What Happens in the Postpartum Period (Puerperium)?

What's known as the postpartum period starts the moment your baby is born and lasts for about six weeks. Sometimes referred to as the puerperium or the “fourth trimester,” this is an important time for both you and your baby.

In addition to emotions that can range from joy to sadness, you will also experience some physical challenges and be adapting to some lifestyle changes.

Read on to discover the physical, emotional, and lifestyle adjustments that may lie ahead during the first six weeks postpartum. You'll learn about postpartum depression, sex during the postpartum period, and when you may have your first menstrual period after giving birth.

We’ll also cover when your first postpartum checkup may be scheduled and what medical conditions to be aware of during this time, as well as a whole lot more.

What Is the Postpartum Period?

The postpartum period — sometimes referred to as the puerperium — starts with the birth of your baby and extends until about six weeks after childbirth. Keep in mind that some of the effects of your pregnancy and the delivery of your baby may last much longer.

The postpartum period is a time of adjustment. Adjusting to your new life as a mom and how your days are filled. Adjusting as a couple as you parent a newborn. Adjusting physically as your body recovers from pregnancy and childbirth. And adjusting emotionally as you get used to all these changes.

Reading about what may be in store may help you feel more prepared, and your healthcare provider can also answer any questions you may have about what you’re feeling and experiencing at this time.

Physical Changes

During the weeks and months after you give birth, your body will go through many changes as it adjusts post-pregnancy. Here’s a breakdown of some of what you might be experiencing physically.

The First Few Days After Giving Birth

Your little one has finally arrived! In addition to feeding your newborn and giving her lots of skin-to-skin contact, you'll be starting to recover from labor and childbirth.

Here are some of the physical changes you may experience in the first few days after giving birth:

• Vaginal bleeding. The blood and tissue that lined your uterus during your pregnancy will usually shed in the first few days and weeks after you give birth, though sometimes this bleeding lasts longer. This vaginal discharge is called lochia. It usually starts out bright red, but over time the bleeding will become lighter in volume and turn a brown or yellow color. As you breastfeed you may notice a little more blood gushes out, as breastfeeding can cause the uterus to contract.

• Contractions. You might feel postpartum cramping or “afterbirth pains” for about 10 days after you give birth. This happens as your uterus shrinks back to its normal size and returns to its normal position near the pubic bone. If you're uncomfortable, you can take an over-the-counter pain reliever, but check with your healthcare provider first if you’re breastfeeding.

• Perineal pain. If you gave birth vaginally, the area between your vagina and anus — called the perineum — stretched to make way for your baby. If you had a perineal tear or an episiotomy, you may have had stitches. In the postpartum period, you may experience swelling and pain in this area as the skin, tissue, and muscles recover. Depending on the extent of the tear or pain, your healthcare provider will advise on an appropriate treatment. In general, applying a cold pack, sitting on a comfortable pillow, or sitting in warm water may help relieve some of the pain. You could also ask your provider about using a numbing cream or spray.

• Painful urination. During childbirth, if you gave birth vaginally, your baby’s head placed a lot of pressure on your bladder and urethra. In the postpartum period, you may feel pain during urination or have the urge to pee but not be able to. Running warm water over your vaginal area as you pee, and drinking lots of water, may help ease the pain.

• Swollen legs and feet. To help, keep your legs elevated on a pillow or footstool to help reduce the swelling.

• Constipation. You might be reluctant to have a bowel movement because of the pain, or have sluggish bowels due to surgery or pain medication. If constipation strikes, try walking, eating lots of high-fiber foods (like fruits and vegetables), and taking a stool softener if recommended by your healthcare provider. Drinking lots of water can also help get things moving.

• Swollen breasts. Your breasts may feel hard, full, and tender a couple of days after you deliver your baby, as they are filling with milk. Once you settle into a regular breastfeeding routine, the discomfort will go away. If you’re formula feeding your baby, the engorged feeling in your breasts will probably subside within about 7 to 10 days. If you don’t plan to breastfeed, you can lessen the discomfort by wearing a comfortable bra and loose clothes, taking pain relief medication (if your healthcare provider gives you the green light), and applying ice packs to the area to help reduce swelling. Just don’t express any breast milk to lessen the pain — this sends a signal to your body to produce more milk, which will prolong the process.

