Postpartum: First 6 Weeks After Childbirth

Recovery At Home

During the days and weeks after the delivery of your baby (postpartum period), your body will change as it returns to its nonpregnant condition. As with pregnancy changes, postpartum changes are different for every woman.

Physical changes after childbirth

The changes in your body may include sore muscles and bleeding.

• Contractions called afterpains shrink the uterus for several days after childbirth. Shrinking of the uterus to its prepregnancy size may take 6 to 8 weeks.
• Sore muscles (especially in the arms, neck, or jaw) are common after childbirth. This is because of the hard work of labor. The soreness should go away in a few days.
• Bleeding and vaginal discharge (lochia) may last for 2 to 4 weeks and can come and go for about 2 months.
• Vaginal soreness, including pain, discomfort, and numbness, is common after vaginal birth. Soreness may be worse if you had a perineal tear or episiotomy.
• If you had a cesarean (C-section), you may have pain in your lower belly and may need pain medicine for 1 to 2 weeks.
• Breast engorgement is common between the third and fourth days after delivery, when the breasts begin to fill with milk. This can cause discomfort and swelling. Placing ice packs on your breasts, taking a hot shower, or using warm compresses may relieve the discomfort. For more information, see the topic Breast Engorgement.

Call your doctor if you are concerned about any of your symptoms. For more information, see When to Call a Doctor.

Care after vaginal birth

Most women need some time after delivery to return to their normal activities. It's important to focus on your healing and on taking care of your body after delivery.

• Use pads instead of tampons for the bloody flow that may last as long as 2 weeks.
• Ease cramps or afterpains with ibuprofen (such as Advil). If the doctor gave you a prescription medicine for pain, take it as prescribed.
• If you have swelling or pain around the opening of your vagina, try using ice. You can put ice or a cold pack on the area for 10 to 20 minutes at a time. Put a thin cloth between the ice and your skin.
• Cleanse yourself with a gentle squeeze of warm water from a bottle instead of wiping with toilet paper.
• Try sitting in a few inches of warm water (sitz bath) 3 times a day and after bowel movements.
• Ease the soreness of hemorrhoids and the area between your vagina and rectum with ice compresses or witch hazel pads.
• Ease constipation by drinking lots of fluid and eating high-fiber foods. Ask your doctor about over-the-counter stool softeners.

What to avoid

Give your body a chance to heal. Wait to start certain activities.

• Wait until you are healed (about 4 to 6 weeks) before you have sexual intercourse. Your doctor will tell you when it is okay to have sex.
• Try not to travel with your baby for 5 or 6 weeks. If you take a long car trip, make frequent stops to walk around and stretch.
• Do not rinse inside your vagina with fluids (douche).

Care after a C-section

If you had a C-section, you will need to take it easy while the incision heals.

• Avoid strenuous activities, such as bicycle riding, jogging, weight lifting, and aerobic exercise, for 6 weeks or until your doctor says it is okay.
• Until your doctor says it is okay, don't lift anything heavier than your baby.
• You may have some vaginal bleeding. Wear pads. Do not use tampons until your doctor says it is okay.
• Hold a pillow over your incision when you cough or take deep breaths. This will support your belly and decrease your pain.
• You may shower as usual. Pat the incision dry when you are done.

For more information, see the topic Cesarean Section.

Coping With Emotions

Having a new baby is exciting. But it also can be exhausting and stressful. It's common to feel a range of emotions at this time.

Tips for coping during the postpartum period include accepting help from others, eating well and drinking plenty of fluids, getting rest whenever you can, limiting visitors, getting some time to yourself, and seeking the company of other women who have new babies.

Expect changes in your relationship

If you have a partner and this is your first baby, your focus may have shifted from being part of a couple to being parents. That's a common—and wonderful—change. But it can take some time to adjust. You and your partner may not have as much time or energy for each other for a while. But you also will get to know each other in new ways, as parents.

It is common to have little interest in sex for a while after childbirth. During the time when your body is recovering and your baby has many needs, you and your partner will need to be patient with one another. Talking together is a good way to deal with the changes in your sexuality after childbirth.

Watch out for depression

"Baby blues" are common for the first 1 to 2 weeks after birth. You may cry or feel sad or irritable for no reason. If your symptoms last for more than a few weeks, or if you feel very depressed, ask your doctor for help. You may have postpartum depression. It can be treated. Support groups and counseling can help. Sometimes medicine can also help. For more information, see the topic Postpartum Depression.

Get support from others

If you're feeling tired or overwhelmed, talk to your partner, friends, and family about your feelings. You also might want to:

• Go for walks with your baby.
• Find a class for new mothers and new babies that has an exercise time.
• Try yoga, meditation, massage, or other ways to cope with stress. For more information, see the topic Stress Management.

