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What Happens in the Postpartum Period (Puerperium)?

You go through a lot both physically and emotionally during pregnancy and giving birth. It’s natural that after your baby's arrival, your body needs time to heal and to return to its pre-pregnancy state. The postpartum recovery timeline is highly individual. It can depend on your general health as well as any complications associated with your pregnancy or your baby’s delivery.

Although there are differences between healing after a vaginal delivery compared to a cesarean delivery, much of it is simlar. Read on to get an approximate postpartum recovery timeline, keeping in mind that your situation is unique and your personal timeline may be a little (or a lot!) different.

Week 1

You’ve brought your little one home. Congratulations are in order! Although there’s lots of joy as you welcome your newest family member, you may face challenges as you try to balance caring for your tiny newborn with healing after childbirth.

Try to remember that healing doesn’t happen overnight. Give yourself the time and space to just "be" as you make this initial adjustment; being patient and gentle with yourself helps take the pressure off. Your body needs to recover and regain strength. Focusing too much on things like losing weight or getting back to your old exercise routine may do more harm than good right now.

Here are just some of the things that may be happening this week:

Incision Site Healing

If you gave birth vaginally, you may have had an episiotomy to widen the vaginal opening to make room for your baby, or you may have had vaginal tearing. After your baby’s birth, this small incision or tear would have been repaired with stitches that dissolve on their own.

Healing often takes a couple of weeks, but you may be tender or sore for up to a month. It may take up to six weeks for the area around the incision or the tear to get back to normal. You may want to begin strengthening your pelvic floor muscles by doing Kegel exercises, but check with your healthcare provider first before starting any new exercise.

If you have a fever, or your episiotomy or tear site suddenly hurts or has a pus-like discharge, contact your healthcare provider, as this may be an infection.

With a cesarean, the abdominal incision may take up to six weeks to heal. To help the healing process along, you may like to try the following:

  • Use pain-relief medicine as recommended by your healthcare provider

  • Get as much rest as you can, and try to sleep when your baby sleeps

  • Do not lift anything heavier than your baby, and avoid the squatting position

  • If you’re breastfeeding, support your belly with pillows during nursing sessions

  • Stay hydrated by drinking plenty of water

  • Speak to your healthcare provider if you notice any signs of infection such as redness, swelling, or discharge.

Perineal Pain

The space between the vagina and anus, the perineum, stretches during the birth process if you give birth vaginally. In some cases, it tears, which might result in anything from a minor tear that heals on its own to a large tear that may require stitches.

If you do have a perineal tear, you can expect a few weeks of swelling as it heals. Here are some tips for dealing with the pain of a perineal tear:

  • Try applying cold packs or chilled witch-hazel pads to the area

  • Try a numbing spray or cream if recommended by your healthcare provider

  • Try sitting on a pillow or a special seat cushion if sitting is uncomfortable

  • Try a sitz bath—sitting in a basin filled with warm water, which you can place over the toilet seat.

Vaginal Discharge

The blood and tissues that line your uterus during your pregnancy will shed after your baby is born. This discharge is referred to as lochia. It’s normal for lochia to last from a few weeks up to a few months.

In the beginning the bleeding will be very red and heavy, and there may even be blood clots. Wear sanitary pads instead of tampons during this time.

Eventually the bleeding will lighten in volume and in color. In a week, it may be pink or brown. In two weeks, brown, or yellow. You may, however, experience a gush while breastfeeding due to contractions in your uterus that can be triggered while breastfeeding.

Check in with your healthcare provider if your bleeding gets heavier and not lighter with time, or if you’re unsure if your bleeding is lochia or caused by something else.

Afterbirth Pains

Soon after your baby is born, your uterus will begin the process of returning to its normal size. It will also descend from your navel back down below your pubic bone.

The uterine contractions associated with this are often referred to as afterbirth pains, and they may feel like strong cramps.

Over-the-counter pain relievers may help if these cramps become too uncomfortable, but check with your healthcare provider first before taking any medications while breastfeeding.

