexual activity, waist pounding, perfume, vegetable oil, and pointed shoes... So, cold drinks are just one of them.
The word taboo is too serious; not following it feels like it could kill you. Some of it is based on the experiences of our ancestors, some are theoretical deductions, and some are just nonsense, okay? Pushing and pushing leads to contradictions! I believe that in the absence of scientific evidence, ladies should interpret these "taboos" as "suggestions" and choose based on their own bodily reactions.
I wish ladies a pleasant relationship with Aunt Flo.
The First Lesson of Motherhood—How to Properly Care for Your Baby#
I guess during the ten months of pregnancy, you must have imagined countless first moments of holding your baby, but when the baby arrives in your arms, apart from the unstoppable maternal glow shining all around, you must also feel quite at a loss: Baby, is this how I hold you? Baby, do you want milk? Baby, how much do you need to eat to be full? Baby, why are you crying again? Is it because I’m not smiling brightly enough? ... There are so many questions that they could circle the ward thirty times. I think if these doubts are not resolved, you might not have time to care for yourself.
Relax, relax, the baby is already born; what can’t you handle?
(1) A Personal Demonstration of the Correct Breastfeeding Position, Please Pay Attention (Facepalm)
"Chest to chest, belly to belly, chin to breast, nose to nipple." Easy to remember? Repeat it a few times for the baby to hear. Before breastfeeding, gently massage your breast for a while to stimulate the milk ejection reflex; the breastfeeding position should be comfortable for you, whether sitting, semi-reclining, or using a pillow for support, as long as you don’t fall asleep. Once ready, bring the baby over, supporting their head, shoulders, and bottom, ensuring their head and body are in a straight line, with their belly pressed against you, and enjoy the smooth softness of the baby’s skin; soon your attention will be elsewhere. At this point, the baby’s nose is already aligned with the nipple, and their face is facing the "granary," but it’s not time to start yet; mischievously touch the baby’s lips with your breast, and they will instinctively open their mouth due to the rooting reflex, and the mouth will open wider and wider. Oh right, the reflex means—it's innate, with practical skills built-in! When the mouth opens wide enough, quickly bring the baby close to your breast, allowing them to latch onto both the nipple and the areola—uh, if the mouth doesn’t open wide enough and only latches onto the nipple, it will be very painful, and the baby won’t be able to suck effectively.
Once successfully latched, you can continue to radiate maternal glow while observing the baby eat with interest. If the baby is satisfied, their temples and little ears will twitch slightly, and you won’t feel significant pain in your nipples; both the baby and you are doing well. When the baby is nearly full, they will naturally release their mouth and stop—don’t forcibly stop them, as it can easily injure the nipple. After breastfeeding, generally, there’s no need to wash the nipples; no soap, detergent, or even alcohol should be used, as it will make the baby’s feeding experience unpleasant, and what if the nipples become dry and cracked? You can use a clean ice towel to apply a little, allowing the blood vessels to constrict, reducing breast swelling.
It’s not very considerate to command the baby to eat on a schedule; this should be a spontaneous act, and you and the baby can decide together. If the baby cries from hunger, naturally, you should feed them; if you feel the granary is replenished, then it’s time to bring the baby over for a meal. This balance of supply and demand is perfect; there’s no need for mechanical feeding or even setting an alarm as the ultimate battle preparation. However, to protect the nipples and achieve sustainable development, the duration of each feeding should be gradual. Generally, during the first three days after birth, each breastfeeding session should not exceed 5 minutes, then 10 minutes on the fourth day, and 15 minutes on the fifth day, allowing both the baby and you to adapt; after a few days of developing a tacit understanding, the time can be freely controlled between 15-25 minutes. In fact, while the baby is effectively sucking, 4 minutes can yield 80% of the milk, and 10 minutes can reach 100%. So what is the baby doing with the remaining time? Enjoying the experience! Therefore, there’s no need to worry that the baby isn’t full if they suck for a short time, or that they will overeat if they suck for too long.
