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Overview: What a Big Deal Pregnancy Is#

1. 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 replenished. By puberty, the number of follicles decreases 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, generally, one egg is released each month; accompanying it are over 1,000 follicles that are eliminated due to insufficient strength (the essence of survival of the fittest).
   Alright, next, girls reach their reproductive age and prepare to create little humans. First, you need an egg, preferably a high-quality one. In the vast sea of eggs, we find one: "Wow, we have high hopes for you!" This one is destined to become the "Heavenly Egg," and let's call it L.
   "Hey, wake up!" The only 30μm L is awakened. At this time, it, like hundreds of thousands of other follicles, is in the smallest sleep state, called primordial follicle. "You more than 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 grow to 120μm. During this process, they grow independently, without interference, quietly coexisting, and transition from primordial to primary follicles.
   From the little L (primary follicle), it officially enters the competition mode and outperforms over 1,000 follicles (becoming the dominant follicle), which takes 85 days. Now, guess why it's often said that preparing for pregnancy takes three months? If you can't answer, go face the wall and think about it.
   First, the follicles need to grow (nutritional growth phase). This phase includes four levels; each time they gain weight, 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 an insatiable appetite, so it grows impressively and smoothly advances to 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 advances to the glorious level 8, earning the honorary title: mature follicle (>18mm). From level 5 to level 8, there is a 5-day gap between each level, totaling 15 days.
   Here’s a secret about L's undefeated status: 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 without much food. L is the one with the best constitution and the hardest worker, receiving the most food and absorbing it well, thus growing the largest.
   Finally, ovulation occurs. When the estrogen secreted by the follicles is sufficient (>200pg/ml), the bosses happily provide more food—FSH and luteinizing hormone (LH)—encouraging everyone to work, creating positive feedback. As estrogen, FSH, and LH levels peak in succession, the peak of LH triggers ovulation, and the egg breaks free from the follicle: "Hello, world!"
   (2) You Are Not Alone in the Battle
   Even the powerful L will starve if no one provides food. Who approves this food supply, and who distributes it? 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 smaller roles. The ovaries are a type of gonad responsible for storing, nurturing, and releasing eggs (reproductive function) and producing hormones like 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, and its effects have already been seen during follicle growth. Additionally, the pituitary 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 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, provides food to the ovaries. FSH is the most needed substance for follicle growth: it can wake sleeping follicles; directly stimulate their growth and development; activate an enzyme (aromatase) in the follicles, enabling them to produce estrogen; and select dominant follicles, eliminating those that are less competitive and cannot obtain enough FSH. Additionally, the pituitary sends LH to the ovaries, assisting mature follicles in releasing eggs; after ovulation, LH helps keep the egg in its nest (follicle wall, follicle membrane) and with its companions (granulosa cells, theca cells), transforming them into the corpus luteum and maintaining its function to produce and secrete a large amount of progesterone and a certain amount of estrogen to prepare the uterine lining for the fertilized egg.
   The ovaries are obedient and well-behaved. In the early stages of follicle growth, the estrogen produced is not that much (<200pg/ml), and the follicles' appetites are not that big, so the ovaries report to the bosses, "It's important to save costs; just a little FSH will do!" (negative feedback). Later, when the follicles have been selected and the dominant ones that can both work and eat appear, they produce a lot of estrogen (≥200pg/ml), making the leaders extremely happy, and they start releasing large amounts of FSH and LH (positive feedback), helping the egg to be released at peak levels. After ovulation, the leaders only provide a little food to the ovaries to protect the potentially fertilized egg, limiting the development of small follicles in the warehouse; otherwise, if pregnancy occurs while still ovulating, it would be chaotic!

