Postpartum

What does postpartum mean?

Postpartum (or postnatal) refers to the period after childbirth. Most often, the postpartum period is the first six to eight weeks after delivery, or until your body returns to its pre-pregnancy state. But the symptoms and changes that occur during the postpartum period can last far beyond eight weeks.

Major body and life changes are happening at the same time during the postpartum period. Some changes are physical — for example, breast engorgement and vaginal bleeding. Other changes occur due to changing hormones. The bottom line is, giving birth is a major physical and emotional challenge. Being a caregiver and adjusting to life with an infant during the postpartum period is also incredibly demanding.

Pay attention to how you feel after giving birth and let your healthcare provider know if something feels off. Just because you gave birth doesn’t mean your care ends or that your health isn’t important. You should try prioritizing resting and taking care of your health in addition to caring for your baby.

Your healthcare provider will schedule postpartum checkups with you so they can continue to monitor your recovery and healing. It’s important to attend these appointments because this is where your provider can identify potential complications. This is also a time when you can ask questions and have honest conversations about your healing.

Postpartum recovery timeline

Your recovery — like your pregnancy — is unique to you. There isn’t a one-size-fits-all timeline to postpartum. But there’s a general timeline of what you can expect.

Some of the things you can expect in the hours and days immediately after birth are:

• Your uterus needs to shrink back to its usual size. This causes cramps and vaginal bleeding. Your provider may even massage your uterus through your belly to help it get smaller.
• Hormonal shifts. This can cause symptoms like hot flashes, changes to your mood and headaches.
• Breast engorgement. Your breasts will produce milk, and even if you choose not to breastfeed, you’ll have painful and swollen breasts.
• Perineal soreness. It’s normal to have pain in the space between your vagina and anus (butthole) if you gave birth vaginally. Up to 70% of people have some degree of vaginal tearing during childbirth. People who have a C-section will feel extra sore around the incision site for a few days.
• Swelling from extra fluids. This is typically normal and your body’s way of getting rid of fluid you accumulate during pregnancy. Your swelling should go down within a week. When swelling comes with symptoms like chest pain and trouble breathing, it could be a sign of something more serious.
• Fatigue. Labor, childbirth and caring for a newborn may introduce you to a new level of exhaustion. Feeling tired for the days and weeks after you give birth is very normal. Trying to rest as much as you can whenever possible will help you feel better.

What are the three stages of postpartum?

Healthcare providers classify postpartum into three phases: the acute phase, the subacute phase and the delayed phase.

• Acute phase: This is the first six to 12 hours after you give birth. You’re most likely to experience conditions like eclampsia, postpartum hemorrhage and certain medical emergencies during this time. Your care will include things like your provider monitoring your blood pressure, heart rate and bleeding, and checking you for excess swelling.
• Subacute phase: This phase begins around 24 hours after birth and lasts for about two to six weeks. Your body is still changing, but you’re less likely to experience a medical emergency. Some of the concerns your provider may have during this period include cardiomyopathy, postpartum depression and symptoms related to urinary incontinence.
• Delayed phase: This phase lasts from about six weeks postpartum until six months postpartum. Changes during this phase are gradual and mainly consist of your muscles and tissues returning to their pre-pregnancy state. Your healthcare provider may treat you for conditions like pelvic floor dysfunction, painful sex and uterine prolapse in the delayed phase.

What are normal symptoms of postpartum?

You go through significant changes in the postpartum period. A lot of them happen naturally due to hormone changes. Symptoms can be physical, emotional or a combination of both.

Physical symptoms

Physical symptoms in postpartum affect your body — things like what it does, what it looks like and how it feels. Some of the most common physical symptoms in postpartum are:

• Soreness and pain in your perineum: Your perineum is the space between your vagina and anus. This area stretches, and sometimes tears, during vaginal childbirth. Your entire perineal area may be sore, swollen and tender for weeks after childbirth. Sitting on a pillow, squirting warm water to rinse the area and using a cold sanitary pad are ways to help with this discomfort.
• Vaginal discharge: Lochia is the name for the vaginal bleeding you’ll have after giving birth (even if you had a C-section). It begins red and tapers off to brown before it ends as a light brown discharge. This entire process can last up to six weeks. Remember, wear a pad to catch vaginal bleeding after childbirth (no tampons).
• Uterus involution: This is the medical term for your uterus shrinking back to its pre-pregnancy size. The entire process can take up to six weeks, but it begins almost immediately after your baby is born. You can also expect to feel afterbirth pains (or strong cramps) while this happens. Most of the intense pains go away after a few days, but they can also feel more intense during breastfeeding.
• Breast engorgement and nipple pain: You can expect swollen and painful breasts for at least a few days or longer (if you breastfeed). Some people need the help of a lactation consultant to help with painful symptoms of breastfeeding like cracked nipples.
• Sweating: Your hormones shift dramatically almost immediately after you give birth. It’s common to sweat more, especially at night. It’s a normal symptom that should subside within a week or two.
• Constipation: Being unable to poop after childbirth is a normal symptom in the postpartum period. If you had an epidural, this can slow down your bowels and make it harder to poop. Sometimes, the fear of pushing to poop leads to constipation. Some healthcare providers recommend stool softeners after you give birth to help. Hemorrhoids are also common in the postpartum period.
• C-section recovery: If you have stitches due to a C-section, your skin will take up to 10 days to heal. The deeper stitches can take up to 12 weeks to heal completely. Watch for signs of infection like pus seeping from the incision or having a fever.
• Hair loss: Losing your hair is a common occurrence in the postpartum period, mostly due to hormones.