(2) The Benefits of Breast Milk
The breast milk produced within the first week after birth is called "colostrum." In the 21st century, do mothers still believe the foolish saying that "colostrum is dirty and should be discarded"? It’s actually thick because it contains a lot of nutrients! Colostrum is rich in β-carotene, which gives it a yellow color; its protein and mineral content is higher than that of later milk, while fat and lactose content is lower, making it very easy to digest; the key is—there are also many antibodies that help the baby resist neonatal diseases! If it is wasted, it’s a disservice to the hungry baby! The breast milk produced in the first 1-2 weeks after birth is called "transitional milk," where the protein content gradually decreases, while the energy-providing fat and lactose gradually increase. After 2 weeks postpartum, breast milk is referred to as "mature milk." The superiority of breast milk is at a legendary level that formula milk can’t replicate, no matter how hard it tries to add "calcium, magnesium, zinc, selenium, vitamins." The calcium and phosphorus content in breast milk is scientifically balanced, not overburdening the baby’s fragile kidneys; absorption is also different; 70% of the iron in breast milk can be absorbed, while formula milk only allows for 10-30% absorption; the zinc content is also very high. What does a certain zinc oral solution advertisement say? "If you don’t drink it, you’re foolish!" Our breastfed babies won’t be foolish. Therefore, within 4 to 6 months, everything the baby needs can be provided by breast milk; moreover, in addition to nutrients, there’s also warmth and a sense of security on a spiritual level.
(3) N Ways to Increase Milk Production
At this point, I hear some mothers crying, "Who doesn’t know that breast milk is great, but I can’t produce it no matter what. It’s because my breasts are too small, sob..." Hold on, let me say a fair word about cup size: breast size does not determine milk production! The breast is made up of fat and glandular tissue: fat is external, and the overall beauty and fullness of the breast depend on the amount and distribution of fat, which varies greatly among individuals; glandular tissue is internal, radiating from the nipple into 15-20 branches, with the ends of the branches (alveoli) responsible for storing milk. There’s no difference in glandular tissue among different sizes of breasts. So, since both big and small breasts start from the same line, how can we increase production?
The first secret is the baby’s sucking. After birth, the mother’s body is in a "responsive" state; as long as the baby sucks on the nipple, sensory signals are sent to the brain, causing prolactin levels to rise, which acts on the breasts to produce milk. The earlier the baby sucks, the earlier the milk is produced, and within 30 minutes after birth, they should start serving the baby. The first breastfeeding requires a lot of patience; use the correct position demonstrated earlier to make the baby comfortable, and slowly cultivate the tacit understanding between mother and child. If you impatiently introduce a bottle, the baby may develop a "nipple confusion," as the bottle is much easier to suck from than the breast, making them reluctant to switch back to the more challenging task. Furthermore, the more the baby sucks, the greater the production; the effort and reward are rarely proportional. Some mothers worry that the baby will go hungry if they eat too much, meticulously rationing their feeding or even scheming to store milk, which is absolutely not advisable; the less milk there is, the more the baby should suck or the mother should pump to increase milk production. After the baby empties one side of the breast, switch to the other side; if the little one doesn’t finish, still empty the breast; remember, don’t be stingy! Don’t be stingy! Don’t be stingy! Milk retention in the breast not only affects future production but can also lead to mastitis, which is counterproductive.
Massage is also effective, but should be done with caution. In the streets around obstetrics and gynecology hospitals, the most heavily advertised services besides postpartum centers are lactation services. Various meridian acupoint lactation massages, essential oil massages, and even music therapy for lactation are emerging; mothers must choose reliable ones and preferably follow the advice of healthcare professionals when there is a genuine need, as unqualified lactation consultants using inappropriate techniques can backfire and worsen milk duct blockages. In most cases, the baby sucking more and simple self-massage is sufficient; the technique is as follows: place your index and thumb symmetrically on either side of the areola, press down, and then push outward, repeating the action at different angles until all branches of the glandular tissue are attended to, with the pressure adjusted by yourself. In the first few days after giving birth, you may feel breast engorgement, which is not only due to milk secretion but also because of elevated levels of prolactin and other hormones, causing the breasts to feel full and congested, rather than blocked ducts. Persist in letting the baby suck, and the engorgement will naturally subside in about a week.
