Health Library

Postpartum Care for Mothers

Pregnancy and birth are a lot of work for the body. Your body will need a few weeks to recover. Listen to your body and your emotions to help you heal at your pace. Recovery will be a little different for each person but some basic steps apply to most. Knowing what to expect can help you handle some of these changes.

Uterine Contractions and Bleeding

Your care team will help your recovery start after the baby is born and placenta is passed. The uterus will be massaged to help it contract. Medicine may also be given. These contractions help to shrink the uterus to its pre-pregnancy size. It will also stop excess bleeding. The uterus can often return to its pre-pregnancy size about 6 weeks after giving birth.

The contractions may feel like sharp abdominal pains for some. These pains, called afterpains, often start to go away by the third day. Afterpains are more common in those who have given birth before. They are also more likely to happen during breastfeeding. Pain medicine can help to manage severe pain.

Bleeding after birth is normal. A bloody discharge called lochia occurs for 3 to 4 days after giving birth. Lochia should be pinkish-brown within a week of delivery. There should be less blood after 2 weeks. Lochia can continue for 6 to 8 weeks but will fade to white or yellow. Sanitary pads should be changed at least every 4 hours. Call your doctor for any of the following:

  • Bloody discharge that lasts longer than 4 to 5 weeks
  • Bleeding that saturates 1 extra-large sanitary pad every hour for 4 to 5 hours
  • Blood clots that are larger than a golf ball over several hours

Soreness of Perineum

The perinuem is the skin between the vagina and anal opening. It can be very sore after giving birth. It may be most sensitive when passing urine or stool. A tear may have also happened or the doctor may have made a cut to help during birth. The tears or cut will be closed with stitches. To help ease discomfort or pain:

  • Sit on or apply ice pack to the area. Use ice pack for 10 minutes at a time. Repeat throughout the day.
  • Use a bottle to squirt warm water over the area while you pass urine.
  • Sit in a tub with just enough water to cover the area. Try warm or cold water to see which works best for you. Repeat as often as it is helpful.
  • Ask about a stool softener. Hard stool or straining can cause pain.

An episiotomy or tear should heal within 3 weeks. Call your doctor if you have any of the following:

  • Pain that does not begin to fade after first few days
  • Moderate to severe pain
  • Fever
  • Increased redness or swelling
  • The wound begins to separate
  • Increased pain with urinating or having a bowel movement
  • Little improvement after 3 weeks

Urination and Bowel Movements

You may notice an increase amount of urination. Pregnancy increases the fluid in your body. The body will need to get rid of the extra fluid after birth. The most common way is to increase urination.

Labor and delivery can cause injury to muscles and nerves in the pelvis. It can make it hard to control urine or sometimes even gas or stool. A sanitary pad can help catch leaks. Kegel exercises may help strengthen weakened pelvic muscles. For most women, leaks will go away within 6 weeks. Talk to your doctor if symptoms last for more than 6 weeks.

It may take 3 to 4 days before your first bowel movement. The first bowel movement can be painful. Drinking a lot of water and juices can help to keep stool easier to pass. A stool softener can also help. Do not avoid bowel movements. This can lead to constipation and hemorrhoids. Clean with warm water (using a squeeze bottle or wash cloth) after passing stool. Pat dry with gauze or a sanitary wipe.

Recovering From a Cesarean Section

A cesarean section (C-section) is major surgery. You may take longer to heal. Pain is greatest the day after surgery and should decrease from then on. Take care to protect your incision. Watch for swelling or redness. Alert your doctor immediately if you see any. Your doctor will also give you specific instructions for bathing, lifting, and gentle exercise during recovery.

When breastfeeding, avoid placing your baby directly on your stomach. Place a pillow on your stomach or use the football or lying down positions.

Breast Engorgement

Breasts will start to increase milk production soon after birth. You will notice them filling up quite quickly. This fullness can be uncomfortable. It is most obvious by day 3 or 4. Breastfeeding often and using both breastscan help. Hot showers, warm compresses, or ice packs can also help. Wearing tight, binding clothes can also help to reduce symptoms if you are not breastfeeding.

General Soreness and Body Changes

Work from labor and delivery can cause soreness in your upper body and head as well. It can also cause bloodshot eyes or facial bruising. All of these aches and pains should fade over the next few days.

Hormone changes can also cause some issues. You may have hot flashes or chills. You may also notice changes in your mood. These will settle over the next few months.