Emotional symptoms

Emotional symptoms in the weeks and months after childbirth involve anything that affects your mind, your stress level or your body image.

• Baby blues: Baby blues is feeling sad and teary after giving birth. While these new feelings can take you by surprise, they tend to go away after a few weeks.
• Postpartum depression: This is a type of depression that causes extreme sadness and despair in the weeks and months after childbirth. Unlike the baby blues, this doesn’t go away and often involves treatment with medication or behavioral therapy.
• Postpartum anxiety: Excessive worrying that occurs after having a baby is called postpartum anxiety. It can be accompanied by physical symptoms like losing sleep or heart palpitations. Postpartum depression and postpartum anxiety can often come together. Treatment for postpartum anxiety can also involve medication or behavioral therapy.
• Weight loss: Your body went through lots of changes during pregnancy and childbirth. It’s common to have loose skin and stretch marks, and stress about extra weight around your hips or belly. Try to relax and give yourself time to recover. You’ll lose between 10 and 20 pounds before you leave the hospital. Focus on eating nutritious foods and taking care of yourself. Remember that your body has just been through a lot.

What are complications that can occur during the postpartum period?

Many health conditions can begin after delivery. Your healthcare team monitors you in the hours and days after birth to watch for some of the more severe conditions. Some symptoms are normal after delivery, but others can be a sign of a problem.

Some of the most serious conditions that can happen in the postpartum period are:

• Postpartum hemorrhage.
• Postpartum preeclampsia.
• Deep vein thrombosis (DVT).
• Pulmonary embolism.
• Mental health conditions like postpartum rage or postpartum psychosis.
• Sepsis.

The best thing you can do for your health after you give birth is listen to your body. If something doesn’t feel right, please reach out to your healthcare provider. You don’t have to wait until your postpartum checkup to call your pregnancy care provider with questions or concerns. Your recovery and overall health are important to them.

What are ways to take care of myself after having a baby?

One of the most important things you can do for yourself after giving birth is to allow yourself time to rest and heal. While this may be easier said than done, getting rest allows your body and mind time to recover. Ask for help when you need it. This could mean limiting visitors, asking for help with childcare or asking for help with things like cleaning and making meals.

Other than resting, some of the other ways to take care of yourself in the weeks after delivery could involve:

• Nutrition: Try to drink lots of water and eat healthy foods like lean protein, fruit, vegetables and whole grains. Staying hydrated can also help with constipation.
• Caring for your perineal area: If you had a vaginal delivery, you may be sore for a few weeks. Your provider probably gave you some tips to help care for your bottom at home. Using a peri bottle with warm water to rinse after using the bathroom and using witch hazel pads are ways to help your bottom feel better.
• Limiting physical activity: While you may want to return to your pre-pregnancy size, don’t rush to exercise or get back in shape. Your healthcare provider will let you know when it’s safe to exercise. Most people can begin walking or doing gentle movements a few days after giving birth. People who had a C-section birth may need to wait longer. Once you’re able to exercise, begin slowly so you don’t accidentally injure yourself.
• Mental health support: Don’t be afraid to ask for help and be patient with your emotions. The postpartum period can be challenging in so many ways. If you feel sad, overwhelmed, anxious or stressed, talk to a friend, your partner or your healthcare provider about it. There are many resources available to support you.

When should I contact my healthcare provider?

Some postpartum symptoms could be signs of a problem. You shouldn’t ignore your symptoms or feel shame discussing how your recovery is going. If you have concerns either about how you’re healing or how you feel, it’s best to contact your healthcare provider.

Some symptoms you should watch for include:

• Heavy vaginal bleeding. This generally means you’re filling a pad every hour for several hours. It can also mean that you’re bleeding more each day instead of bleeding less.
• Passing several large clots. A large clot is typically anything larger than a quarter. Passing one large clot is OK, but passing many could be a sign of a problem.
• Fever higher than 101 degrees Fahrenheit (38 degrees Celsius).
• New pains or an increase in pain. You should generally feel better over time, not worse.
• Foul-smelling vaginal discharge.
• Pain in your legs or ankles, especially with swelling.
• Leaking pus or bloody discharge from your C-section incision.
• Dizziness or changes to your vision.
• Severe and persistent headaches.
• Chest pains or shortness of breath.

If you have feelings of harming yourself or your baby, please call 911 or call, chat or text the Suicide and Crisis Lifeline at 988.