Next, let’s bravely invade the territory of mothers-in-law and mothers: the dietary realm. Caring elders often can’t wait to prepare a pot of soup before the due date, eager for their daughter/daughter-in-law to emerge from the delivery room to serve a pot of soup for milk production. But this is not scientific. You see, a woman who has just given birth is weak all over, and her gastrointestinal function is also extremely weak; digesting such greasy soup is difficult, and excessive nourishment can instead burden the body. The main way to stimulate milk production still relies on the baby; sucking is the most effective and important method, while soups and medicinal dishes can only serve as supplements and should not be relied upon from the start. Moreover, the stomach of a newborn is only the size of a grape, so the seemingly small amount of colostrum is enough to fill them up; producing too much milk that the baby cannot finish will just clog the ducts. It seems that not everything is better in excess.
After a week postpartum, when the mother’s strength has mostly recovered and the baby’s stomach has gradually grown, if needed, one can consider starting food to stimulate milk production. Breast milk is 70-80% water, so the combination of water and protein is the best choice—low-fat, high-protein chicken or fish soup, with peanuts, tofu, or loofah added for lactation, can also be non-greasy. The recipe can be flexible; after all, the decision-making power is not in the hands of the daughters-in-law or daughters, but the advisory power should be retained. For example, don’t blindly believe in the miraculous effects of certain dishes; eating stewed pig trotters for a week and stewed chicken for two weeks, while consuming a lot, is still considered malnutrition. Additionally, caloric intake must be considered; after all, what goes into the baby’s mouth is limited, and the rest must go to the mother’s body, which can lead to tears down the line. During the breastfeeding period, consuming an additional 500-800 calories per day is sufficient to maintain milk production.
Returning to Work, Like a Cool Mom#
With a baby at home, it’s hard for mothers to just toss their hair and walk away; even just the feeding part can be nerve-wracking. How can one return to work like a cool mom while raising a great baby?
Continue to insist on breastfeeding; it’s simpler than you think. Let’s calculate: if you pump milk at the right time and store it properly, breast milk can be warmed up and given to the baby directly, saving the step of preparing formula and saving costs; only breast milk can provide the baby with protection against diseases, which means the baby will get sick less often, saving time off work to go to the hospital and saving costs; breastfeeding can provide the best comfort and sense of security for the baby, making it easier to care for, thus saving costs. Given these three prominent "cost-saving" points, breastfeeding should also be an excellent choice for working mothers.
Although after returning to work, breast milk will be fed through a bottle, there’s no need to train the baby in this skill too early. This is because bottles are much easier to use than breasts; once the baby gets a taste of the convenience, they will instinctively avoid the harder task of breastfeeding, leading to a decrease in milk production due to fewer suckling sessions, which is known as "nipple confusion." There’s no rush; wait until the baby is three to four weeks old, has accumulated enough experience suckling from the breast, and is indulging in the enjoyment of suckling; then switching between the bottle and the breast will no longer be a big issue.
There are two methods for preparing food for the baby: manual pumping and using a breast pump. Manual pumping is the simplest and most convenient; the process is similar to the baby’s "sucking, which can only be imitated but never surpassed": after washing your hands, place your thumb and index finger above and below the areola, with the other fingers supporting the breast; press both fingers toward the chest wall while gently squeezing the milk ducts below the areola; repeatedly press and release, turning to cover every direction. At first, the amount pumped may be small, but just like the baby didn’t give up, you can’t lose heart! With more practice, the production will increase. Whether manual pumping or using a breast pump, the frequency of pumping should match the time intervals of feeding at home, about every 2-3 hours; this way, combined with the baby’s efforts, 8-12 sessions of milk expression a day can ensure the baby doesn’t go hungry. Each pumping session should last about the same time as your baby’s feeding duration, generally around 15 minutes, and each collection should use a separate container. Bottles are best; glass bottles are naturally the best, safe and non-toxic; there are also specially designed milk collection bags available on the market, suitable for freezing. Here’s a little secret: milk secretion is a reflexive response; if you think of the baby while pumping, or look at a photo of the baby or smell their little clothes, it can reflexively increase milk production.
