The puerperium refers to the six-week period, which follows childbirth. During this time, the pelvic organs return to the non-pregnant state, the physiological changes of pregnancy are reversed and lactation is established. Immediately after placental expulsion, the fundus of the uterus is slightly below the umbilicus. During the puerperium, the uterus begins to shrink so that within two weeks the fundus will have descended below the symphysis pubis. The process by which the postpartum uterus returns almost to its pre-pregnancy state is known as involution. Vagina gradually diminishes in size. The hymen disappears and is represented by several small tags of tissue which cicatrize and are known as carunculae myrtiformes. This is a characteristic sign of parity. Lochia is the vaginal discharge for the first 2 to 3 weeks during puerperium. It is comprised of blood and necrotic decidua. The puerperal bladder has increased capacity and is insensitive to the raised intravesical pressure. Therefore, the bladder can be overdistended and incomplete emptying is common in the puerperium. Cardiac output rises soon after delivery and remains elevated for at least 48 hours postpartum. Offensive lochia, which may be accompanied by pyrexia and a tender uterus, suggests endometritis. Persistent red lochia suggests delayed involution that is usually associated with infection or retained bits of placental tissue. Constipation is a common problem in the puerperium. Postnatal examination is carried out at the end of 6 weeks. The abdomen is examined and the state of the musculature noted. Pelvic examination is performed to check if episiotomy has healed and that the uterus has involuted. Practical contraceptive advice should be given to women to space their next pregnancy. The milk ejection reflex is initiated by suckling which stimulates the release of oxytocin from the posterior pituitary. Oxytocin contracts the myoepithelial cells surrounding the alveoli and the lactiferous ducts thereby aiding expulsion of milk.