Urination Pain or Incontinence

In the days after birth, you may feel pain or a burning sensation when you urinate. You may also feel the urge to pee, but are unable to. This is due to the pressure put on your bladder and urethra during birth, which may cause stretching and swelling that affects urination.

To help with the swelling or pain, try a few of the following strategies:

  • Have a sitz bath (sit in a basin filled with warm water)

  • When you have the urge to urinate, use a squeeze bottle to spray water over your genitals as you sit on the toilet; this may help take some of the sting out of peeing

  • Try running the tap to encourage urination

  • Drink lots of water and other fluids to ensure that you are hydrated enough to pass urine.

Another concern you may have after giving birth is urinary incontinence. Wearing a sanitary pad may be helpful with this condition. Kegel exercises can help strengthen your pelvic floor muscles, which in turn can help stop the leakage. Ask your healthcare provider for advice on how to do Kegel exercises or what to do if the incontinence doesn’t go away with time.

Your Post-Baby Bump

You may be concerned that after delivery you still look pregnant. This is normal, as your abdominal muscles stretch a lot during pregnancy and do not snap back immediately. It will be a while before your body resumes its pre-pregnancy shape and fitness level.

Certain gentle postpartum exercises like leg raises, knee touches, and leg extensions are good for toning those stretched-out muscles. When you're ready, and with your healthcare provider's approval, you can begin regular workouts. Exercising three times a week and keeping an eye on your food intake can help tone your abdomen and even help you lose some of that baby weight.

For some moms the muscles of the rectus abdominus separate during pregnancy and don’t go back to their normal positions. This is called diastasis recti. If your healthcare provider diagnoses you with diastasis recti, you may be referred to a physical therapist. In some cases, surgery may be required to close the muscles.

Hemorrhoids

If during your pregnancy you had hemorrhoids or varicose veins in your vulva, these conditions may worsen after delivery. They may even appear for the first time during labor, due to the intense straining. In time, these conditions may subside or go away completely.

Here are some of the ways you can seek comfort if you suffer from hemorrhoids or vulvar varicosities:

  • Use a medicated spray or ointment

  • Apply dry heat to the affected area with a heat lamp or a hair dryer on the lowest setting

  • Have a sitz bath, which means sitting in a basin of warm water

  • Appy a cold compress like a chilled witch-hazel pad

  • Try to avoid straining when passing a bowel movement, as it can make these conditions worse.

Check with your healthcare provider if these home treatments don’t work or of your condition worsens, as your provider may be able to recommend another form of treatment.

Bowel Conditions

Passing a bowel movement may be difficult for a few days after delivery, and you may find that the urge to go feels different than it did before giving birth. You may also experience uncontrollable bowel movements or the passing of gas when you didn’t mean to. The following may be some reasons for these problems after giving birth:

  • Fecal incontinence or accidental bowel leakage can be a result of damage to the nerves and muscles in your rectum and anus during delivery if you gave birth vaginally

  • Stretched muscles in your abdomen

  • Sluggish bowels associated with surgery (if you had a cesarean) or as a side effect of pain relief medication

  • An empty stomach because you didn’t eat during labor

  • Fear of pain, which could arise if you had a perineal tear or have hemorrhoids.

If you’re experiencing constipation or painful gas, try these tips to get some relief:

  • Go for a short walk as soon as you can and are able, as this can move things along

  • Eat high-fiber foods such as vegetables, fruits, and whole grains, and drink lots of water and other fluids

  • Take an over-the-counter stool softener if it’s recommended by your healthcare provider.

The Baby Blues

It’s common to feel a little sad after your baby’s birth. In fact, about 70 to 80 percent of new moms have what’s referred to as the “baby blues.” The baby blues typically start a few days after giving birth and go away within a couple of days.

Some characteristics of the baby blues can include:

  • Feeling depressed

  • Feeling anxious

  • Being upset

  • Wondering why you’re feeling depressed

  • Thinking that you’re a bad mother.