(1) Meeting on the Magpie Bridge: The Fallopian Tubes#

Ladies, please sit tight and elegantly spread your arms. Take a deep breath and imagine your body as a uterus. Great, 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 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 place by ligaments).
When the egg breaks free from the ovary and enters the abdominal cavity, it finds itself in complete darkness. "What if I can't find my way?!" Just then, it feels a warm hand, which 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's a new method of protecting women's fertility internationally, which involves removing a portion of the ovarian tissue for freezing and later transplanting it back into the body at the right time, often in a location not where the original ovary was, but behind the peritoneum. 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 deserves the title of international fimbriae!
Next, let's look at the cross-section of the fallopian tube, which is divided into three layers from the outside to the inside: the outermost layer is a membrane (serosa), the middle is smooth muscle (muscular layer), and the innermost is mainly a layer of cilia (mucosal layer). After the egg enters the fallopian tube from the fimbriae, the muscular layer of the fallopian tube begins to contract rhythmically, and the cilia start to wave toward the uterine cavity. The egg is thus pushed and swept forward, coming to a stop in the ampulla of the fallopian tube, where it waits for the sperm to arrive. Oh, here comes a sperm that has overcome numerous challenges! After the two happy beings combine into a fertilized egg, they continue to roll forward happily with the help of the muscular layer and cilia, taking root and sprouting in the uterus.
(2) This Route is Closed, Please Detour
However, the Magpie Bridge may encounter illegal construction and become impassable, accounting 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 intimate moments 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 hinder their duties. A series of inflammatory responses can lead to ciliary damage, tissue adhesion, and even fallopian tube blockage.
Illegal construction two: endometriosis. The main culprit is endometrial tissue that has migrated to the fallopian tubes. Endometrial tissue has an innate ability to shed and bleed if pregnancy does not occur, being very self-aware and not caring whether it is in the uterus. Occasionally, if some endometrial tissue leaves the uterus and wanders into the fallopian tube, it insists on setting up camp there (proliferating) and dutifully sheds and bleeds regularly, leading to blood clots and inflammatory responses similar to those caused by salpingitis.
Additionally, there are other less common illegal constructions, such as benign polyps in the fallopian tubes, small nodules, or spasms caused by issues with the fallopian tube control system, which can also lead to blockage or obstruction of the fallopian tubes.
Some girls may be frightened: how do I know if there is an illegal construction team? Here are a few tips.
First tip: pay attention to your body and seek medical attention promptly.
Let's start with prevention; the most common and should be guarded against are infections. Couples should maintain hygiene in their daily lives and take contraceptive measures when not intending 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 vaginal discharge, or abdominal pain, you need to see a doctor promptly. After diagnosis, immediate treatment can help chase away the construction team and repair the damage they caused.
Second tip: check for fallopian tube patency.
"Construction ahead, please detour." This phrase may bully an inexperienced egg, but how dare it 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, it indicates 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; after the liquid passes, pathogens may return, and the construction team will continue their work. What's worse, this procedure can confuse 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. This involves placing absorbable LED lights (contrast agents) in every corner of the uterus, fallopian tubes, and even the pelvis, and then pressing a switch (X-ray imaging) to reveal everything: whether the fallopian tubes are patent, the location and severity of any blockages, the shape of various organs, and whether there are fibroids or polyps, etc. Knowing both yourself and your opponent makes it easier to deal with. Moreover, the development of contrast agents has become increasingly advanced; previously, it took three months after the procedure to conceive, but the new types reportedly only require a month to be safe and worry-free.
(3) The Fallopian Tubes Cannot Bear the Weight of Life
Sometimes, the fertilized egg does not roll into the uterus but instead 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 recently shocked us by ending up in the spleen.

1. The Confused Fertilized Egg
   The main reason for fallopian tube pregnancy is issues with the passage. Salpingitis can narrow the lumen and damage the cilia; peri-tubal inflammation can cause surrounding tissues to adhere, twisting and distorting the fallopian tubes, leading to abnormal movement; nodular salpingitis occurs when the muscular wall of the fallopian tube undergoes nodular hyperplasia, growing inward and creating its own barriers; there can also be excessively long fallopian tubes, lack of cilia, and failure to respond to hormonal regulation, or even psychological factors. All these barriers can affect the movement of the fertilized egg, but once fertilization occurs, the growth process is initiated, and it must implant somewhere.
   Additionally, the fertilized egg may go rogue. After the egg meets the sperm in the fallopian tube, the two combine, but who knew they would want to go on a honeymoon, heading north without turning back (not entering the uterine cavity), and end up implanting in the other fallopian tube, causing trouble for the mother.
2. The Fallopian Tube Cannot Bear the Burden
   Life is tough for the fertilized egg that has settled in a foreign land. The fallopian tube is not well-equipped, so it can only make do with a makeshift bed; due to the narrow lumen, it cannot provide enough nutrition, and the fertilized egg often dies early. However, some are resilient and can grow even in harsh conditions. The severity of the consequences is somewhat related to the implantation site.
   The ampulla of the fallopian tube is where the egg meets the sperm, and it is relatively spacious. If the fertilized egg grows into a blastocyst here, it generally will miscarry between 8 to 12 weeks (yes, those in the fallopian tube are also called miscarriages). Sometimes it can completely detach and be expelled into the abdominal cavity (complete miscarriage); but sometimes it does not detach completely, and some tissue remains in the wall of the fallopian tube, thinking it is on a thick bed and wanting to continue snuggling (which is actually an invasion), leading to repeated bleeding from the fallopian tube.
   If the fertilized egg implants 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 previously mentioned fallopian tube miscarriage, as it can result in 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 difficult to detect.
3. If Only I Knew It Was an Ectopic Pregnancy...
   Ectopic pregnancy is a nightmare for women. How can one know early? The typical symptoms of ectopic pregnancy are: missed period, vaginal bleeding, and abdominal pain. However, this textbook description may not apply to everyone; the general situation may look like this:
   If your period is delayed by a week, you must, 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) will test positive. Next, continuously monitoring blood HCG levels can reveal ectopic pregnancy. In a normal early intrauterine pregnancy, 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 a slower increase, doubling every 3 to 8 days. When you find that HCG is doubling abnormally and barely reaches the threshold (1500 to 1800 IU/L), do a vaginal ultrasound; this time, you will definitely catch it if no pregnancy is found in the uterus.
   This may be too technical, but women need to be vigilant and take responsibility for themselves. If there are abnormalities in menstruation and a possibility of pregnancy, seek medical attention promptly and leave the professional matters to the doctors.

