The early postpartum period (within three to four months of giving birth) is often referred to as the fourth trimester, and for good reason. Your body, having delivered a baby, is undergoing major hormonal and physical changes, and is trying to provide nutrition for your baby in new ways (via breastmilk). Here’s what you can expect in the first days, weeks and months postpartum—yes, it can take months to heal.
How long does postpartum recovery last?
The first six weeks are considered the most important for recovery, but in general, recovering from giving birth will look different for each person. Some women are up and about within days, while others may stay in bed with baby for a couple weeks.
Consider that your experience of labour and delivery can influence your recovery too. Labours that last days or that involve multiple hours of pushing can increase exhaustion, while the use of unexpected interventions and the overall experience can have an impact on your emotional well-being. Which means there’s a huge range when we talk about the recovery period and how long it lasts. Some may take weeks, some may take a year.
What do I need for postpartum recovery?
Everyone will have different needs in the postpartum period, but here’s a brief shopping list to help you prepare. Consider this your postpartum recovery kit.
- Maxi pads
- Padcicles (homemade or store-bought)
- Sitz bath blend
- Peri bottle
- Witch Hazel
- Nipple cream
- Breast pads
- Hemorrhoid donut
- Postpartum supplement
It's also a great idea to cook some meals to freeze, or ask for family and friends to help out with food ahead of time. Having a good postpartum diet can support your breastfeeding efforts (if you're nursing) and make a big difference in your energy levels and recovery.
What happens in the first few days postpartum?
Vaginal swelling and perineum soreness (if you had a vaginal birth)
The perineum is the area between your vagina and anus and it experiences a lot of pressure (and often tears) during delivery. Expect this area to feel sore and swollen for a few days (or weeks) after giving birth.
How to relieve vaginal discomfort postpartum:
- Ice pack or padcicles: You can sit on an icepack several times per day for five to ten minutes at a time.
- A peri-bottle: This is a special squirt bottle used to rinse the perineum with warm water, each time you use the toilet.
- Pillow: Sit on a pillow or use a padded ring for as long as you need the extra cushioning.
What is a padcicle?
A padcicle is a cold pack designed specifically for the perineum. You can make them ahead of time by soaking overnight menstrual pads with water and storing them in the freezer until needed. You can also add liquid Witch Hazel to help with healing, or, to make a really soothing option, brew up an herbal sitz bath and pour it over the pads, soaking them with the herbal infusion, before freezing. Herbal sitz baths can be found as pre-made blends typically containing a blend of Witch Hazel, Yarrow, Calendula and Comfrey.
Vaginal bleeding occurs regardless if you gave birth vaginally or via Caesarean section because the uterus needs to shed its lining. This type of bleed (a.k.a., lochia) will resemble a menstrual flow but last anywhere from a few days to a few weeks. The heaviest flow tends to last about two weeks and should then taper off with spotting lasting up to six weeks after delivery. (Avoid the use of tampons during this time to avoid infection and instead opt for sanitary pads.)
Your uterus stretched to an impressive size during your pregnancy, and now it’s ready to shrink back down. As this happens you might notice some dull cramping in the lower abdomen especially during breastfeeding or skin-to-skin time with your baby. That’s because both these activities increase oxytocin, a hormone that causes the uterus to contract. If you’re finding the discomfort to be too much, add a heating pad or hot water bottle to the area for up to twenty minutes.
With the perineum feeling sore you might be a little nervous about having a bowel movement, but it’s important to stay regular—being backed up can cause even more discomfort and lead to hemorrhoids. Some pain medications and anesthetics used during labour can often slow the bowels, so it’s important to keep things moving by drinking lots of water (about two to three litres per day) while getting enough dietary fiber. Using a footstool in the bathroom will also help relieve pressure and promote elimination. And if you’re really stuck, eating prunes (a fruit with laxative effects) is an excellent way to get things moving.
When you push (either from childbirth or strained bowel movements during pregnancy), hemorrhoids can pop up and be a literal pain. These firm, tender lumps are swollen veins that can occur both inside the rectum and outside, around the anus. They can feel sore, tender and even itchy. You may also notice streaks of blood within your stool or on wiping. Witch hazel can help with healing, prevent bleeding and provide some relief—another great reason to use a padcicle or an herbal sitz bath.
It can take a few days post-birth before your milk comes in, and as this is taking place it’s common to have sore or tender breasts. This can continue for the duration of breastfeeding as the breasts are repeatedly emptied and refilled, though most report less discomfort as they settle into a breastfeeding routine.