Remember that your body is adjusting to changes that happen after you give birth, and know that it’s normal to have these types of feelings. It doesn’t mean that you are a bad mother.

If you think you’re experiencing the baby blues, reach out to your healthcare provider. You may also consider trying some of the following:

  • Have a conversation with your partner or a close friend

  • Get as much rest as you can (which isn't that easy when you’re caring for a newborn!)

  • Ask your partner, a close friend, or a family member for help with caring for your little one or taking on some household chores, for example

  • Take some alone time; for example, get out of the house every day even if it’s just for 15 minutes.

Week 2

If you had a cesarean delivery, tearing during a vaginal delivery, or an episiotomy, you may still be sore this week. You may like to take pain-relief medication if it’s recommended by your healthcare provider.

Try to walk around to increase your circulation, and consider getting some help with household chores so that you can concentrate more on yourself and your new baby. Think about letting some lesser tasks slide so that you can use the time to focus on what’s really important right now.

You may start to feel better by the end of the week. You may still have lochia, and some moms experience sore nipples around this time. Read on to find out more about what postpartum recovery may look like this week.

Swollen Breasts

About two to four days after you deliver, your breasts will fill with milk, which results in your breasts feeling hard, full, and even tender. For as long as you breastfeed, your breasts will remain enlarged, but you may notice this more so in the first four to six weeks.

Breastfeeding can alleviate these uncomfortable feelings, especially once you get into a nursing routine with your little one.

If you’ve decided not to breastfeed, you may experience engorgement discomfort. If your breasts are not stimulated to produce more milk, this discomfort will subside in about 7 to 10 days.

As you wait for the engorgement to go away, you may find comfort by trying some of the following:

  • Wear a support bra or sports bra, but don’t bind your breasts as it can make the pain worse

  • To reduce swelling, apply ice packs to your breasts

  • Take some over-the-counter pain medication

  • Don’t express any milk, as this sends a signal to increase breast milk production and will prolong the discomfort of engorgement associated with not breastfeeding.

Sore Nipples

With breastfeeding sometimes comes sore nipples. You’ll notice that as your nipples toughen up, the soreness will go away. If your nipples are sore, cracked, or bleeding, it may be time to contact your healthcare provider or a lactation consultant. Here are some home remedies for sore nipples:

  • Change your baby’s position during breastfeeding

  • Ensure your baby is latching on correctly with your entire areola in his mouth, not just the tip of your nipple

  • Rub some expressed milk onto your nipples to help soothe them

  • Avoid using harsh soap or body wash on your breasts

  • Wear a cotton bra so that moisture is drawn away from your breasts

  • Allow your nipples to air-dry after a feeding.

Week 3

There’s a lot going on this week. You're continuings to heal, and at the same time you’re adapting to motherhood and all the extra work it entails. The dynamic between you and your partner may be changing as you get used to caring for your newborn together, and you may be experiencing some of the highs and lows of parenthood. All of this can take a toll on your emotions, and produce stress and anxiety. Some moms, however, experience more severe feelings of sadness and despair.

Read on to find out more about one symptom of the postpartum period that some moms start to experience around this time.

Postpartum Depression

About 10 to 15 percent of women are affected by depression during pregnancy and in the postpartum period, beginning as early as one to three weeks after giving birth, or even up to one year later.

Postpartum depression can interfere with your ability to take care of your baby, and it can also make you feel miserable. These are some of the symptoms of postpartum depression:

  • Feelings of guilt or low self worth

  • A loss of appetite or overeating

  • Panic attacks and/or general anxiety

  • A fear of touching your baby

  • Feeling overwhelmed, and feeling that you are unable to care for your baby

  • Having trouble sleeping

  • Having low energy and trouble getting out of bed in the morning

  • Thinking about suicide or harming yourself or your baby

  • Losing interest in activities you used to enjoy.

If you’re noticing any of these symptoms, reach out for help right away. Talk with your healthcare provider about how you’re feeling. Treatment often includes individual or group therapy or medication. Sometimes a combination of treatments works best.