Dear Aunt Flo#

1. 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.
   Once this large follicle matures (over 18mm, not the egg itself), it will break through the ovary (causing ovulation pain) and be released into the abdominal cavity, where it is caught by the claws of the fallopian tube (fimbriae). This egg rolls and rolls, coming to rest in the designated spot (ampulla) to wait for sperm. If a sperm swims over successfully, the two will happily combine into a fertilized egg and continue rolling forward to take root and sprout in the uterus. If no sperm arrives, the egg must wait until it ages and passes away sadly, while Aunt Flo will come to remove the bedding (the endometrium) prepared for the fertilized egg, and start again next month.
2. Who Commands 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 is in charge.
   Days 5-14: A batch of follicles is summoned. During this joyful growth process, they continuously secrete estrogen, thickening the endometrium. When enough estrogen (>200pg/ml) makes the two bosses happy, they release more FSH and LH to encourage the follicles to work (positive feedback). As estrogen and FSH, LH levels peak in succession, the peak of LH triggers ovulation.
   Days 15-28: Ovulation is just the egg's solo journey; the house it leaves behind (follicle membrane and follicle wall) forms the corpus luteum with its companions (granulosa cells, theca cells). 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 wait for the sperm, the corpus luteum will stop working, and estrogen and progesterone will cease production, leading to a drop in their levels and the shedding of the endometrium, bringing Aunt Flo.
3. Is Aunt Flo Being Lazy Normal?
   From the above, it can be seen that Aunt Flo is determined by changes in internal sex hormones.
   Normal menstruation does not necessarily mean ovulation, but if it has not come for several months, it is likely due to ovulation abnormalities (after hysterectomy or endometrial ablation, these beds have been dismantled, so what bedding can be laid?). Sex hormones fluctuate, and checking them every day for a month will yield different results, requiring judgment based on the corresponding period for any abnormalities. 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 unpredictable and elusive ovulation periods, how can one plan for pregnancy? This depends on the specific situation.
   (4) How Has Your Aunt Flo Been Lately?
4. Normal Aunt Flo Looks Like This
   Normal menstruation 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 blood loss is calculated. Here's how: in the lab, alkaline hematin is measured; in daily life, based on experience, one medium-sized sanitary pad fully soaked is about 10ml. For those seeking the truth, you can refer to the "Menstrual Blood Loss Table" below for scoring calculations.
   Each sanitary pad's blood-stained area is categorized as: mild, blood-stained area ≤ 1/3 of the entire pad; moderate, blood-stained area occupies 1/3 to 3/5 of the entire pad; severe, blood-stained area is nearly the entire pad. Scoring is 1 point, 5 points, and 20 points respectively, with lost blood clots sized <1 yuan coin counted as small clots, scoring 1 point; ≥1 yuan coin as large clots, scoring 5 points; if the lost blood cannot be represented by clots, estimate it as a fraction of the recorded amount. Fill in the scores, quantities, 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. Everything within the standard is normal, and occasional irregularities should not 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 take action.
5. Reasons Aunt Flo Doesn't Listen
   In the flower of youth, if a girl is generally healthy (no major issues found during check-ups), menstrual irregularities are mostly functional disorders. What does that mean? It means a disruption in the reproductive endocrine axis. What does that mean? I won't explain it a third time! Go back and review the previous text, dear. Yes, it's the collaboration of the big boss hypothalamus + the second boss pituitary + the third boss ovaries + the obedient 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 their 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; relying on luck is not advisable.
6. Judging Whether Ovulation Occurs is Very Important
   Determining whether ovulation occurs is very! important! because it is closely related to the choice of treatment plan, and because girls worry about their fertility when Aunt Flo is irregular. Methods of judgment include:
   Blood tests: Check sex hormones on days 21-23 of the cycle (the first day of menstruation is counted 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, and having intercourse when the test strip shows a strong positive.
   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, and don't drink water; that is 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 for 10-14 days, then drop, known as "biphasic temperature." For girls who have ovulated but have irregular Aunt Flo, count your high-temperature days. If they are too long, it indicates incomplete luteal regression, leading to endometrial shedding, and there are not many 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 puberty, menopause, polycystic ovary syndrome, etc., 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.
7. What to Do About Irregular Aunt Flo
   I want to say, regarding treatment, don't worry too much; leave it to the doctors! But your body is your own, and here are things you need to do:
   Diet. Don't be too confident about your dietary structure; in current nutritional assessments, the pass rate is less than one-third. 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 any of you who don't work out or exercise? Raise your hands; let me see.
   Staying up late. Don't stay up late often! Many hormones in the body have diurnal fluctuations; if you don't sleep, they still want to sleep.
   Mindset. Don't be too nervous, especially for girls worried about having babies in the future; 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 when the holiday is coming, "treatment is so hard, work is so hard, I can't do it anymore; I want to take a good rest."

(5) Is Decreasing Menstrual Flow a Sign of Aging?
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, patients often come to the clinic only after experiencing severe bleeding that leaves them unable to stand, looking pale, yet still managing to smile like a hero, which is heartbreaking to see.