Common Problems

Some women have problems—such as constipation, hemorrhoids, and sore breasts—that last for a while after childbirth. Many minor postpartum problems can be managed at home. If you develop problems and your doctor has given you specific instructions to follow, be sure to follow those instructions.

Constipation and hemorrhoids

Home treatment measures are usually all that is needed to relieve mild discomfort from hemorrhoids or constipation.

To prevent or ease symptoms of constipation:

• Eat a high-fiber diet with lots of fruits, vegetables, and whole grains.
• Drink plenty of fluids, especially water and fruit juices.
• Try a stool softener, such as Colace.
• Do not strain (push hard) during a bowel movement.
• Get more exercise, such as walking, every day.

To treat the itching or pain of hemorrhoids:

• Keep the anus clean by wiping carefully after each bowel movement. Gently wipe from the front to the back. Baby wipes or hemorrhoid pads are usually more gentle than toilet paper. If you use toilet paper, use only soft, undyed, unscented toilet paper.
• Take warm soaks in a tub or a sitz bath. Warm water can help shrink or soothe hemorrhoids. Add baking soda to the water to relieve itching.
• Use cold packs. You can put ice or a cold pack on the area for 10 to 20 minutes at a time. Put a thin cloth between the ice and your skin.
• Do not sit for long periods, especially on hard chairs.
• Drink plenty of fluids and use stool softeners, if needed. Don't strain (push hard) during a bowel movement.

Vaginal and perineal problems

Soreness in the vagina and the area between it and the anus (perineum) is common after delivery. You can ease the pain with home treatment. To reduce pain and heal:

• Try using ice. You can put ice or a cold pack on the area for 10 to 20 minutes at a time. Put a thin cloth between the ice and your skin.
• Cleanse yourself with a gentle squeeze of warm water from a bottle instead of wiping with toilet paper.
• Try sitting in a few inches of warm water (sitz bath) 3 times a day and after bowel movements.

Recovery from an episiotomy or perineal tear can take several weeks.

Pelvic bone problems

Recovery from pelvic bone problems, such as separated pubic bones or a fractured tailbone (coccyx), can take several months. Treatment includes ice, nonsteroidal anti-inflammatory drugs (NSAIDs), and sometimes physical therapy.

Breast problems

Breast engorgement is common between the third and fourth days after delivery, when the breasts begin to fill with milk. This can cause breast discomfort and swelling. Placing ice packs on your breasts, taking a hot shower, or using warm compresses may relieve the discomfort. If you aren't breastfeeding, use ice rather than heat for breast soreness. For more information, see the topic Breast Engorgement.

For breast problems related to breastfeeding, see the topic Breastfeeding.

Postpartum Checkup

Your doctor will want to see you for a checkup 2 to 6 weeks after delivery. This visit allows for your doctor or midwife to check on your recovery from childbirth and see how you are doing emotionally. You may have a pelvic exam to make sure that you are healing well. If you had a C-section, your doctor will check your incision.

Your doctor or midwife will talk with you about birth control and find out how you're doing with breastfeeding. He or she also will ask about your moods and check you for signs of postpartum depression.

This visit is also a good time to talk to your doctor about anything you are concerned or curious about.

• Keep a list of questions to bring to your postpartum visit. Your questions might be about:
  • Changes in your breasts, such as lumps or soreness.
  • When to expect your menstrual period to start again.
  • What form of birth control is best for you.
  • Weight you have put on during the pregnancy.
  • Exercise options.
  • What foods and drinks are best for you, especially if you are breastfeeding.
  • Problems you might be having with breastfeeding.
  • When you can have sex. Some women may want to talk about lubricants for the vagina.
  • Any feelings of sadness or restlessness that you are having.

Health and Nutrition

It is easy to get too tired and overwhelmed during the first weeks after childbirth. Take it easy on yourself. Get rest whenever you can, accept help from others, and eat well and drink plenty of fluids.

Getting rest

Like pregnancy, the newborn period can be a time of excitement, joy, and exhaustion. You may look at your wondrous little baby and feel happy. You may also be overwhelmed by your new sleep hours and new responsibilities. Make time to rest.

• Rest every day. Try to nap when your baby naps. Stay flexible so you can eat at odd hours and sleep when you need to.
• Ask another adult to be with you for a few days after delivery.
• Plan for child care if you have other children.
• Plan small trips to get out of the house. Change can make you feel less tired.
• Ask for help with housework, cooking, and shopping. Remind yourself that your job is to care for your baby.

Sexuality, fertility, and birth control

Your body needs time to heal after childbirth. This can take about 4 to 6 weeks, but it's different for each woman. Avoid sexual intercourse and putting anything in your vagina (including tampons) until you have stopped bleeding. Your doctor will let you when it's okay to have intercourse.