Next, it’s time to properly store milk for the baby. Breast milk is exceptional, loaded with antibodies, immunoglobulins, lactoferrin, and lysozyme, which not only give the baby a strong physique but also endow breast milk with extraordinary antibacterial properties when stored outside the body. Although studies have shown that breast milk can be safely stored at room temperature for 10 hours, to be safe, collected breast milk should be refrigerated immediately and sealed in the communal food fridge at work. After work, bring it home; refrigerated milk can be stored for 8 days, and if frozen, it can last for 6 months without issue. While long-term freezing may result in some loss of antibodies, even so, breast milk can still proudly say, "I’m better than formula!" After all, it’s better than nothing. By the way, remember to label each bottle with the production date before storing—produced by mom, guaranteed quality, with the label: exclusively for my baby.
Before heading to work, don’t rush to leave in style; for the reliable person left at home to feed the baby, you still need to remind them a few more times. "The bottled breast milk taken out of the fridge should be warmed with running warm water or placed in a pot of heated water; remember not to heat it directly (including in the microwave) or boil it. Frozen breast milk should be thawed in the fridge overnight or placed in running cold water, then gradually warmed; once thawed, it cannot be refrozen, and must be used within 24 hours..." The reliable person impatiently glances at the clock: "I’ve heard this a day, I can recite it by heart, you can go with peace of mind!"
Thus, you leave with peace of mind, elegantly head to work, and think of the baby at home being well-fed, which gives you more combat power in the workplace and confidence in upgrading your self-system. A mother who can switch between dual roles effortlessly is the coolest.
Let’s Talk About the Postpartum Period, I’m Serious#
After giving birth, mothers, mothers-in-law, distant relatives, and close relatives all gather around, announcing that each mother has entered the postpartum period and passing down the ancestral orders: avoid water, avoid wind, avoid certain foods, and avoid movement. The rules of postpartum confinement are like the golden seal pressed down by the Buddha on the Five Finger Mountain, making it impossible to resist, as they are scared of the severe consequences: "If you don’t do a good job during confinement, you’ll regret it later!" Under such pressure, the remaining science and rationality in one’s mind inevitably takes a step back: "Well, it’s better to believe it than not to believe it..."
Is "better to believe it" a zero-risk strategy? Don’t rush to answer.
Indeed, postpartum confinement is the experience that our ancestors painstakingly summarized to deal with postpartum complications, but it can only be considered a special product of ancient times. Back then, the maternal mortality rate was extremely high, and our ancestors had no other choice but to regard some seemingly effective methods as treasures to be passed down orally. "Women who are pregnant have half the chance of miscarriage, half the chance of difficult labor, and half the chance of stillbirth"—this phrase is familiar, right? It may not come from official history, but it roughly reflects the medical level of ancient times.
Postpartum hemorrhage and puerperal infection have always been the main causes of maternal mortality, even in the face of medical advancements over hundreds of years. Postpartum hemorrhage is dangerous; in ancient times, without blood transfusion technology, oxytocin, vascular ligation, uterine artery embolization, hysterectomy, or shock rescue techniques, one can imagine how helpless the ancients were and how much the mothers had to rely on fate. As for puerperal infection, even with strict sterile procedures today, it ranks second among causes of maternal mortality; one can only imagine how high the incidence of postpartum infections was for ancient people who gave birth on unclean bedding, used rusty scissors to cut the umbilical cord, and had midwives with poor hygiene habits. Naturally, infections lead to fever and chills, and the ancients diagnosed this as wind and cold, blaming it on the postpartum body being weak and catching a chill (back then, who knew what bacteria were?). "How can we let colds take so many lives? No, we must strictly control!" Thus, mothers were required not to get out of bed, not to meet guests, not to be exposed to wind, not to touch water, and not to eat cold food. From the perspective of promoting these restrictions, there was some effect, as the high mortality rate served as a baseline; even a small improvement was a big step for humanity. From a scientific perspective, some measures made sense in ancient times, such as only having basin baths, as prohibiting showers reduced the risk of ascending infections.
However, for those of us living in the 21st century, most of the postpartum rules do more harm than good: the confinement customs have led to a uniquely Chinese postpartum disease known as "puerperal heatstroke," which can be fatal; closing doors and windows, not washing hair or bathing, rapidly cultivates generations of bacteria, which can also be fatal; absolutely not getting out of bed postpartum greatly increases the risk of thrombosis due to stagnant blood flow, which can lead to pulmonary embolism and can be fatal... All of these can be considered the price of "better to believe it than not to believe it"?