1. Does More Bleeding Mean Youth? Does Less Bleeding 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 problems 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 being less than 5ml is considered hypomenorrhea! What does that mean? It means that the total blood loss over several days does not even wet half a sanitary pad... Who doesn't meet this standard? Raise your hands. For those who didn't raise their hands, your menstrual flow is normal; don't be paranoid. Moreover, according to the guidelines, the average blood loss per menstrual period is 20-60ml, which means that during the entire period, one should fully use 2-6 medium-sized sanitary pads. If you require longer night pads, they will leak, and Aunt Flo will be exhausted!
2. What Affects Menstrual Volume?
   We need to discuss the causes of abnormal uterine bleeding. Let me put on a serious tone; teachers may overlook this, medical students can read along, and young girls can skip ahead. "PALM-COEIN," this cool term comes from the initials of these terms: endometrial polyps, adenomyosis, leiomyoma, atypical endometrial hyperplasia, systemic coagulopathy, ovulatory dysfunction, local 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 on the causes of light menstruation. Returning to a serious tone, the key to judging Aunt Flo's sentence is first to see if she comes regularly (the cycle relates to ovulation), then how many days she stays (the duration), and finally how much (the volume, and the doctor will directly ask how many sanitary pads you used, not how you feel about your menstrual flow).
   Furthermore, it's not just thick endometrial tissue that causes heavy bleeding; if the endometrium is too thin, exposing blood vessels can also lead to significant bleeding.
3. Does Decreased Menstrual Flow Mean Aging?
   The thickening of the endometrium relies on estrogen, so if menstrual flow is heavy, it indicates high estrogen levels! Women with high estrogen are delicate like flowers! But don't forget that progesterone also plays a role in menstruation. After ovulation, the egg left in the ovary forms a corpus luteum, which begins to produce progesterone and estrogen. Progesterone transitions the endometrium from a proliferative phase to a secretory phase, making it thicker, softer, and more nutritious. If there is no pregnancy, the levels of estrogen and progesterone drop sharply, leading to the endometrium shedding and Aunt Flo arriving. You see, there are many steps in between; it cannot be said that if the endometrium grows by 1cm, it must shed 1cm.
   That said, ovarian function decline is essentially due to a tight reserve of follicles, so they are reluctant to ovulate; if there is no ovulation, menstruation will be irregular, and it may not come for several months or even amenorrhea. But conversely, this does not necessarily hold; girls who have not had their period for several months should not panic. As long as girls with normal ovulation, the estrogen produced during the growth of follicles is sufficient; otherwise, they will not release them if they haven't done enough work or grown enough. Moreover, the estrogen produced cannot all be used on the endometrium; all organs in the body need it, so it doesn't necessarily mean that one area gets more while another gets less.
   So, are you feeling a bit happier now?
   (6) Is Aunt Flo Irritable, Is It My Fault?
4. Cold Water and Dysmenorrhea
   Everyone knows that dysmenorrhea is divided into primary and secondary types. Friends, if a disease is called "primary," it is mostly because the "cause is unknown." So, could cold water be the cause of dysmenorrhea? It's unclear, and no relevant research literature has been found. But just because there is no evidence doesn't mean one should say, "Come on, girls, eat cold food, ice cream, and your stomach won't hurt! Don't you? 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, and I need to hold my stomach when drinking cold water.
   Lack of theoretical basis does not mean that one should ignore the phenomenon. My view is that girls should "listen" to their bodies, as reactions during menstruation vary from person to person. If some girls can drink ice water without any reaction, then continue to drink; if you feel cold with water below body temperature, you must keep warm. If you are too weak to exercise, rest more. I have 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 those like me, who can only squat by the cabinet and eat all the snacks I can reach while holding my stomach to alleviate dysmenorrhea (including the forbidden chocolate).
5. Causes and Treatment of Primary Dysmenorrhea
   In exploring the causes, ancient 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 me 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 uterine smooth muscle contractions 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 the pain threshold (tolerance to pain) of girls and psychological factors.
   You see, modern medicine's focus is entirely different; it must study molecules, hormones, nerves, feedback axes, etc. Cold water may affect one of these links, but as far as I know, there has been no large-scale research on it.
   If hot water, blankets, snacks, etc., do not alleviate the pain, or if the pain is so severe that you feel like dying, it is better to take painkillers. I recommend ibuprofen and diclofenac (Voltaren tablets), and the dosage must follow the instructions, not exceeding the maximum daily dosage. Many girls have dysmenorrhea and excessive menstrual flow, and some have not ruled out adenomyosis, so aspirin should not be taken casually!
6. 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 beating, perfume, vegetable oil, and pointed shoes... so cold drinks are just one of them.
   The term taboo is too severe; not following it feels like it could lead to death. Some of it is based on ancestral experience, some is theoretical speculation, and some is just nonsense, okay? It contradicts itself! I believe that in the absence of scientific evidence, girls should interpret these "taboos" as "suggestions" and choose based on their body's reactions.
   I wish the girls 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 moments of holding your baby for the first time. But when the baby arrives in your arms, apart from the unstoppable maternal glow shining everywhere, you must also feel quite a bit of confusion: Baby, is this how I hold you? Baby, do you want milk? Baby, how much do you need 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 hospital 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 reflex; the breastfeeding position should be comfortable for you, whether sitting, semi-reclining, or propped up with a pillow, 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 shift away from this. At this moment, the baby's nose is already aligned with the nipple, facing the "granary," but it’s not time to start yet; play a trick by touching 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 yes, the reflex means—it's innate, a practical skill; when the mouth is wide open, 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 hurt, and the baby won’t be able to suck effectively.

