Postpartum recovery

Childbirth is extremely hard on a woman’s body. Recovery may therefore take a few weeks. Below, we discuss the main issues that occur after giving birth.

Uterine cramping

After birth, labour contractions give way to uterine cramping, or after-birth pains. These contractions serve to shrink your uterus back to its normal size and prevent excessive blood loss. It takes about 4–8 weeks for your uterus to return to its pre-pregnancy size.

Uterine cramps feel a lot like menstrual cramps. If you’re breastfeeding, these pains will be more intense when your baby is nursing. In general, women experience more severe cramping with each new birth. To relieve uterine cramping, you can take ibuprofen (Advil^®) unless a health care professional advises otherwise. However, if you experience extreme pain in your stomach or groin, or if the cramping is accompanied by a fever, contact your doctor.

Vaginal discharge (lochia)

Immediately after delivery, a new mother loses about 500 ml of blood. Vaginal bleeding can last from 10 days to 6 weeks. In the first few days, it’s heavier than menstrual bleeding and bright red. Some women may also lose blood clots. If you lose a clot that’s larger than a golf ball or an egg, it’s best to contact your doctor.

After the first week, the bleeding will gradually become lighter and less frequent. It will also change colour, turning pink or brown before becoming a yellow or white discharge. Irregular bleeding may last for up to 6 weeks.

It’s recommended to use sanitary pads and avoid tampons during this period. Inserting objects into your vagina increases the risk of infection. At first, you should change your sanitary pad regularly, at least every 4 hours.

If your vaginal bleeding increases and has a bad odour, or if you have a fever, contact the facility where you gave birth to receive appropriate care. You should also see a doctor if the bleeding soaks more than one sanitary pad per hour.

Vaginal and perineal healing

After childbirth, the vagina and perineum may be swollen and sore. The pain may be worse if you had a tear or an episiotomy during labour. Vaginal and perineal discomfort can last a few weeks and is generally more intense when walking or sitting. If you’re uncomfortable, try sitting on a pillow.

In the first few days after giving birth, you can apply ice or a cold pack to the painful area. You can also soak in a warm sitz bath for 10–15 minutes several times a day. Make sure your tub is clean. Don’t use essential oils, scented soaps, or bubble bath. Dry yourself well before getting dressed.

After using the toilet, gently pat the area from front to back. Wash your hands before and after. For the first few days, rinse your vulva with water using a spray bottle every time you urinate or have a bowel movement. If you’d had stitches, don’t worry: they won’t split while you’re in the bathroom.

Your doctor or midwife may also suggest a topical painkiller cream or ointment. If the pain worsens or you notice abnormal swelling or pus, you may have a local infection. In this case, you should consult a health care professional.

Hemorrhoids and constipation

Constipation

It’s normal to not pass stool for the first few days after giving birth. Once bowel movements resume, they should be regular. However, certain medications, such as opiates, can increase constipation.

To treat postpartum constipation, stick to fresh or minimally processed foods, eat lots of fibre (e.g., fresh fruits, vegetables, whole grains), and drink plenty of water (2 L per day). Prune juice and some over-the-counter medications (e.g., Metamucil^®, Colace^®, Lax-A-Day^®) also help soften stools.

Hemorrhoids

Hemorrhoids are stretched, swollen veins in the rectal area. They’re fairly common following childbirth and usually disappear within a few days. Sitz baths are an effective way to relieve discomfort. If sitting is too painful, you can use a cushion.

Hemorrhoids can be painful during bowel movements. It’s therefore important to take steps to prevent constipation, and to avoid straining when moving your bowels. Locally applied ointments (e.g., Anusol HC^®) can also help.

Urinary incontinence

Receiving anesthesia and sustaining an injury during delivery can affect your bladder control. In the first few days after giving birth, some women may have difficulty urinating and emptying their bladder. Splashing a little warm water over your perineum or turning on the faucet to hear water running can help.

Pregnancy, as well as the stretching and contracting of your pelvic muscles during delivery, can make it difficult to control the passage of urine, especially when you cough, laugh, or exert yourself. Your bladder control should improve with time. Kegel exercises are also beneficial in reducing urinary incontinence. In the meantime, you can wear a sanitary pad. If your bladder control doesn’t improve, discuss it with your doctor.

Fatigue

Most women feel exhausted for the first few weeks after childbirth. Simple actions, like walking or moving your body, can be tiring. This lack of energy can lead to feeling frustrated and depressed. If your fatigue is accompanied by muscle pain throughout your body, speak with your doctor.

Your body needs time to recover, so it’s important to get enough rest. In the days following delivery, try to sleep when your baby is sleeping. You may also want to limit your visitors.

Don’t hesitate to ask your friends and family for help cooking meals, doing housework, and babysitting older children. Once you’ve offloaded a few tasks, you can relax, curl up with a book, or listen to music.