Worldwide, 99% of maternal deaths occur in developing countries, closely linked to medical levels (poverty), lack of information, and cultural customs. Compared to the experiences of ancient people, how many lives can modern medical technology save? In 1990, China’s maternal mortality rate was 88.8 per 100,000; by 2014, it had dropped to 21.7 per 100,000, a decrease of 75.6%! At this point, I wonder if science can give you the courage to choose modern medicine over outdated customs, rather than "better to believe it than not to believe it."
Scientific Reboot, Reject Bugs#
Since a little person inside needs to eat, drink, and grow, the mother’s body enters a high-speed operation mode, with changes occurring in the circulatory system, endocrine system, reproductive system, and even the urinary, digestive, and respiratory systems, presenting a significant challenge for the mother. Otherwise, why do ancient people refer to childbirth as "the gate of ghosts"? Thank goodness the baby arrives safely, and the mother must return to normal: dealing with the excess 15-25% of blood, body fluids, and tissue fluids, coping with the turbulent hormone levels that are either plummeting or skyrocketing, shrinking the basketball-sized uterus back to the size of a chicken egg, and reorganizing the territory of organs and tissues... With so many reboot projects, will there be bugs? Let’s discuss them one by one.
(1) I’m Not a Magpie, You’ve Got the Wrong Person
A slight increase in body temperature postpartum is normal. Within 24 hours after the baby is born, the mother’s temperature may rise slightly due to fatigue, generally not exceeding 38 degrees. After the baby starts feeding, for 3-4 days, the breasts may swell due to extreme fullness of blood vessels and lymphatic vessels, accompanied by fever, generally reaching 37.8 or even 39 degrees, which will self-resolve after 4 to 16 hours without intervention, known as "lactation fever." This is a normal phenomenon that requires no treatment; quickly soothe the family’s anxiety as they hover between medication and breastfeeding restrictions. However, if the fever persists for too long, a doctor should be called to rule out the possibility of infection.
Postpartum uterine contractions are normal. "Hey? The baby has been out for a while, why are there still contractions? This is so strange; I need to call the doctor." Calm down, mother of the child. Think about it; at the end of pregnancy, the baby expands the uterus to the size of a basketball, and it takes time to return to normal size, roughly six weeks; during childbirth, contractions are necessary to push the baby out, and after the baby is born, contractions are still needed to stop the bleeding. Finally, the uterus can only return to its previous form and position through contractions, so just bear with the pain. Normal postpartum contractions are paroxysmal severe pains in the lower abdomen, occurring 1-2 days postpartum, lasting only 2-3 days. Some mothers may experience increased abdominal pain while breastfeeding, as oxytocin is reflexively secreted in greater amounts; your baby is helping your uterus recover.
Postpartum lochia is normal. After the baby leaves the uterus, not only does the uterus undergo changes in size and shape, but it also needs to be remodeled internally: the specially crafted endometrium is no longer needed and must be removed, and the area where the placenta detaches is quite large, requiring repair. As a result, with the shedding of the uterine lining, blood, necrotic tissue, and other materials are expelled through the vagina, forming lochia. Lochia can last from one to six weeks. Generally, it starts as red blood lochia, containing a lot of blood and small clots; after 3-4 days, the color lightens (serous lochia), and after 10 days, the color disappears, turning into thick white lochia, which may take about three weeks to clear completely. Therefore, postpartum vaginal bleeding and discharge are different from regular Aunt Flo; this one requires patience and can take weeks to resolve. Normal lochia should never have an odor; if there is a foul smell accompanied by fever, a doctor should be called.
Postpartum sweating is normal. During the ten months of pregnancy, the mother’s blood circulation supports the baby’s blood circulation, "Your nutrition is supplied by me, and your waste is filtered by me," which is so great, so the mother’s blood volume increases by 40-45%. After the baby becomes independent, it only takes away the blood volume it needs, leaving 15-25% behind in the mother’s body. What to do? Expel it! Therefore, not only does the mother frequently use the bathroom, but the spectacle of sweating is also beyond the imagination of ordinary people. However, in the eyes of our ancestors, excessive sweating is a sign of weakness. Seeing the mother sweating so much, they would panic, insisting on careful monitoring, forbidding her from touching water or seeing the wind, wrapping her up tightly, closing doors and windows, and not allowing her to bathe, which provides an excellent warm and humid breeding ground for bacteria, leading to wound infections. Therefore, excessive sweating postpartum is normal; it’s the abnormal treatment that is frightening.