Once the connection is made smoothly, 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; if the baby is good, you are good too. When the baby is almost full, they will naturally release the latch—don’t forcefully stop them, as this can easily injure the nipple. After breastfeeding, there’s generally no need to wash the nipple; avoid soap, detergent, or even alcohol, as these can make the baby’s feeding experience unpleasant, and what if the nipple becomes dry and cracked? You can use a clean ice towel to apply a little pressure for a while to constrict blood vessels and reduce 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 clock for this ultimate preparation. However, to protect the nipples and achieve sustainable development, the duration of each feeding should gradually increase. 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 yourself 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? Just enjoying it! Therefore, there’s no need to worry that the baby didn’t eat enough because the sucking time was short, or that they might overeat if the time was too long.

(2) The Wonders 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 is 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 also higher than that of later milk, while its fat and lactose content is lower, making it very easy to digest; the key is—there are many antibodies in it that help the baby resist neonatal diseases! If it is wasted, it would be 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 content gradually increases. After 2 weeks postpartum, the breast milk can be called "mature milk." The superiority of breast milk is at a legendary level that formula milk cannot replicate, no matter how hard they try to add "calcium, magnesium, zinc, selenium, and vitamins." The calcium and phosphorus content in breast milk is scientifically balanced, not overloading 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 did the advertisement for a certain zinc oral solution 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, besides nutrients, there is also the warmth and security of emotional support.

(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 must be because my breasts are too small, sob..." Hold on, let me say something fair about cup size: breast size does not determine milk production! Breasts are made up of fat and glandular tissue: the fat is external, and the fullness of the breast depends on the amount and distribution of fat, which varies greatly among individuals; the glandular tissue is internal, radiating from the nipple into 15-20 branches, with the terminal lobules responsible for storing milk, and there is no difference in glandular tissue among different sizes of breasts. So, since both large 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 sooner the milk is produced; within 30 minutes after birth, they should start serving the baby. The first breastfeeding requires great 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 breast. Moreover, the more the baby sucks, the greater the production; the effort and reward are rarely proportional. Some mothers worry that if the baby eats too much, they won't have enough for the next feeding, so they meticulously ration and even plot to store milk, which is absolutely not advisable; the less milk there is, the more sucking or pumping should be increased to boost milk production. After the baby empties one side of the breast, switch to the other side; if the little one has a limited appetite and doesn’t finish, still empty the breast; remember, don’t hold back! Don’t hold back! Don’t hold back! If milk remains in the breast, it not only affects future production but can also lead to mastitis, which is counterproductive.

Massage is also effective, but it must be done cautiously. In the streets around obstetrics and gynecology hospitals, the most advertised services besides postpartum centers are lactation services. Various acupressure lactation techniques, essential oil massages, and even music therapy for lactation are emerging; mothers must choose wisely and preferably follow the advice of healthcare professionals when there is a real need, as unqualified lactation consultants using improper techniques can backfire and worsen milk duct blockage. In most cases, the baby sucking more combined with 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 motion at different angles until every branch of the glandular tissue is addressed, controlling the pressure as needed. 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 hormones like prolactin, causing the breasts to feel full and congested, rather than blocked ducts. Keep letting the baby suck, and the feeling of fullness will naturally disappear 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 come out of the delivery room, all for the purpose of increasing milk supply. But this is not scientific. You see, a woman who has just given birth is weak all over, and her gastrointestinal function is extremely weak; digesting such greasy soup is difficult, and over-supplementing can burden the body. The primary driver of milk production is still 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 promote lactation. Breast milk is 70-80% water, so a 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 a certain dish; eating stewed pig trotters for a week or stewed chicken for two weeks may lead to an unbalanced diet, which is still considered malnutrition. Additionally, caloric intake must be considered; after all, the limited amount that goes into the baby’s mouth must also be accounted for in the mother’s body, and later on, it will all be tears and pain. During the breastfeeding period, consuming 500-800 extra calories daily 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 back and walk away; even just the feeding part can be quite stressful. 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 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, meaning the baby will get sick less often, saving time off work to go to the hospital and saving costs; breastfeeding provides the best comfort and security for the baby, making it easier to care for, thus saving costs. For these three obvious "cost-saving" reasons, breastfeeding should also be the best choice for working mothers.

Although after returning to work, breast milk will be fed from 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 tastes the sweetness, they will instinctively prefer the easier option, leading to reduced sucking from the breast and decreased milk production, which is known as "nipple confusion." No need to rush; wait until the baby is three to four weeks old, has gained enough experience sucking from the breast, and is immersed in the enjoyment of sucking; then switching between the bottle and breast will no longer be a big issue.

There are two methods to prepare milk 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" that can only be imitated but not surpassed: after washing your hands, place your thumb and index finger above and below the areola, with the other fingers supporting the breast; press the two fingers toward the chest wall while gently squeezing the milk ducts below the areola; repeatedly press and release while rotating to cover every direction. Initially, 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 gradually increase. Whether manual pumping or using a breast pump, the frequency of pumping should match the intervals between feedings at home, roughly every 2-3 hours, so that combined with the baby’s efforts, 8-12 times of milk expression a day can ensure the baby is not hungry. Each pumping session should reference how long your baby typically feeds; generally, around 15 minutes can collect 60-120ml of breast milk, and each collection should use a separate container. Bottles are best, with glass bottles being the safest and non-toxic; there are also specially designed milk collection bags suitable for freezing. Here’s a little secret: milk secretion is a reflexive response; if you think about the baby while pumping or look at a photo of the baby or smell their little clothes, it can reflexively increase milk production.

