postpartum period postpartum period the postpartum (or postnatal) period begins after childbirth and is typically considered to end within six weeks. however, there are three distinct but continuous phases of the postnatal period; the acute phase, lasting for six to twelve hours after birth; the subacute phase, lasting six weeks; and the delayed phase, lasting up to six months. during the delayed phase, some changes to the genitourinary system take much longer to resolve and may result in conditions such as urinary incontinence. the world health organization (who) describes the postnatal period as the most critical and yet the most neglected phase in the lives of mothers and babies; most maternal and newborn deaths occur during this period. mother with newborn baby in scientific literature, the term is commonly abbreviated to px, where x is a number; for example, "day p5" should be read as "the fifth day after birth". this is not to be confused with the medical nomenclature that uses g p to stand for number and outcomes of pregnancy (gravidity and parity). a woman giving birth in a hospital may leave as soon as she is medically stable, which can be as early as a few hours postpartum, though the average for a vaginal birth is one to two days. the average caesarean section postnatal stay is three to four days. during this time, the mother is monitored for bleeding, bowel and bladder function, and baby care. the infant's health is also monitored. early postnatal hospital discharge is typically defined as discharge of the mother and newborn from the hospital within 48 hours of birth. the postpartum period can be divided into three distinct stages; the initial or acute phase, 8–19 hours after childbirth; subacute postpartum period, which lasts two to six weeks, and the delayed postpartum period, which can last up to six months. in the subacute postpartum period, 87% to 94% of women report at least one health problem. long-term health problems (persisting after the delayed postpartum period) are reported by 31% of women. various organizations recommend routine postpartum evaluation at certain time intervals in the postpartum period. acute phase infant placed directly on the chest following childbirth postpartum uterine massage helps the uterus to contract after the placenta has been expelled in the acute phase. the first 6 to 12 hours after childbirth is the initial or acute phase of the postpartum period. during this time the mother is typically monitored by nurses or midwives as complications can arise. the greatest health risk in the acute phase is postpartum bleeding. following delivery the area where the placenta was attached to the uterine wall bleeds, and the uterus must contract to prevent blood loss. after contraction takes place the fundus (top) of the uterus can be palpated as a firm mass at the level of the navel. it is important that the uterus remains firm and the nurse or midwife will make frequent assessments of both the fundus and the amount of bleeding. uterine massage is commonly used to help the uterus contract. following delivery if the mother had an episiotomy or tearing at the opening of the vagina, it is stitched. in the past, an episiotomy was routine. however, more recent research shows that routine episiotomy, when a normal delivery without complications or instrumentation is anticipated, does not offer benefits in terms of reducing perineal or vaginal trauma. selective use of episiotomy results in less perineal trauma. a healthcare professional can recommend comfort measures to help to ease perineal pain. infant caring in the acute phase infant nursing shortly after birth woman nurses twins six days after birth. the linea nigra is still visible. within about 10 seconds the infant takes its first breath and the caregiver places the baby on the mother's chest. the infant's condition is evaluated using the apgar scale. the apgar score is determined by evaluating the newborn baby on five criteria which are summarized using words chosen to form an acronym (appearance, pulse, grimace, activity, respiration). until recently babies were routinely removed from their mothers following birth; however beginning around 2000, some authorities began to suggest that early skin-to-skin contact (placing the naked baby on the mother's chest) is of benefit to both mother and infant. as of 2014, early skin-to-skin contact, also called kangaroo care, is endorsed by all major organizations that are responsible for the well-being of infants. thus, to help establish bonding and successful breastfeeding, the caregiver carries out immediate mother and infant assessments as the infant lies on the mother's chest and removes the infant for further observations only after they have had their first breastfeed, depending on the mother's preference. the world health organization (who) also encourages skin-to-skin contact for the first 24 hours after birth to help regulate the baby's temperature. subacute postpartum period the subacute postpartum starts after the acute postpartum period concludes and can last for two to six weeks. physical recovery in the subacute postpartum period