(2) The Correct Postpartum Reboot
You can and should shower and wash your hair. The ancestors prohibited postpartum women from showering and washing their hair, fearing that they would catch a cold and leave "hidden illnesses," right? Centuries later, we are racing toward a well-off society (serious face), and I believe that readers of this book can find a warm place to stand and take a hot shower, after all, water heaters have existed since "the name of my grandfather's grandfather." So, with a little care, it’s quite difficult to catch a cold from showering in modern society. On the contrary, not showering or washing hair cultivates a large number of bacteria, leading to postpartum infections, which is the real "hidden illness"!
You can shower the day after giving birth, but avoid basin baths to prevent unclean bathwater from flowing into the reproductive tract, causing bacteria to flow back up and cause infections. The water temperature should be adjusted to around 36 degrees for the best results; when you emerge from the bath, be sure to keep warm. Washing hair is also fine because we have hair dryers; using a temperature-controlled hair dryer is even better, as it won’t blow hot or cold air. There are also rumors that showering affects postpartum recovery; indeed, some studies have compared blood pressure, uterine contractions, and lochia conditions and found no differences, debunking the rumor. Another rumor says, "You’re fine now, but you’ll know later!" Oh, again, it’s a psychological battle of "better to believe it than not to believe it," and the sense of threat isn’t as scary as "you’ll wait for it after school." Let me tell you: "You’re fine now, but you’ll know in a few days. Oh, by the way, the incidence of postpartum infections is as high as 7%."
You can and should ventilate or even use air conditioning. The most comfortable room temperature for the human body is 22-26 degrees, regardless of the season. Since postpartum women are often considered weak and delicate, they should live in the most comfortable temperature; what are we covering up for? The benefits of air circulation are not only to lower the temperature but also to sterilize. I’ll let the data speak: under controlled variables, the number of bacteria indoors during natural ventilation is 0-32 cfu/m3, while without ventilation, it is 160-204 cfu/m3, more than six times higher! Using ventilation as a basic method of indoor air disinfection has become a consensus in hospitals and other institutions. Of course, in areas with heavy smog, it’s better to be cautious about opening windows; remember to use a fresh air system for ventilation. When ventilating or using air conditioning or fans, avoid direct blowing on the mother; don’t set the temperature too low just to feel cool.
You can and should brush your teeth. The rule of not brushing teeth during confinement is even more inexplicable and turns cause and effect upside down: brushing teeth causes bleeding and leads to postpartum illness, so I won’t brush my teeth, leading to the proliferation of oral bacteria and periodontal disease. Occasionally brushing once leads to bleeding gums and loose teeth, reinforcing the belief that one really shouldn’t brush their teeth. Interestingly, the elderly who issue the no-brushing command often lack knowledge about oral hygiene. According to the results of the third national oral health epidemiological survey, the incidence of dental caries among elderly people aged 65-74 is 98.4% (I’m not mistaken), with an average of 11 teeth lost, and only 75.2% of elderly people brush their teeth at least once a day; however, this result has seen significant improvement, as the brushing rate for the elderly group was only 30% twenty years ago. The elderly may not understand, but young people must keep up with the times to protect their oral health, right? Especially during pregnancy and postpartum, neglecting oral care can lead to a buildup of bacteria in the swollen and congested gums, which can corrode the gums and lead to the loss of teeth. In summary, the less you brush, the more you bleed, and the more likely you are to develop the so-called postpartum illness—if this vague illness refers to infections, bleeding, and tooth loss. In fact, in the competitive market, many businesses have produced special toothbrushes for pregnant and postpartum women, which are soft and comfortable, allowing for a great brushing experience and saying goodbye to bacteria.