Next, let’s properly store milk for the baby. Breast milk is exceptional, loaded with antibodies, immunoglobulins, lactoferrin, and lysozyme, which not only provide the baby with a strong physique but also give breast milk 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, freshly collected breast milk should be refrigerated immediately, sealed, and placed in the communal food refrigerator 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 any issues. While long-term freezing may lead to some loss of antibodies, even so, breast milk can still proudly say, "I am better than formula!" After all, it’s better than nothing. Oh, and remember to label each bottle with the production date before storing—mother’s products are guaranteed to be high quality, with the label: exclusively for my baby.

Before heading to work, don’t rush to leave; for the reliable person at home feeding the baby, you still need to remind them a few more times. "The bottled breast milk taken from the refrigerator should be warmed with running warm water or placed in a pot of heated water; remember, do not heat it directly (including in the microwave), and do not boil it. Frozen breast milk should be thawed in the refrigerator overnight or placed in running cold water, then gradually warmed; once thawed, it cannot be refrozen, and can only be stored for 24 hours..." The reliable person impatiently glances at the clock: "I’ve heard this a hundred times; 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 knowing that your baby is well taken care of at home gives you more fighting spirit and confidence to upgrade your own 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, aunts, and cousins all rush in, announcing that the mothers have entered the postpartum period and passing down ancestral orders: avoid water, avoid wind, avoid certain foods, and avoid movement. The rules of the postpartum period are like the golden seal pressed down by the Buddha on the Five Finger Mountain, making it impossible to resist, as they scare you with severe consequences: "If you don’t sit properly during the postpartum period, you’ll regret it later!" Under such pressure, the remaining science and rationality in your mind can’t help but take a step back: "Well, it’s better to believe it than not to believe it..."

Is "better to believe it" really a zero-risk strategy? Don’t rush to answer.

Indeed, the postpartum period is an experience that our ancestors summarized through their utmost efforts to cope 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 treat some seemingly effective methods as treasures to pass down orally. "Women who are pregnant, half will miscarry, half will have difficult births, and half will have stillbirths"—this phrase is not unfamiliar, 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 leading causes of maternal death, even in the present day, where medicine has advanced for 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 as the second leading cause of maternal death. One can only imagine how high the incidence of postpartum infection was for the ancients, who gave birth on everyday bedding, used rusty scissors to cut the umbilical cord, and had midwives with poor hygiene habits. Naturally, infections would lead to fever and chills, which the ancients diagnosed as wind-cold, blaming it on the postpartum body being weak and catching a chill (back then, who knew what bacteria were?). "How can letting a cold take so many lives? No, we must strictly supervise!" 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. The intensity of these restrictions had some effect, as the high mortality rate served as a baseline; even a small step forward was a significant leap for humanity. From a scientific perspective, some measures made sense in ancient times, such as the fact that only basin baths were available, and prohibiting showers reduced the risk of ascending infections.

However, for us living in the 21st century, most of the postpartum rules have more harm than good: the practice of "sitting the month" has led to the uniquely Chinese postpartum disease of "puerperal heat stroke," which can be fatal; closing doors and windows, not washing hair or bathing, rapidly cultivates generations of bacteria, which can also be fatal; and absolutely not getting out of bed increases the risk of thrombosis due to stagnant venous 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."

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 the ancients, 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%! Therefore, 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 Restart, 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, how could the ancients refer to childbirth as "the gates of hell"? Thank goodness the baby arrives safely; the mother must also return to her normal state: 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 down to the size of a chicken egg, and reorganizing the tissues and organs... With so many restart projects, will there be bugs? Let’s discuss them one by one.

(1) I’m Not a Parrot; 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, within 3-4 days, the breasts may swell due to the extreme fullness of blood vessels and lymphatic vessels, accompanied by a fever, generally reaching 37.8 or even 39 degrees, which will resolve on its own after 4 to 16 hours without intervention, known as "lactation fever." This is a normal phenomenon that requires no treatment; you should quickly soothe the family's anxiety as they hover between taking medication and the breastfeeding taboo. However, if the fever lasts too long, it’s time to call a doctor to rule out the possibility of infection.

Postpartum uterine contractions are also 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: during the late stages of pregnancy, the baby stretches the uterus to the size of a basketball, and it takes time to return to its normal size, roughly six weeks; during childbirth, contractions are needed to push the baby out, and after the baby is born, contractions still help stop the bleeding. Finally, the uterus can only return to its previous shape and position through contractions, so just endure the pain. Normal postpartum contractions are a type of paroxysmal severe pain in the lower abdomen, occurring 1-2 days after birth, 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.

Lochia is normal after childbirth. After the baby leaves the uterus, not only does the size and shape change, but the inside also needs to be remodeled: the specially tailored endometrium is no longer needed and must be removed, and the area where the placenta detaches is quite large, requiring some rebuilding. As a result, with the shedding of the endometrium, blood, necrotic tissue, and other materials are expelled through the vagina, forming lochia. The duration of lochia can range 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, it disappears, turning into a thick white discharge that lasts for about three weeks before it is completely clean. Therefore, postpartum vaginal bleeding and discharge are different from regular Aunt Flo; this one requires patience and will take weeks to resolve. Normal lochia should never have an odor; if there is a foul smell accompanied by fever, it’s time to call a doctor.