The First Few Months After Giving Birth

Your body has gone through a lot during pregnancy, labor, and delivery, and it takes time to recover and return to “normal” after giving birth. You may discover that there is a “new normal,” as some things may not return to exactly how they were before. This is only natural — you’ve just had a baby, so some things are bound to change.

Here is what you may notice or feel in the months after giving birth:

• Fatigue. In the first few months after giving birth, it’s natural to feel exhausted. You’ve been through a lot both emotionally and physically, and you have some new experiences to process. Your newborn also needs to be fed frequently, and may not be sleeping for long stretches, so you’ve got good reason to be feeling tired. To help reduce exhaustion and stress, sleep when your baby sleeps, ask for help, limit visitors, follow a balanced diet with lots of high-protein and iron-rich foods, and only do the bare minimum of everything else. For example, let the dishes pile up and let someone else cook or provide home-delivered meals. This is the time to take it easy, and focus on yourself and your baby.

• Sweating. Hormonal changes during the postpartum period may leave you drenched in sweat, especially at night. This should soon pass, but in the meantime you may prefer to sleep on a towel to prevent your sheets from getting soaked. Chat with your healthcare provider if you’re concerned about how much you’re sweating.

• Changes to your abdominal area. Initially you may still look pregnant as your stretched out abdominal muscles slowly return to normal. Some women experience diastasis recti (or abdominal separation), which is when the left and right sides of the “six pack” muscles separate during pregnancy but don’t return to normal in the postpartum period.

• Stretch marks. Some women get stretch marks during pregnancy, and although these tend not to disappear completely they do typically fade with time.

• Hair loss. It’s not uncommon to experience some hair loss in the postpartum period. As your hormones settle down, your hair will return to normal. Read all about postpartum hair loss.

• Weight loss. You may lose up to 20 pounds quite quickly during the postpartum period, but your weight may not fully return to what it was for a while yet. Remember, not all the weight you gained during pregnancy was fat. Giving birth to your baby and the placenta, losing the amniotic fluid, and a reduction of the extra blood and body fluid you had during pregnancy will make you feel lighter during the postnatal period. Following a healthy diet and exercising can help you get back in shape, and you could be close to where you were in a few months. According to experts, now is not the time to diet though, as your body needs to be getting all the nutrients it needs to recover from pregnancy and childbirth. Be patient with yourself and your body. If you are breastfeeding, it’s especially important to avoid drastic weight loss, as this can affect your breast milk supply. Your provider can offer guidance on the weight loss to aim for, and how you can safely achieve it in the long term.

• Urinary incontinence. If you find that a little urine unexpectedly leaks out from time to time, you’re not alone. Many women experience urinary incontinence after giving birth. Factors such as like giving birth vaginally or having a large baby can increase the risk. Practice Kegel exercises to restore muscle tone, and seek help from your healthcare provider if things don’t improve with time. In many cases, urinary incontinence may resolve on its own within about three months.

• Fecal incontinence. You may find you leak some stool or that you pass gas when you didn’t mean to. During childbirth, the muscles and nerves around your rectum may have been damaged. If you’re experiencing this symptom, let your healthcare provider know, as things like physical therapy and medications may be prescribed to help resolve it.

• Hemorrhoids. If you experienced varicose veins in your vulva or hemorrhoids while you were pregnant, you may find they become worse now that you have given birth. You might also get them now, even if you didn’t have them before, because of the straining you did during labor and childbirth. Your healthcare provider can recommend suitable treatment, such as a medicated spray or cold witch-hazel compresses, for example. In time, these sore swollen veins should reduce in size or go away completely.

Coping With Physical Changes

There were many physical changes during pregnancy, and there are many physical changes to get used to during the postpartum period and beyond. Try to go easy on yourself. It took time for your baby to grow and develop inside you, and your body adjusting now will also take some time.

Eat a well-balanced diet of healthy foods, get some exercise, nurture yourself by enjoying some “me time,” and be patient with yourself. You’ve got a lot on your plate right now so give yourself plenty of time to get back on track.