Week 4

By this week, your healing process is well under way. Keep in mind, though, that some people need more time than others to bounce back. Try not to be impatient or disheartened if some elements of your postpartum recovery are taking longer than expected.

If you gave birth vaginally, this might be a good time to start postpartum exercise, if you haven’t already; check with your healthcare provider first before resuming workouts or beginning a new exercise program. If you gave birth via a cesarean section, you’ll want to wait with exercise until you see your provider at your postpartum checkup and you get the all clear.

You may find that exercising and moving around in general boosts your energy levels. For example, even if you feel too tired to exercise, pushing yourself to do just a little may give you a burst of extra energy. You don’t have to jump back to doing intense workouts; even taking a walk while you push your baby’s stroller can make a difference.

Fatigue

All those middle-of-the-night feeds as well as the adjustment to life caring for a newborn will no doubt leave you feeling tired. There are things you can do to give you a little extra energy, like the following:

  • Reach out for help. Friends and family are often eager to pitch in, but they may not know exactly how to help you without seeming intrusive. Don’t be afraid to text loved ones to ask them to pick up groceries for you, or to send out a call for some frozen or takeout meals. Ask someone you trust to watch your baby for a few hours while you take a much-needed nap.

  • Sleep when the baby sleeps. When your baby is napping, use the opportunity to take a nap as well.

  • Organize quiet play. If you have an older child, try to engage him in some independent quiet play like a puzzle or a picture book to give you just a little down time.

  • Don’t overdo it. Do only the most important things, and let go of the others. For example, don’t worry if your house is a little messier than usual, or if you put off an errand that you’d usually get to sooner.

  • Limit visits. If you’re not ready to see people, don’t feel guilty about saying no to eager family and friends who want to visit. One option is to organize a sip and see party (or ask a friend to organize it for you) when you’re feeling up to it, as this can help reduce some of those unexpected drop-ins.

  • Eat healthily. Do your best to refuel with healthy, nutritious foods, even when you feel too tired or too busy to eat, or are tempted to fill up on junk food. Experts recommend ensuring you’re eating enough protein and iron-rich foods as these can help fight fatigue.

Week 5

The healing process continues every day. You may find that this week your vaginal area or your cesarean incision may feel much better. Contact your healthcare provider if you’re ever concerned about how the incision site is healing.

You may also feel some tightness or looseness in your vaginal area. Sometimes it can take a little longer to return to what’s normal for you. Speak to your provider if you’re concerned.

This week you may also find that an old friend returns — that is, your period.

Menstruation

If you’re breastfeeding, it may be months before your menstrual period returns, perhaps not until after your baby has been weaned. If you’re not breastfeeding, your periods may resume between six and eight weeks after your baby’s birth.

Menstruation may seem different. Some women have shorter or longer periods than before, while others find the menstrual cramps or period pain they used to experience are less noticeable post-pregnancy.

Before your menstrual period returns, your ovaries may release an egg, which means there’s a chance of you getting pregnant again if you are having sex. Speak to your healthcare provider about your family planning options.

Week 6

Part of the postpartum healing process includes feeling like your old self again. However, getting to this point can be challenging. The role of parent isn’t always an easy one, and sometimes you may feel as if you’ve been neglecting the role of partner. Your partner may also be finding it difficult to adjust to being a parent.

You and your partner may be long overdue for reconnecting, perhaps during a date night. Or maybe a heart-to-heart is in order to talk about how you’re both adjusting to parenthood and how you can better support each other.

Sex After Giving Birth

You may or may not be interested in sex again during this time, and either is OK. Be sure to keep the lines of communication open with your partner.

Although it may be safe to have sex from as early as two weeks postpartum, when the chance of bleeding and infection are no longer high, generally healthcare providers recommend waiting at least six weeks. You may want to check with your healthcare provider before starting to have sex again as she will be most familiar with how your postpartum recovery is tracking.