Postpartum sweating is normal. During the ten months of pregnancy, the mother’s blood circulation supports the baby’s blood circulation, "your nutrients are supplied by me, and your waste is filtered by me," which is so great that the mother’s blood volume increases by 40-45%. After the baby becomes independent, it only takes away the blood volume it needs, leaving the excess 15-25% in the mother’s body. What to do? Expel it! Therefore, not only will the mother frequently go to the bathroom, but the amount of sweating will also exceed what ordinary people can imagine. However, excessive sweating in the eyes of our ancestors is a sign of weakness. Seeing the mother sweating so profusely, they would panic, insisting on keeping her warm, not allowing her to touch water or see the wind, wrapping her 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, postpartum sweating is normal; it’s the abnormal treatment that is scary.

(2) The Correct Postpartum Restart Position

You can and should take showers and wash your hair. The ancestors prohibited postpartum women from bathing and washing their hair, fearing that they would catch a cold and leave "hidden diseases." Hundreds of years later, we are running full speed on the road to a moderately prosperous society (serious face), and I believe that readers of this book can find a warm place to take a hot shower while standing. After all, water heaters have existed since "my grandfather's grandfather's name was used," so with a little attention, it is quite difficult to catch a cold from bathing in modern society. On the contrary, not washing hair or bathing cultivates a large number of bacteria, leading to postpartum infections, which is the real "hidden disease"!

You can take a shower the day after giving birth, but avoid tub baths to prevent unclean bath water from entering the reproductive tract, causing bacteria to flow back up and cause infections. The water temperature should be around 36 degrees; it’s best to keep warm while bathing. 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 excessively. There are also rumors that bathing will affect postpartum recovery; in fact, research has shown that there are no differences in blood pressure, uterine contractions, or lochia conditions, debunking this rumor. Another rumor says, "You’re fine now; you’ll know later!" Oh, again, it’s a psychological war of "better to believe it," right? The sense of threat is not as intimidating as "you’ll regret it later."

You can and should ventilate or even turn on the 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 they covering up for? The benefits of good air circulation are not just to lower the temperature; it also plays a more important role: sterilization. I will let the data speak: under controlled variables, the number of bacteria indoors during natural ventilation is 0-32 cfu/m3, while without ventilation, the number of bacteria is 160-204 cfu/m3, more than six times! Using ventilation as a basic disinfection method for indoor air 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 be greedy and set the temperature too low; just keep it acceptable.

You can and should brush your teeth. The rule against brushing teeth during the postpartum period is even more inexplicable and turns cause and effect upside down: brushing teeth causes bleeding and leads to postpartum diseases, so I won’t brush my teeth, leading to the proliferation of oral bacteria and periodontal disease. Occasionally brushing leads to bleeding gums and loose teeth, reinforcing the belief that one should not brush their teeth. Interestingly, the elderly who issue the no-brushing orders 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 shown significant improvement, as the brushing rate was only 30% twenty years ago. The elderly may not understand, but young people should 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, leading to bleeding, loosening, and even loss of teeth. In short, the less you brush, the more you bleed, and the easier it is to develop so-called postpartum diseases—if this vague disease refers to infections, bleeding, and tooth loss. In fact, in the competitive market, countless businesses have produced special toothbrushes for pregnant and postpartum women, which are soft and comfortable, allowing for brushing with warm water, leading to excellent oral health and saying goodbye to bacteria.

Use abdominal binders cautiously. As mentioned earlier, an important postpartum restart project is the reorganization of tissues and organs. 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 say binding will help you lose weight! Let me blow some wind for the mothers; please calm down. Research has indeed confirmed that using a moderately tight abdominal binder below the pubic symphysis can somewhat alleviate the damage to the pelvic floor muscles caused by childbirth; however, in terms of body shape recovery, the effects of abdominal binders and exercise are no 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 is only wrapped around the belly, bending over to lift something or coughing will put pressure on the abdomen, transferring all the pressure 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 shaping garments; although I know you want to point to it to lose weight, the idea that "the tighter, the better" must not be entertained. Once bound, air cannot come in, food cannot go down, affecting blood circulation, and it will also compress the internal organs. Additionally, since lochia is still relatively abundant after giving birth, using an abdominal binder too early can affect the expulsion 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 postpartum; choose a breathable abdominal 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 out of bed and move around as soon as possible. Under the strict supervision of mothers-in-law and mothers, even turning over can disturb them, let alone getting out of bed in front of their eyes. In fact, mothers who have had a vaginal delivery can get out of bed within half a day, and those who have had a cesarean section can do so 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 really for better postpartum recovery. Lying in bed leads to muscle relaxation, lethargy, and blood circulation almost falling asleep; how can the body be activated? The promise of a restart cannot be changed to sleep mode! Getting out of bed and moving is the first step to actively embrace the new era, promoting the expulsion of accumulated blood in the uterus to prevent infection; active blood circulation will not easily lead to thrombosis; lying in bed will cause muscle atrophy, and moving will help restore tightness sooner, which is exactly what mothers want!

