Your Physical Recovery
In the hours and days after giving birth, your body will undergo enormous physical changes. This article describes some of what you may experience.
Nearly all women experience some kind of body soreness after labor and birth. Back pain or other body aches can result from the physical exertion of labor, or from particular labor positions. These aches and pains during the first few days are completely normal.
Soaking in tubs, getting massages, and moving around can help alleviate general soreness. (For information about specific cramps and pains, see “Cramping” below.) If the pain is severe, is not controlled by self-help techniques or pain medicines, or gets worse, notify your midwife or doctor.
Both women who have vaginal deliveries and women who have cesarean sections will experience vaginal discharge after childbirth. This discharge, called lochia, is blood mixed with material from the uterine lining that supported the baby in the womb. It is initially red, then will lighten to pink, then brown, before becoming clear or yellowish and finally stopping two to eight weeks after the birth. Women who have cesarean sections may have lochia for a shorter period of time, because much of this material is removed during surgery.
The lochial discharge is a normal, healthy process. Although it is common to see some small, coin-sized clots at first, the amount of bleeding should steadily decrease over the first few weeks. Most hospitals and pharmacies have large maternity pads (oversized maxi pads) you can use. Do not use tampons, as they are not absorbent enough and are a potential source of infection (in addition to being very uncomfortable after a vaginal birth). If you have large clots or unusually heavy bleeding (soaking a large maxi pad in under an hour), the blood has a bad odor, or you have fever and chills, contact your health care provider. These may be signs of an infection or of a retained piece of placenta.
Do not be surprised if your bleeding becomes slightly heavier for a day or two when you become more active. If this happens, you may be doing too much; try resting for a day.
No one ever talks about it, but a postpartum woman’s best friend is a box of high-quality overnight maxi pads—with wings! A friend told me to bring my own before I went into the hospital—and double up on them, front and back—so that I wouldn’t have to rely on the hospital’s awful ones that move and don’t absorb anything anyway. It was great advice. I even wore them while laboring because I had already broken my water and didn’t like the feeling of sitting in a pool of wet all night.
Like lochia, uterine cramping is a normal part of recovery from childbirth. This cramping is a sign that the uterus is contracting and returning to pre-pregnancy size. Uterine cramping is often more intense for women who have had previous pregnancies. Breastfeeding can make the cramps occur during the first few days. These “afterpains” generally stop being painful by the third day after giving birth.
To relieve the cramping, hold a pillow or a heating pad over your abdomen, lie on your stomach if this is comfortable, or lie on your side with a pillow between your legs and over your stomach. If the pain is not relieved, you can try over-the-counter pain medicines such as ibuprofen (sold under brand names like Motrin or Advil) (if you don’t have other medical conditions that can be made worse by taking ibuprofen). The usual recommendation is to take the medication about fifteen minutes before breastfeeding.
I hardly remember the cramping after the birth of my first child. . . Not so with my second. The pain was like extraordinarily intense menstrual cramping. It shocked me. My breasts would fill painfully with milk, and I would happily put the baby to nurse, but the moment she started to suck, the cramping would begin. It made me dizzy, it was so intense. I got used to propping the baby on a pillow on my aching stomach— nursing pillow and cramping pillow in one. . . Gazing at my new baby hungrily nursing away helped distract me from the pain.
Perineal pain due to episiotomy, tears, stitches, or just the stretching of vaginal birth is also very common. Perineal pain may make it uncomfortable to walk or sit.
During the first twenty-four hours, most women find it helpful to apply ice packs, which not only assist with pain relief, but can help reduce the swelling in the area. After twenty-four hours, women may find comfort in warm compresses or sitz baths, soaking the vulvar/perineal area in tepid water in the bathtub or in a special insert—a sitz bath—that can be placed on the toilet. You can also use pain medication for perineal pain. If your pain is not relieved by these strategies or if it worsens, contact your health care provider.
To relieve the stinging that can occur as urine comes in contact with sutures or small tears, you can keep a squirt bottle with warm water in the bathroom and use it to spray water on your vulvar area when you urinate. It is important to avoid constipation in the postpartum period as straining during bowel movements may be painful to the perineum.
In rare cases, women who have had epidural or spinal anesthesia experience anesthesia-related headaches after giving birth. These headaches are worse when sitting or standing, and are usually relieved by lying down. A spinal headache is initially treated with fluids and over-the-counter or prescription pain medication, and should resolve in two to four days. If it does not go away or is particularly severe and includes symptoms such as double vision or neck pain, notify your health care provider as soon as possible. The spinal headache can often be treated with an injection into the epidural space, which will make the headache go away more quickly.