Sex for the first time after having a baby can make you feel apprehensive or uncomfortable since your body may feel and look different now. Your partner may also be feeling differently about sex. It’s worth having an honest conversation about what you both want. The following tips can help:

  • Find a time when both you and your partner are not rushed, when the baby’s asleep, or when she’s with a friend or family member for a couple of hours

  • If you’re breastfeeding, you may have vaginal dryness due to lower levels of estrogen. A water- or silicone-based lubricant can help.

  • Try different positions to find what’s most comfortable for you and to take pressure off a sore area.

  • Consider being intimate in other ways such as hugging and kissing.

  • Have a long conversation about how you’re both feeling, which can also help you feel more emotionally connected and give you both a feeling of intimacy.

Postpartum Checkup

Between four and six weeks after your baby’s birth might be a good time for a postpartum checkup with your healthcare provider. If you had a cesarean delivery, your provider may want to see you two weeks after the surgery to check on the incision.

During this visit, your provider will perform a physical exam to determine how you’re healing, checking on your weight, blood pressure, breasts, and abdomen. She may examine your incision site, if you have one, and check that your uterus and cervix have returned to their pre-pregnancy state.

Your provider may also ask about how you’re feeling, and how you’re adjusting to motherhood.

Before the appointment, write down any questions you have. For example, you may have questions about

  • the postpartum healing process and timeline

  • nipple pain or breast soreness

  • lifestyle changes you may need to make in order to improve your health

  • weight loss, hair loss nutrition, and exercise

  • any feelings of sadness or depression you have

  • coping with fatigue

  • sex after the birth of your baby

  • family planning

  • what help is available to you, whether it’s free resources for moms that may be on offer in your local area, or how to find a good babysitter

  • returning to work (if you plan to, and you haven’t already).

When to Contact Your Healthcare Provider

It’s normal to have certain discomforts during the postpartum period, but there are some that may point to an underlying problem. Contact your provider if you observe any of these signs or symptoms:

  • A temperature above 100.4 degrees Fahrenheit

  • Nausea and/or vomiting

  • Pain or a burning sensation during urination

  • Bleeding that is much heavier than a normal period

  • Severe abdominal pain

  • Swelling, tenderness, or pain in your legs

  • Coughing, gasping for air, or chest pain

  • Red streaks on your breasts, or painful lumps in your breasts

  • Worsening pain, redness, or discharge at an incision site or perineal tear

  • Vaginal discharge that has a foul odor

  • Feelings of sadness after your baby’s birth that last more than 10 days or seem to be getting worse. Contact your provider right away if you have thoughts of harming yourself or your baby.

FAQS AT A GLANCE

  • Walking and other forms of gentle exercise can help your postpartum recovery. Exercise can boost your energy levels, restore your strength, improve your mood, and help you get back into shape. Taking brisk walks can help ease you back into fitness. Consider strolling with your baby or meeting a friend for a walk while someone else cares for your little one. Be sure to check with your healthcare provider before starting any new exercise routine during your postpartum recovery.

  • You will probably lose weight during the first few weeks after birth, but it may take longer for your stomach and your whole body to return to the way it was before your pregnancy. Check with your healthcare provider about safe exercises that can help tone your abdomen. Your provider can also give you nutrition advice and tips to help you lose some of that baby weight.

The Bottom Line

Just like pregnancy and childbirth, your postpartum recovery is personal and unique. During this time, focus on your newborn and your own well-being. It’s more than OK to be easy on yourself during this time.

If you’re having difficulties during your postpartum recovery, don’t be afraid to contact your healthcare provider at any time. And don’t hold back on sharing your feelings with your partner, or reaching out to close friends and family members for help with the baby. Your physical and emotional health is important, so make sure to give yourself a break when you need it the most.

How We Wrote This Article

The information in this article is based on the expert advice found in trusted medical and government sources, such as the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists. You can find a full list of sources used for this article below. The content on this page should not replace professional medical advice. Always consult medical professionals for full diagnosis and treatment.