Be cautious with abdominal binders. As mentioned earlier, an important postpartum reboot project is the reorganization of organs and tissues. Once it involves body shape, it becomes a big deal; some mothers are eager to bind their abdominal binders right after giving birth, fearing they will miss the opportunity for uterine contraction and organ repositioning. The key is that advertisements claim binding will help you lose weight! Let me blow some wind for the mothers; please calm down. Research has confirmed that using a moderately tight abdominal binder below the pubic symphysis can alleviate some damage to the pelvic floor muscles caused by childbirth; however, in terms of body shape recovery, the effects of abdominal binders and exercise are not different. Before moving on, promise me to check what the pubic symphysis is. Yes, it’s the skeletal part that connects the upper and lower body in the middle. The abdominal binder needs to cover below the pubic symphysis to protect the pelvis; if it’s only wrapped around the belly, bending down to lift something or coughing will stabilize the belly, but the pressure will all be transferred to the pelvic floor, making it more likely to lead to organ prolapse, which is worse than not binding at all. Furthermore, regarding tightness, postpartum abdominal binders are not shapewear; although I know you want to use it to slim down, the idea that "the tighter, the better" must not be entertained. Once bound, air cannot come in, and food cannot go down, affecting blood circulation, and it will also compress internal organs. Additionally, since lochia is still relatively abundant after giving birth, using an abdominal binder too early can affect the discharge of lochia (the business card of lochia has already been given to everyone). Therefore, the correct way to use an abdominal binder is: start using it a week after giving birth; choose a breathable binder without much elasticity; bind it below the pubic symphysis, with moderate tightness; and do not exceed 8 hours a day, using it for a maximum of 6 weeks. Report complete.
Get up and move as soon as possible. Under the strict supervision of mothers-in-law and mothers, even turning over in bed can disturb them, let alone getting out of bed under their watchful eyes. In fact, mothers who have had a natural birth can get out of bed half a day after giving birth, and those who have had a cesarean section can get out of bed the next day. Getting out of bed doesn’t mean the mother has to run 800 meters around the playground; just slowly move around the hospital bed, even at a snail's pace, is better than lying in bed. Don’t say women should not make things difficult for women; it’s truly for postpartum recovery. Lying in bed causes muscle relaxation, mental fatigue, and blood circulation to slow down; how can the body be activated? The promised reboot cannot be turned into sleep mode! Getting out of bed is the first step to actively embrace the new era, promoting the discharge of accumulated blood in the uterus to prevent infection from accumulation; active blood circulation will not easily lead to thrombosis; lying in bed will cause muscle disuse, leading to further relaxation, while moving will help restore tightness, which is exactly what mothers want!
Timely resume intimate life. Male counterparts, don’t rush to thank me for my thoughtful consideration; according to scientific advice, you still have to wait at least six weeks. During childbirth, to allow the baby to be born smoothly, the cervix opens to the maximum; the extremely dilated vagina needs time to gradually restore muscle tone, but during this time, mothers can do more pelvic floor muscle training, which is good for both you and them. Additionally, the repair of the cervix’s wall damage also requires time, and the lochia in the uterus takes weeks to clear; a little impatience can ruin the big plan.
Let’s also discuss contraception for male counterparts after successfully resuming intimate life. After giving birth, the levels of estrogen and progesterone in the mother’s body drop sharply, returning to pre-pregnancy levels in about a week; however, prolactin levels remain high due to breastfeeding, although they do decrease, they are still much higher than pre-pregnancy levels. High levels of prolactin can suppress ovulation to some extent, "I can’t even feed one baby, so ovaries, don’t cause trouble"; if only the ovaries would listen! After all, prolactin is not their direct superior. Sometimes, small follicles may grow secretly and unexpectedly ovulate, with the sluggish Aunt Flo reporting two weeks after ovulation, which can cause trouble for both parents. Therefore, as soon as postpartum intimate life resumes, contraception must be practiced; contraceptive pills cannot be taken during breastfeeding, so barrier methods should be used, which are safe and have no side effects.