Emotional Changes

The first few weeks after a new baby are full of changes. It is common to feel bouts of sadness, anxiety, or irritability. Many call it "baby blues". Worries about baby, physical and hormone changes, new schedules, and lack of sleep can all play a role.

These feelings are normal and should fade over first few weeks. Some tips may help to manage these changes:

  • Accept or ask for help from friends and family. Help with meals, shopping, cleaning, and other errands can take pressure off of you. Consider hiring a cleaning service or teenager to take over cleaning duties for a while.
  • If visitors stress you out, limit them. It’s okay to ask that visitors keep their visits short or don't visit while you are finding a routine for the baby.
  • Sleep whenever you can. Being tired never helps.
    • Sleep when your baby naps.
    • Pump your breast milk or prepare a bottle for someone else to feed the baby so you can sleep for a longer stretch of time.
  • Nourish yourself . Eat well and drink plenty of fluids. Most women can return to a normal diet after they deliver. Extra calories may be needed to help support breastfeeding. Aim for 64 ounces of fluids per day.
  • Exercise . Begin slowly. Increase the time and effort level slowly. Exercise is a great way to increase your energy and sense of well-being. Non-impact activities such as walking, swimming, and yoga may be good early choices.
  • Make time for relaxation each day . Set aside time for reading, listening to music, watching TV, meditating, showering, or any relaxing activity. Even 10 minutes can help
  • Find time every day for you and your partner to be alone and talk.
  • Spend time enjoying your baby every day . Don’t get too focused on just feeding and changing diapers.
  • Ask questions . Call your medical care team if you have concerns. Consider joining a support group or other mother’s group, such as infant massage or mother-infant yoga.

Postpartum Depression

Postpartum depression (PPD) is intense negative feelings that last longer than a few weeks. Common symptoms include:

  • Extreme fatigue
  • Loss of pleasure in daily life, lack of interest in the baby
  • Problems sleeping
  • Sadness, anxiety, hopelessness
  • Feelings of worthlessness and/or guilt
  • Irritability
  • Changes in appetite
  • Poor concentration.

Hormone changes are believed to play a role in PPD. PPD may also be more likely in those with a history of depression or family with a history of depression.

PPD can be treated with counseling, medicine, or both. Symptoms can improve quickly with treatment. Women who do not get treatment can have symptoms for seven months or more.

Medical help is needed immediately if PPD has led to desire to hurt self or others. Call your doctor or emergency medical services. You can also call the national suicide hotline or the national child abuse hotline. These are people who want to help you.

Birth Control and Sexual Relations

It can take 4 to 6 weeks for the pelvic area to heal and stop bleeding. Sex should wait until the area has healed. This will make sex more comfortable and reduce the risk of infection.

Wait at least 3 months before trying to become pregnant again. This will allow your body time to recover from pregnancy. It also gives you time to settle into new schedule. Talk to your doctor about which birth control method is right for you. Do not depend on breastfeeding as effective birth control.

Resources

Kids Health—Nemours Foundation
http://kidshealth.org

Office on Women's Health
https://www.womenshealth.gov

Canadian Resources

The Society of Obstetricians and Gynaecologists of Canada
https://sogc.org

Women's Health Matters
http://www.womenshealthmatters.ca

References

Cesarean sections. Kids Health—Nemours Foundation website. Available at: http://kidshealth.org/en/parents/c-sections.html. Accessed January 29, 2021.

Episiotomy. American Pregnancy Association website. Available at: http://americanpregnancy.org/labor-and-birth/episiotomy. Accessed January 29, 2021.

Postpartum depression. The American College of Obstetricians and Gynecologists website. Available at: http://www.acog.org/~/media/For%20Patients/faq091.pdf?dmc=1&ts=20121227T0904085197. Accessed January 29, 2021.

Recovering from birth. Office on Women's Health website. Available at: https://www.womenshealth.gov/pregnancy/childbirth-and-beyond/recovering-birth. Accessed January 29, 2021.

Recovering from delivery. Kids Health—Nemours Foundation website. Available at: http://kidshealth.org/en/parents/recovering-delivery.html. Accessed January 29, 2021.

Urinary incontinence fact sheet. Office on Women's Health website. Available at: https://www.womenshealth.gov/publications/our-publications/fact-sheet/urinary-incontinence.html. Accessed January 29, 2021.

US medical eligibility criteria for contraceptive use, 2010. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/mmwr/pdf/rr/rr59e0528.pdf. Accessed January 29, 2021.