Your menstrual cycle—and your ability to become pregnant again—will return at your body's own pace. Remember that you can ovulate and get pregnant during the month before your first menstrual period, as early as 3 weeks after childbirth. If you don't want to become pregnant right away, use birth control even if you are breastfeeding.

• If you don't breastfeed, your menstrual periods may begin within a month or two after delivery.
• If you breastfeed full-time, your periods will probably not resume for a few months. The average among women who breastfeed exclusively is 8 months. But breastfeeding is not a dependable method of birth control. For more information, see Breastfeeding as Birth Control.

Most methods of birth control are safe and effective after delivery. But in the first couple of weeks after delivery, it's best to use a method that doesn't contain estrogen. Talk to your doctor about which type is best for you. For more information, see the topic Birth Control.

Healthy eating

Eating a variety of healthy food is important to help you keep your energy and lose extra weight you gained during your pregnancy.

• Eat a variety of foods to help you get all the nutrients you need. Your body needs protein, carbohydrate, and fats for energy.
• Eat a diet high in fiber. Include foods such as whole-grain breads and cereals, raw vegetables, raw and dried fruits, and beans.
• Drink plenty of fluids, especially water.
• Eat small snacks throughout the day to keep up your energy. Don't skip meals or go for long periods without eating.
• If you're breastfeeding, a healthy diet is good for your overall health. For more information, see Nutrition While Breastfeeding.
• If you breastfeed, avoid alcohol and drugs. If you quit smoking during pregnancy, try to stay smoke-free.^{footnote 1}

For more information on eating well, see the topic Healthy Eating.

Exercise

Exercise helps you feel good and helps your body get back to its prepregnancy shape. In general, you can start exercising 4 to 6 weeks after delivery. But check with your doctor before you start exercising, especially if you had a cesarean birth (C-section).

• Start daily exercise after 4 to 6 weeks, but rest when you feel tired.
• Try to exercise regularly. Get outside, take walks, or keep your blood moving with your favorite workout.
• Learn exercises to tone your belly.
• Do Kegel exercises to regain strength in your pelvic muscles. You can do these exercises while you stand or sit.

• Fitness: Staying Active When You Have Young Children

Newborn Basics

During your baby's first few weeks, you will spend most of your time feeding, diapering, and comforting your baby. You may feel overwhelmed at times. It is normal to wonder if you know what you're doing, especially if this is your first child. Newborn care gets easier with every day. You may get to know what each cry means and be able to figure out what your baby needs and wants.

Feeding

Breastfeeding is a learned skill—you will get better at it with practice. You may have times when breastfeeding is hard. The first two weeks are the hardest for many women. But don't give up. You can work through most problems. Doctors, nurses, and lactation specialists can all help. So can friends, family, and breastfeeding support groups.

Some women choose to feed their babies using formula. While breast milk is the ideal food for babies, your baby can get good nutrition from formula.

For more information, see the topics Breastfeeding and Bottle-Feeding.

Sleeping

Most babies sleep for a total of 18 hours each day. They wake for a short time at least every 2 to 3 hours. Always put your baby to sleep on his or her back, not the stomach. This lowers the risk of sudden infant death syndrome (SIDS).

For more information on sleeping, diapering, and other areas of newborn care, see the topic Growth and Development, Newborn.

When to Call a Doctor

Call 911 anytime you think you may need emergency care. For example, call if:

• You have thoughts of harming yourself, your baby, or another person.
• You passed out (lost consciousness).
• You have chest pain, are short of breath, or cough up blood.
• You have a seizure.

Call your doctor now or seek immediate medical care if:

• You have severe vaginal bleeding. You are passing blood clots and soaking through a pad each hour for 2 or more hours.
• Your vaginal bleeding seems to be getting heavier or is still bright red 4 days after delivery, or you pass blood clots larger than the size of a golf ball.
• You are dizzy or lightheaded, or you feel like you may faint.
• You are vomiting or cannot keep fluids down.
• You have a fever.
• You have new or more belly pain.
• Your breast or breasts have hard, red, or tender areas.
• You have an urgent or frequent need to urinate, along with a burning feeling.
• You have severe pain, tenderness, or swelling in your vagina or the area between your rectum and vagina.
• You have severe pains in your chest, belly, back, or legs.
• You have symptoms of a blood clot in your leg (called a deep vein thrombosis), such as:
  • Pain in the calf, back of the knee, thigh, or groin.
  • Redness and swelling in your leg or groin.
• You have signs of preeclampsia, such as:
  • Sudden swelling of your face, hands, or feet.
  • New vision problems (such as dimness, blurring, or seeing spots).
  • A severe headache.
• You have feelings of severe despair or great anxiety.

Watch closely for changes in your health, and be sure to contact your doctor if:

• Your vaginal bleeding seems to be getting heavier.
• You have new or worse vaginal discharge.
• You feel sad, anxious, or hopeless for more than a few days.
• You do not get better as expected.