Adjusting to Lifestyle Changes

With a newborn to care for, your life and lifestyle will change in a number of ways. You might feel absolutely thrilled about this, or miss parts of your “old” life — most likely you’ll feel a mix of emotions. Accepting that things will be different now is an important step in making a successful transition to your new role as a parent.

Beyond the joyful moments, it’s also a stressful and tiring time so taking care of yourself, body and soul, is important.

Ask for help whenever possible, and share the load with your partner as much as possible. For example, you might have a friend who’s happy to bring you some home-cooked meals, and you might like to share night-time bottle feeds with your partner so you can have some extra sleep.

Share how you’re feeling with friends and family. You might find that by telling them what’s on your mind, you might find it less of a burden.

If you ever feel so stressed that you think you might take it out on your little one, leave your baby in his crib and leave the room. Give yourself a moment to take a breather. Never shake your baby out of frustration.

Find strategies to prevent you from feeling overly stressed. You may need more help from your partner, or you may need to ask your loved ones to give you a hand. Find out from your healthcare provider what community services may be available in your local area to give you more of a support network.

Exercise During the Postpartum Period

Although you might feel tired and too busy, exercise can really boost your energy levels, and help you get back into shape.

Aim for about 150 minutes of moderate exercise a week. If you gave birth vaginally, you can typically start exercising as soon as you feel ready. If you had a cesarean section, you might need to wait until four to six weeks have passed to give your body enough time to heal.

Always ask your healthcare provider for the OK before starting to exercise again. Also, keep in mind that it may take a while to build up to the same intensity as you were used to before you got pregnant.

Brisk walks, swimming, and classes designed for the postpartum period can all be good options.

Try not to focus on just the weight loss element and on getting back into a certain pair of jeans, for example. Instead, see exercise as a way to stay healthy, and to have the energy you need to care for your little one.

At this time, it’s especially important to strengthen your core — your back and abdominal muscles — which became weakened during your pregnancy. If you get your healthcare provider’s OK, you may like to try exercises like those shown here:

Using the illustration above and the instructions below to guide you, do about 20 repetitions of each exercise.

Note: During each of the exercises, focus on always keeping your abs engaged and remember to breathe. Try to avoid arching your back, and for those poses where you’re lying on your back make sure your back is fully touching the floor during the movement.

1. Four-point kneeling. Kneel on all fours with your hips positioned over your knees and your shoulders positioned over your hands. Take a deep breath, and upon exhaling, contract your abs. This is called engaging your abs. You’ll want to engage your abs in all of these exercises.

2. Leg slides. While lying on your back, with your knees slightly bent and your feet flat on the floor, contract your abs. Take a deep breath and straighten out one of your legs by sliding your foot along the floor. Exhale, and bring the leg back into the starting position. Now do the same with your other leg.

3. Knee raises. Get in the same position as with the leg slide. Raise one of your legs with your knee bent so that your knee is above your hip. Then straighten out your other leg. Then “cycle” the legs so that the bent leg is straight and the straight leg is bent.

4. Heel touches. Lying on your back, raise both of your legs into a 90-degree angle above your hips, keeping your calves parallel to the floor. Lower one of your legs to the floor so that the heel touches while keeping your knee bent. Repeat this exercise with the opposite leg.

5. Leg extensions. Lying on your back, raise both of your legs into a 90-degree angle above your hips, keeping your calves parallel to the floor. Extend one of your legs upward so that the leg is straight and the foot is about one to two feet above the floor. Return it to the starting position, and repeat the exercise with your opposite leg.

Returning to Work

Planning a return to work can involve different factors for different women, including finances, maternity leave options, and general family considerations. Even if you mapped everything out when you were still pregnant, your circumstances might have changed, or you might find that you’d like something else. If you can, give yourself time to make a choice you feel comfortable with.

Under the Family and Medical Leave Act, you may have access to 12 weeks of unpaid leave, although policies vary between states and employers, so your situation may differ. Your partner may also have access to some form of paternity leave.

As you plan a return to work, find out whether there are any benefits available to you. For example, your workplace may offer flexible work hours or on-site child care.

If you are breastfeeding, by law your workplace must offer you a space other than a bathroom for pumping breast milk.

If both you and your partner are returning to work, you will need to consider your child care options. You might ask your family to help out, hire a nanny, get in-home care, or put your little one in day care. Give yourself time to find a solution you're comfortable with.