Restore intimate life at the right time. Male partners, don’t rush to thank me for being considerate; according to scientific advice, you must wait at least six weeks. During childbirth, the cervix is fully dilated to allow the baby to pass through, and the extremely stretched vagina needs time to gradually regain muscle tone; during this time, mothers can do more pelvic floor muscle training, which is good for both parties. Additionally, the repair of the cervical walls also takes time, and the lochia in the uterus will take weeks to clear; a little impatience can disrupt the overall plan.

Let’s also discuss contraception for male partners after being successfully rehired. After childbirth, the levels of estrogen and progesterone in the mother’s body drop sharply, returning to pre-pregnancy levels in about a week; while prolactin, which is responsible for breastfeeding, although it decreases, is still much higher than in non-pregnant states. Abundant prolactin can suppress ovulation to some extent, "I can’t even feed one baby, so ovaries, don’t cause trouble"; if only the ovaries were that obedient! After all, prolactin is not their direct superior. Sometimes, small follicles may grow secretly, and suddenly ovulate, with the slow Aunt Flo reporting two weeks after ovulation, which can lead to trouble for both parents. Therefore, once intimate life resumes postpartum, contraception is essential; 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 from ancient times to the present, and it is the leading cause of maternal death in China, coming on fiercely and being hard to prevent. The most common cause of postpartum hemorrhage is a tired uterus. The uterus has too many responsibilities: it starts contracting rhythmically about ten hours before, and it must contract symmetrically, with the strength gradually decreasing from the fundus downwards; finally, 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 detaching requires contractions to stop the bleeding. If the battle line is drawn too long, the energy is exhausted, and the muscle fibers of the uterus are overly stretched and difficult to contract, the uterus may go on strike. At this point, doctors must use medication (oxytocin) to stimulate it or apply direct pressure to stop the bleeding; if that fails, they must 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; unfortunately, some may linger 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, leading to continuous bleeding that requires timely detection and removal by doctors.

Careful examination of the placenta's integrity is also crucial; even a particularly small remnant in the uterus can pose a risk, causing severe bleeding, just like what is often depicted in dramas. Besides a tired uterus and a stubborn placenta, injuries to the birth canal are also very dangerous, not only causing significant bleeding but also inflicting great harm to the mother from vaginal and perineal tears. To prevent severe consequences, experienced doctors will accurately grasp the timing for episiotomy, yes, the kind of episiotomy that is often discussed in reports like "How Much Do You Know About the Truth Behind Episiotomy?" The truth behind it? Episiotomy expands the birth canal, allowing oversized babies to be delivered, protecting the perineum, and reducing the risk of prolonged labor and excessive bleeding. Claims of doing it for profit? In regular hospitals, the charge for an episiotomy is 35 yuan, and suturing takes about 20 minutes, with the risk of hematoma after the episiotomy, and once back in the ward, careful observation is required, along with dressing changes and suture removal. Why bother? Many postpartum women echo, "Why was I given an episiotomy when I was fine?" Again, this is a case of cause and effect being reversed; why not consider whether things would have gone well without the 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 situation. As for mothers, avoid excessive supplementation during pregnancy to control fetal weight; do more pelvic floor exercises to increase vaginal elasticity, which can reduce the likelihood of needing an episiotomy during delivery. Oh, by the way, the statistic 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 working hard as well.

Puerperal infection occurs when pathogens invade the reproductive tract during the six weeks postpartum, causing local 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 girls are just fine because the vagina has a self-cleaning function, and bacteria are kept in check, remaining peacefully in place. Until this harmonious environment is disrupted, the balance between immune response, bacterial aggressiveness, and bacterial quantity collapses, and bugs appear. Here’s a common knowledge point: breaking the harmony doesn’t only happen postpartum; in daily life, washing the vagina for no reason, relying on so-called cleansing solutions, or even strong soaps, is detrimental to one’s health, as 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 internally without permission. If discomfort occurs, seek medical attention promptly, and only with evidence of infection can targeted treatment be administered, 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, the mucus plug blocks the cervical opening, 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 reason remains the increased number of invading bacteria and their enhanced combat capabilities. Even with strict sterile procedures today, it is impossible to completely isolate the presence of bacteria; prolonged labor creates more opportunities for bacterial invasion, and various hemostatic methods during the management of postpartum hemorrhage inevitably allow bacteria to take advantage of the situation, as blood is their favorite breeding ground. Additionally, an important point is that poor postpartum practices significantly increase the number of bacteria—this has been vehemently criticized earlier, and mothers should heed the words of this young woman. Cunning bacteria will invade through various pathways; after infection, the main symptoms are fever, pain, and abnormal lochia. Infection of the vulva is relatively easy to detect, with significant pain making it hard to sit or lie down, and observable redness and swelling. If bacteria invade through the uterine wound, it can lead to endometritis or even myometritis, and at this time, lochia will turn purulent and emit a foul odor. Some bacteria may have intentions beyond the local area, traveling through the blood vessels and lymphatic vessels beside the uterus to the entire pelvic cavity and abdominal cavity, leading to systemic symptoms of poisoning or even shock, which can be fatal. Speaking of this severity is not meant to scare everyone; puerperal infection ranks among the top three causes of maternal mortality, and since it can be prevented to some extent, why not do everything possible to prevent it?

Puerperal heat stroke can be completely avoided; every time I mention puerperal