Mood swings, or the baby blues
It is not uncommon to experience major mood and emotional changes postpartum. The transition to motherhood, in addition to changes in your hormone levels, can lead to a low or depressed mood, sleep disturbances, exhaustion, stress and feelings of anxiety or isolation. This is what is commonly referred to as the baby blues and it can appear within the first few days of giving birth. A more severe form of these feelings is a condition called postpartum depression (PPD) and it can start as early as those first few weeks.
A lot of energy goes into labour and delivery, and sleep deprivation is very common both during labour, and in those first days to weeks postpartum. Recovery can also take a toll on your energy levels as your body continues to adjust and change and making breastmilk requires a good deal of your body’s resources. Be kind to yourself during this period. Accept help when offered, and nap when you can.
What happens in the first few weeks postpartum?
If you had a Caesarean birth (C-section), you’ll have two layers of incisions and stiches that need to heal. The outer stiches in your skin should heal in about five to 10 days, but those underneath in the muscle layer can take six to 12 weeks to fully heal. Avoid strenuous activities and heavy lifting (your baby should be the heaviest thing you pick up) during this time. Keep the outer incision sites clean and dry (your doctor or nurse will tell you when you no longer need to keep the areas covered). If you notice any redness, swelling or pus, contact your doctor.
Postpartum depression (PPD)
Unlike the baby blues, PPD is a clinical diagnosis of major depressive disorder or bipolar disease that starts within the first four weeks postpartum and can last weeks to months. Common symptoms of PPD include:
- Depressed mood
- Lack of pleasure or interest in activities that were normally enjoyable
- Sleep disturbances and the inability to rest/sleep even when baby is sleeping
- Loss of energy, even if you’re able to nap/sleep/rest
- Agitation and restlessness
- Excessive feelings of guilt or worthlessness
- Reduced ability to concentrate, issues with memory, or feelings of indecisiveness
If you are experiencing any symptoms of PPD, or if your baby blues last longer than two weeks, seek help as soon as possible. Reach out to your family doctor, your obstetrician or midwife, a registered social worker, postpartum doula—anyone who can help set you up with the tools needed to manage these experiences and symptoms. Some hospitals run postpartum health programs and cognitive behavioural therapy (CBT) groups for new mothers which can be incredibly helpful. Read more about postpartum depression here.
What happens in the first few months postpartum?
You may notice more hair lost in the shower, accumulating in your hair brush and, in some cases, the hair left on your head may seem a bit thinner. These are all natural and normal changes postpartum due to the shift in your hormones which cause the hair follicles on your scalp to enter the shedding phase. Postpartum hair shedding can start about two to four months after giving birth, and it can last up to six months. Although losing your hair can be distressing, it’s temporary and should stop by the time your baby is one. In the meantime, take good care of your remaining hair (and the little baby hairs that will start growing again) by using a gentle volumizing shampoo and conditioner (look for ones for fine hair) and avoid using high heat.
Urinary incontinence (a.k.a., leaking)
If you’re noticing urinary leakage, you are not alone. Your pelvic floor is a mighty, multi-layered muscular support for your uterus, bladder and other pelvic organs, but the weight and strain of pregnancy and childbirth (as well as hormonal factors), commonly lead to involuntary urine leakage. You might notice that leaking only happens during stress or when laughing, coughing, sneezing or bouncing. Before you start doing any Kegels, get yourself assessed by pelvic floor physiotherapist. Pelvic floor physiotherapy is an effective way to address many postpartum concerns including returning to sexual activity, urinary incontinence or if you feel like your uterus is going to fall out when standing or walking. Your physiotherapist will do an internal exam to assess the health of the muscles and determine if certain muscles are too tight or too relaxed (meaning that Kegels are not always the answer). Then, they will review different stretches, exercises and techniques for getting that pelvic floor in shape and getting your bladder control back. They can also help to break up scar tissue from any vaginal tearing or incisions (episiotomy).
Most healthcare practitioners recommend waiting until four to six weeks postpartum to resume having sex, to reduce the risk of infection and support the recovery of the vaginal tissues post-delivery. It’s not uncommon to notice vaginal irritation or pain when you resume having sex, so take it slow. Make sure you’re feeling ready (emotionally as well as physically) and get the green light from your healthcare practitioner. As mentioned above, pelvic floor physiotherapy is a great tool to help improve pelvic tone and health post-pregnancy. You will also want to consider contraceptive methods since it’s possible to get pregnant postpartum, (yes, even if your cycles haven’t resumed, and even if you’re breastfeeding).
Be kind and patient to yourself in these days, weeks and months. Being a new parent is a wild, exhausting and exhilarating experience. Yes, you may be filled over the brim with love, but you are also allowed to have feelings of sadness, fatigue, and overwhelm. Your body undergoes major changes and adjustments postpartum, so although some people may have a quick recovery, be prepared for the process to take up to a year and lean on your support system when needed.