Feeling Blue in the Postpartum Period

Although this is generally a happy time, it’s also natural to feel a sense of sadness during the postpartum period. As many as 80 percent of women report feeling the “baby blues” during this time.

Feeling a little down doesn’t mean you’re a bad mother or are ungrateful for what you have; it just means your body is adjusting. Try to remind yourself of this when you’re feeling down.

Confiding in your partner or loved ones, getting as much rest as you can, and taking a little time out for some “me time” are all ways to get out of a funk.

These emotions typically go away after a few days, but if they don’t — or if these feelings of sadness become more intense — consult with your healthcare provider, as it may be something more serious like postpartum depression.

Sex During the Postpartum Period

At some point in the postpartum period you may be wondering when you can start having sex again. You might also be wondering whether it’s normal to have a low libido at this time, especially if sex couldn’t be further from your mind.

Some healthcare providers recommend waiting with sex until six weeks have passed since you gave birth. If you feel ready before this, ask your healthcare provider for personalized advice.

You may also find that your sex drive or your partner’s sex drive has changed. You may feel tired or nervous about feeling pain. Know that many women have a lower libido after childbirth.

Take things slow with your partner, and be honest with each other. It may help to find a time when you can be alone together without interruptions.

Before you begin having sex again, think about which birth control method you will use. Even if you plan to add on to your family, experts recommend waiting at least another 12 months before trying for a baby to give your body time to fully recover between pregnancies. Speak to your healthcare provider about which birth control method may be right for you.

When Is the First Menstrual Period After Giving Birth?

You will experience some vaginal bleeding after you give birth, known as lochia, but this is not a menstrual period.

If you are breastfeeding, your first menstrual period postpartum may not return for at least several months, sometimes up to six months. For some women, menstrual periods don’t return until they have weaned their baby from breastfeeding.

If you are formula feeding, you may get your first postpartum menstrual period about six to eight weeks after giving birth.

Initially, your menstrual periods may be a little different than they were before you were pregnant. For example, they may be shorter or longer, and they may be less painful. In time, your menstrual cycle should return to normal.

One thing to keep in mind is that your ovaries may be releasing eggs before your menstrual period returns. This means you may be fertile and able to conceive even if you are not getting periods yet. If you’re not planning to get pregnant at this time, speak to your healthcare provider about which birth control method may be best for you before starting to have sex again.

Postpartum Checkups

Your own healthcare provider will likely want to see you for a checkup about two to six weeks after you give birth. Your baby's provider will likely want to see your baby on a monthly basis for the first three months as well.

If you had a cesarean delivery, you may need to have a checkup about two weeks after giving birth so that your healthcare provider can take a look at how the incision is healing.

At your first postpartum checkup, your provider will likely check your weight, blood pressure, breasts, and abdomen, and do a pelvic exam.

If you had gestational diabetes, your provider may also recommend an additional blood glucose test.

Before you see your provider, it might help to write down any questions or concerns you have so you can get all the answers you need without missing something important.

The initial checkup will be followed by individualized ongoing care as needed, and your provider will be able to tell you when any subsequent visits or tests need to take place.

You might also need to get vaccinations such as the Tdap vaccine or the flu shot, if you haven’t already. Your provider will be able to tell you which immunizations you are due to have.

Medical Conditions to Be Aware of in the Postpartum Period

It’s worth knowing about potential medical conditions that can affect some women in the postpartum period and beyond. These are some of the more common ones; however, you should always contact your healthcare provider if you’re concerned about a symptom you’re experiencing:

• Preeclampsia. If you had preeclampsia (a blood pressure disorder) during your pregnancy, you may be at a higher risk of having it again during a future pregnancy, or of having cardiovascular disease later in life. During the postpartum period, your healthcare provider will check your blood pressure at your checkups and give you personalized advice on the condition.

• Postpartum depression. Some women feel an intense sadness after giving birth, which doesn’t go away after a few weeks. If you are experiencing this, it may be postpartum depression. You may feel hopelessness, despair, and severe anxiety. You may also cry for no apparent reason, have trouble concentrating, oversleep, or struggle to sleep even when your baby is fast asleep. Postpartum depression typically strikes during the first three weeks after giving birth, but it can also start later on in the first year as well. If you are feeling this way, seek help from your healthcare provider right away — don’t wait for your scheduled postpartum checkup. Your provider will be able to help, usually by recommending medication, therapy, or a combination of both.