(3) Some Bugs Can Be Prevented, Some Cannot
Postpartum hemorrhage is the number one bug throughout history and the leading cause of maternal mortality in China, striking fiercely and being hard to prevent. The most common cause of postpartum hemorrhage is: the uterus is tired. The uterus has too many responsibilities: it starts contracting about ten hours ago and is required to contract rhythmically, symmetrically, and with decreasing strength from the top down; after successfully pushing the baby through the birth canal, everyone can breathe a sigh of relief, but the uterus still has to work, as the large wound formed by the placenta detachment needs contractions to stop the bleeding. If the battle line is drawn too long, excessive fatigue and over-stretched uterine muscle fibers may lead to the uterus going on strike. At this point, doctors have to use medication (oxytocin) to invigorate it or apply direct pressure to stop the bleeding; if that doesn’t work, they have to intercept the upstream blood supply for ligation or embolization, or even remove the uterus, as saving lives is the priority. Normally, the placenta should come out within 15 minutes after the baby is born, but unfortunately, some may linger in the uterus for over 30 minutes (placental retention), some may leave but not completely (placental membrane retention), and some may even root themselves in the uterus (placenta accreta or placenta previa), all of which can affect uterine contractions and keep blood vessels open, requiring timely detection and removal by doctors.
Careful examination of the placenta’s integrity is also very important; even a particularly small residue in the uterus can pose a risk, leading to severe bleeding, just like what is often depicted in dramas. Besides a tired uterus and a stubborn placenta, damage to the birth canal is also very dangerous, not only causing heavy bleeding but also significantly harming the mother due to vaginal and perineal tears. To prevent serious consequences, experienced doctors will accurately grasp the timing for episiotomy, which is what reports like "The Truth Behind Episiotomy, How Much Do You Know?" discuss. The truth behind it? Episiotomy expands the birth canal, allowing oversized fetuses to be delivered, protecting the perineum, and reducing the risk of prolonged labor and uterine atony leading to severe bleeding. Those who say it’s for profit, in regular hospitals, the cost of an episiotomy is 35 yuan, and suturing takes 20 minutes, and there’s also the risk of hematoma after the episiotomy, and after returning to the ward, careful observation is needed, plus dressing changes and suture removal—why bother? There are also many mothers online who agree, "Why did I get an episiotomy when I was fine?" Again, this is a case of reversed cause and effect; why not think about whether things would have been fine without an episiotomy? In the tense atmosphere of the delivery room, every doctor hopes their focus is solely on the surgical field (the visual range during surgery); if the first thought in an emergency is concern for social opinion rather than decisive action honed over years, it would be a terrible thing. As for mothers, avoid excessive supplementation during pregnancy to control fetal weight; do more pelvic floor muscle exercises to increase vaginal elasticity, which can reduce the likelihood of needing an episiotomy. Oh, by the way, the data showing that 95% of Chinese women undergo episiotomy remains unclear, but according to verifiable data, the episiotomy rate at Shanghai First Maternity and Infant Health Hospital in 2015 was 16.72%, and other hospitals are likely also making efforts.
Puerperal infection occurs when pathogens invade the reproductive tract during the six-week postpartum period, causing localized or systemic infections. For mothers during this period, infections are not a small bug, but fortunately, they can be prevented to some extent. The female vagina is a harmonious internal environment, home to a large number of bacteria (which would drive a Virgo crazy), with various types, including aerobic, anaerobic, fungi, chlamydia, and mycoplasma, some of which are beneficial, while others are harmful, almost all gathered together. Although this sounds alarming, most women are fine because the vagina has a self-cleaning function, and the bacteria are kept in check, remaining docile. However, once this harmonious environment is disrupted, the balance between immune response, bacterial aggression, and bacterial quantity collapses, and bugs appear. Here’s a common sense reminder: breaking the harmony doesn’t only happen postpartum; in daily life, washing the vagina frequently, relying on so-called cleansing solutions, or even strong soaps, is detrimental to one’s health, and the more you wash, the higher the risk of infection. In fact, simply washing the vulva with clean water daily is sufficient; don’t invade and clean the inside casually. If discomfort arises, seek medical attention promptly; targeted treatment can only be given when there is evidence of infection, as the resident bacteria are not to be trifled with.
Returning to the postpartum mother. Due to the vagina’s self-cleaning ability, amniotic fluid also contains antibacterial components, and during pregnancy, a mucus plug blocks the cervix, so normal pregnancy and childbirth do not increase the risk of infection. Some severely anemic or immunocompromised mothers may succumb to bacterial attacks postpartum, but this is rare; the main reasons are