2.1.6 Ovaries
The resumption of normal function by the ovaries is highly variable and is greatly influenced by breastfeeding the infant. The woman who exclusively breastfeeds her baby has a longer period of amenorrhoea (absence of monthly bleeding) and delayed first ovulation after the birth, compared with the mother who chooses to bottle-feed. A woman who does not breastfeed may ovulate as early as four weeks after delivery, and most have a menstrual period by twelve weeks; the average time to the first menstruation for a woman who is not breastfeeding is seven to nine weeks after the birth.
Amenorrhoea is pronounced ‘aye-men-or-ee-ah’.
In the breastfeeding woman, the resumption of menstruation is highly variable and depends on a number of factors, including how much and how often the baby is fed, and whether the baby's feed is supplemented with formula milk. Ovulation is suppressed in the breastfeeding woman by a hormone released from the pituitary gland in the woman’s brain whenever the baby suckles. Half to three-quarters of women who breastfeed their babies exclusively, including during the night, will begin their first menstrual period within 36 weeks after the birth.
What kinds of points might you make to a young mother who has given birth recently and is breastfeeding, who asks you when she can resume sexual intercourse?
You could say that once her vaginal discharge (lochia) has more or less ceased and become pale yellow (after five to seven weeks) she can resume sexual intercourse if she feels physically and emotionally ready. You could also explain that breastfeeding makes it hard to predict when she will start ovulating again. And you could encourage her to think of family planning by explaining the risks of another pregnancy so soon after the birth, and the benefits of spacing babies by two years or more.
2.1.5 Abdominal wall