• Postpartum endometritis. Endometritis is an infection of the lining of the uterus. Although postpartum endometritis is quite uncommon, the risk is higher if you gave birth via a cesarean section. If you had a cesarean you were likely given antibiotics to lower the risk of infection. However, in the days after you delivered your baby, if you have a fever, feel sick, or have a sore abdomen, let your healthcare provider know. Your provider will be able to diagnose and treat any infection, usually with antibiotics.

• Postpartum hemorrhage. Heavy bleeding either the day after you give birth or sometime in the first 12 weeks is called postpartum hemorrhage. Bleeding that happens in the first 24 hours usually because the uterus does not contract properly after the placenta was delivered. Placenta accreta (when the placenta grows into the uterine wall) can be another cause. Postpartum hemorrhage in the first 24 hours occurs in only about 4 to 6 percent of pregnancies, but if you experience it your healthcare provider will provide treatment, which may include medication or massage of the uterus to encourage it to contract. If much blood has been lost, your provider may recommend a blood transfusion. Contact your healthcare provider if you notice heavy bleeding at any time during the postpartum period or beyond.

• Postpartum thyroiditis. After giving birth, some women experience having an overactive thyroid in the first two to four months, followed by an underactive thyroid that lasts for a year or so. The thyroid function usually returns to normal after a time, but in some cases it can result in a condition called Hashimoto’s disease that can require lifelong treatment. It’s easy to mistake the symptoms of a thyroid problem, like tiredness and weight changes, for the usual symptoms of the postpartum period or the tiredness of being a new mom; however, if your symptoms seem unusual or don’t go away with time, tell your healthcare provider so that she can investigate whether a thyroid problem may be the underlying cause.

• Gestational diabetes. If you had gestational diabetes during your pregnancy, your healthcare provider will need to keep an eye on the condition during the postpartum period, and beyond. You will likely have a postpartum glucose tolerance test about 6 to 12 weeks after giving birth. To help reduce the risks associated with gestational diabetes, your provider may recommend things like weight loss or medication.

When to Call Your Healthcare Provider

During the postpartum period, contact your healthcare provider right away if you notice any of the following:

• You have a fever of more than 100.4 degrees Fahrenheit

• You’re feeling nauseous or are vomiting

• You feel pain during urination (like a burning sensation, for example)

• Heavy bleeding (for example, you’re soaking through two maxi pads an hour for an hour or two in a row)

• Severe pain in your abdomen

• Swelling of your legs

• Chest pain

• Red streaks or painful lumps on your breasts

• Pain or signs of infection (redness, discharge) in any incision that you had while giving birth, especially if the condition gets worse over time

• A foul smelling vaginal discharge

• Feeling down or hopeless, especially if it lasts more than 10 days.

Getting Help

It takes a village to raise a child, and you shouldn’t feel alone. Ask for help from your partner, family, and close friends if needed. Of course, if the thought of having to engage socially with friends or loved ones stresses you out, then definitely limit visitors.

If you still have access to your midwife or doula, she can be a great resource during the postpartum period, too, by answering your questions and giving you advice.

If you had prenatal classes, the other parents from those classes can be a great source of support as you may be going through similar things at the same time.

Your healthcare provider or the local community center can also be a great resource. They can point you in the direction of support services in your local area.

The six-week puerperium is full of new experiences and challenges for you and your family. Try to take things slow and give yourself lots of time and patience to make this adjustment period as stress-free as possible. Seek help and get support as much as feels right for you.

During this time, you might also start thinking about organizing your sip and see party, so that your loved ones can come over and meet your little one. If you’re having one of these mini get-togethers, there’s no need to rush. Give yourself plenty of time for organizing it, and only start when you feel ready.

_{How We Wrote This Article The information in this article is based on the expert advice found in trusted medical and government sources, such as the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists. You can find a full list of sources used for this article below. The content on this page should not replace professional medical advice. Always consult medical professionals for full diagnosis and treatment.}