Pain After Cesarean Section
If you have had a cesarean section, you will need stronger pain relief medication than women who have had vaginal births. Talk with your health care providers about post-surgical pain relief, both for the first few days and then for the first two to three weeks after going home.
During the first day in the hospital, you may require intravenous medication, followed by a gradual change to pain medication you can take by mouth. You may be given a liquid diet initially, and then solid foods should be added slowly.
Eat what you feel you can tolerate. When you go home, usually four to five days after surgery, you likely will need to continue taking prescription medicines for pain relief. It is best to take opioid pain medication only when it is really needed, because such medicines can cause constipation. Your provider will probably give you a strong dose of ibuprofen, which often works better for post-surgical pain than opioids do. Be sure that you get enough pain relief to be able to comfortably care for yourself and your baby.
You may not move your bowels for a day or two after birth. This is normal.
To make the first bowel movement easier and prevent future constipation, drink plenty of water, move around as soon as possible after delivery (it will probably take a day to begin walking again after a cesarean section), and eat a balanced diet that includes fruits, vegetables, and fiber. A stool softener can help with constipation. If needed, laxatives in the form of either pills taken by mouth or suppositories can also help ease severe constipation. Before using suppositories, check with your health care provider.
Bowel movements may be uncomfortable if you have developed hemorrhoids during either pregnancy or birth. Witch hazel pads and sitz baths can ease the discomfort of hemorrhoids, as can over-the-counter medicines. If your hemorrhoids are very uncomfortable, talk with your provider about prescription creams and suppositories that can help.
Abdominal and Pelvic Floor Weakness
You may experience some abdominal muscle weakness after birth, as well as pelvic floor weakness, which can lead to urinary incontinence (leaking urine). Women can also have bowel incontinence due to weakened pelvic floor muscles. Kegel exercises can help you recover pelvic muscle tone.
If you have had a vaginal birth, light abdominal exercises can help recover abdominal muscle tone. If you have had a cesarean section, your abdominal muscle tone will take longer to recover. During the first few days, you can press a folded towel or a pillow over your abdomen when sitting up or you can turn onto your side to sit up. The towel or pillow and your arm will help you move without having to use your abdominal muscles as much. In the days and weeks immediately following delivery, do not pick up anything heavier than your baby.
Fatigue is a major factor in the days immediately after you give birth. You are recovering from the physical demands of labor and birth and, at the same time, your sleep is being interrupted by your baby. If possible, have your partner or a support person sleep in the room with you—even if you are in a hospital or birthing center—to help support you in your recovery and facilitate your bonding with the baby.
In the first days either at home or in the hospital, be choosy about the visitors you see. Their job is to help you, not the other way around. A visit that interferes with a much-needed chance to rest should be avoided. Ask friends and relatives to stay for a few minutes only or to delay their visits. Many will be happy to share their concern and generosity in another way, like volunteering to care for your other children, do simple errands, or drop off meals for your family. If phone calls are feeling intrusive, consider turning off the ringer or screening your calls, particularly during those precious times when the baby is sleeping.
If at all possible, limit your activities during the immediate post-recovery period to initiating breast-feeding (if you are nursing), bonding with your baby, and resting, which will help you recover physically. Ask for help from your partner, a family member, or another support person. When possible, sleep when the baby sleeps, and postpone or delegate the demands of your household and everyday life for at least a few weeks.
Excessive fatigue can also be a sign of anemia, or low iron in your blood. You may need to increase your intake of high-iron foods, including meat, eggs, leafy greens, and legumes. Another way to prevent anemia is to continue taking your prenatal multivitamin supplement, which contains iron.
The first week after the birth I wasn’t good for much of anything—I was really weak, and it was especially frustrating at the hospital because I was barely strong enough to hold the baby, much less do anything else for her besides feed her. After that first week, though, things started to improve. I really took seriously the injunction to do nothing for the first two weeks, and that really helped me start feeling better.
You may experience hot and cold flashes as your body adjusts its levels of hormones and shifts fluids. If you are nursing, you may feel a rush of warmth when your breasts engorge with milk.
Many new mothers experience “baby blues” after delivery and some experience more serious depression. For more information, see Postpartum Mood Disorders.
Your milk will come in on the second to fifth day after your baby is born. After your milk comes in, your breasts may feel uncomfortable, hard, and engorged. If you are breastfeeding, this engorgement will go away within a few days. If you are not breastfeeding, the milk will stay in your breasts, and your breasts may feel hard and uncomfortable a bit longer. Wearing a tight-fitting bra, binding your chest, using ice packs, and/or taking over-the-counter pain medicines can help with the discomfort. After several days, your body will stop making milk and your breasts will gradually soften and become smaller.