Sex after pregnancy

It’s best to wait 4–6 weeks after delivery before having sex. Don’t insert anything into your vagina during this period, or at least until bleeding has stopped. Waiting reduces the risk of heavy bleeding and infection, and gives vaginal or perineal tears time to heal. It’s also normal to have a lower libido for the first few months after giving birth.

Some women experience discomfort or soreness the first time they have sex after childbirth. It can be helpful to relax your body. Breastfeeding can also cause vaginal dryness. Try a water-based lubricant to make sex more enjoyable. If the discomfort persists, discuss the situation with your health care provider or a physiotherapist specializing in perineal rehabilitation.

Once you’re having sex again, make sure to use contraception—even if you’re breastfeeding —to avoid an unwanted pregnancy.

Weight loss

Right after delivery, you will lose about 4–5 kg (9–11 lb.), which represents the weight of your baby, the placenta, and the amniotic fluid. Your baby bump won’t disappear immediately, as your abdominal muscles were stretched during pregnancy.

It can take several months for you to return to your pre-pregnancy weight. That’s why it’s important to focus on gradual weight loss. Try not to lose more than 1–2 kg (2–4 lb.) per month. The best strategy is to eat a balanced diet and do 15–30 minutes of moderate physical activity each day. In general, women lose most of their excess weight without much effort in the first year after childbirth. Breastfeeding can also help with weight loss.

Physical activity

Ideally, you should wait 2–3 weeks after delivery before exercising. Your abdominal and pelvic muscles (pelvic floor) can stretch significantly during pregnancy and childbirth. Moreover, relaxin, a hormone produced during pregnancy, increases the risk of injury. It can therefore take time for your body to return to normal.

To prevent urinary incontinence and injuries, resume your activities gradually. Your muscles need to be strengthened before you can practise any sports. Regular abdominal and perineal muscle rehabilitation exercises are also recommended. If necessary, consult a physiotherapist specialized in perineal rehabilitation or ask your doctor for advice.

At the start, focus on resuming your daily activities. If all goes well, you can move on to doing 15–30 minutes of moderate physical activity at least 5 times a week. Increase the intensity according to your tolerance. If you experience urinary leakage while doing exercise, this is a sign that your body isn’t ready, or that you’re not contracting your pelvic floor correctly. You should also prioritize low-impact activities that don’t involve jumping, such as walking or yoga.

Recovering from a C-section

Postpartum recovery can be longer after a C-section. Even though you haven’t given birth vaginally, you will experience a period of vaginal bleeding, uterine cramping, urinary incontinence, and constipation.

In the first few days, you will probably experience significant pain, and it may take several weeks for it to fully subside. You may need to take painkillers for 1–2 weeks. Don’t hesitate to take your prescribed medication regularly. You can also opt for over-the-counter pain medication like acetaminophen (Tylenol^®) and ibuprofen (Advil^®), which are safe for breastfeeding moms.

You should also take these precautions during the first few weeks to promote recovery:

• Avoid going up and down stairs
• Take showers and avoid baths or swimming pools
• Don’t drive for 4 weeks
• Avoid activities like cycling, jogging, and aerobic exercise for 6 weeks Two days after your C-section, it’s recommended to begin walking 4 times a day and spending at least 8 hours out of bed
• Don’t lift anything heavier than your baby for 6 weeks

Wound care

If strips of adhesive tape (Steri-Strips^®) have been applied to your incision, they will peel off on their own within 7 days. After this period, you can remove any that remain. Stitches will dissolve on their own. If you have staples, they will need to be removed 3–7 days after your C-section at the CLSC.

When showering, wash with a mild, unscented soap and avoid rubbing the wound. Dry it well and let it breathe as much as possible.

There may be some minor swelling and redness around the wound. A clear, odourless fluid may also seep out. These symptoms are normal and will disappear as the incision site heals. However, consult your doctor if you notice any of the following:

• Abnormal redness around the wound.
• Warmth around the wound.
• Swelling or hardening of the skin
• Pus or other discharge
• Increasing or persistent pain

The skin around your incision may be numb for some time after the procedure. Sensation will gradually return over the next few months.

Six weeks after your C-section, it’s recommended to begin massaging the scar to reduce discomfort. With your fingers, make small circular movements on each side of the scar without pulling at it for 5 minutes a day.

Things to keep in mind

• Recovering from childbirth can take several weeks.
• Common postpartum issues include uterine cramping, vaginal bleeding, perineum pain, hemorrhoids, urinary incontinence, and fatigue.
• It may take several months to return to your pre-pregnancy weight.

Scientific review: Amélie Guay, M.Sc., PNC(C), perinatal advanced practice clinical nurse, CHUM Research and copywriting: The Naître et grandir team Updated: December 2020

Photo: iStock.com/KatarzynaBialasiewicz