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Key takeaways

• Expect soreness, bleeding (lochia), and afterpains in the first weeks.
• Keep your perineum clean and manage pain with simple pain relief.
• Start gentle activity and pelvic floor exercises when you feel ready.
• Contact your midwife or GP for heavy bleeding or unusual symptoms.

What to expect in the first few days and weeks

Your body has gone through a major physical and emotional experience. It is normal to feel sore and tired after giving birth. Recovery takes time, so try to take things slowly and rest when you can.

Your midwife will visit you in the first couple of weeks after giving birth. After this, your health visitor will continue to support you and your baby.

Postpartum bleeding (lochia)

After birth, you will have some bleeding from your vagina known as lochia. This is a normal part of recovery as your womb returns to its pre-pregnancy size.

The bleeding is usually heaviest in the first few days and is typically bright red at first. It then gradually becomes lighter, changing to a pinkish-brown colour before becoming yellowish-white.

You may notice the bleeding is redder and heavier during breastfeeding. This is because breastfeeding causes your womb to contract.

Lochia usually lasts up to 6 weeks, although light bleeding or discharge can continue longer in some people. Use only sanitary towels rather than tampons or menstrual cups until after your 6-week postnatal check, as these may increase the risk of infection.

Afterpains

It is common to experience afterpains, which feel like period pains or cramps in the first few days following birth. These happen as your womb contracts back to its normal size.

Afterpains are often stronger after your second baby or subsequent baby. They may also be more noticeable when breastfeeding. This is because the hormone oxytocin, which helps release your milk, also makes your womb muscles contract. Simple pain relief, such as paracetamol or ibuprofen, can help manage discomfort.

Perineal soreness and stitches

The area between your vagina and anus (your perineum) may feel uncomfortable or painful. This is because the area can be swollen and bruised. If you had an episiotomy (a cut to help your baby be born and prevent tearing) or a tear, stitches may also feel uncomfortable while the area heals.

Piles

Piles (haemorrhoids) are very common after birth. They usually disappear within a few days or weeks.

Care for your healing body

Perineal care and stitches

Wash your perineum daily using water only, without soaps or other products. You can gently rinse the area using a removable shower head or small jug of warm water, particularly during and after passing urine to reduce stinging.

Change your sanitary pads regularly and keep the area as clean and dry as possible. After washing, pat the area dry with a clean towel.

Most tears or episiotomies are repaired with dissolvable stitches, which do not need to be removed. You may notice small threads on your pads or underwear. Some soreness or discomfort is normal and can last for around 4 – 6 weeks, especially when sitting or walking.

Pain and swelling relief

Paracetamol and ibuprofen are both safe to take if you are breastfeeding, but always check the labels and follow dosing instructions. Avoid aspirin while breastfeeding. Stronger prescription pain relief such as dihydrocodeine may be used short-term for severe pain. This should be discussed with your GP or midwife, especially if breastfeeding. This is because they can occasionally cause side effects in babies.

Applying an ice or cool pack to the area for up to 10 minutes at a time can help reduce pain and swelling. Always wrap it in a clean flannel or towel to prevent ice-burn. Your midwife might suggest placing your maternity pads in the fridge or freezer for cooling relief.

Some numbing creams or sprays are available, but there is limited evidence that they are effective.

Comfortable sitting

Sometimes sitting can be uncomfortable due to perineal pain. Change your position regularly, alternating between sitting, standing, and lying on your side, to reduce pressure and improve comfort. If you use a birth ball, slightly deflate it so it feels softer and more supportive. Applying ice or a cool pack to your perineum may also help relieve discomfort and swelling.

Gradually returning to activity

Gentle exercise

If you had a straightforward birth, you can start gentle activity as soon as you feel ready. This includes walking and gentle stretches. Start gradually with short walks, building up to around 30 minutes a day on most days. You can take your baby out in a pram or sling and break activity into smaller sessions if needed.

Your body needs time to heal after birth, so it is important to balance rest with gentle movement. Listen to your body and take things slowly. Wait until after your 6 – week postnatal check before starting high-impact exercise such as running or aerobics.

Avoiding heavy lifting

Avoid lifting anything heavier than your baby for the first 6 weeks. If possible, ask others to help with lifting the buggy, car seat, and any other children. This is especially important if you had a more severe tear or complicated birth.

Driving

There is no legal restriction on when you can start driving again. You should wait until you can comfortably perform an emergency stop, wear a seatbelt without pain, and feel confident to drive. Check with your insurer, as they may have specific guidance about driving after birth.

Preventing blood clots

Staying mobile after birth helps reduce the risk of blood clots (deep vein thrombosis). Try to move regularly, do simple leg exercises such as ankle flexing, and avoid long periods of sitting or lying still. Drink plenty of fluids to stay hydrated and wear compression stockings if you are advised to do so. If you are travelling, take breaks to walk about when it is safe to do so.

Restoring your pelvic and bowel function

It is common to experience changes in your urinary and bowel function after birth.

Urinary incontinence

Leaking urine (urinary incontinence) is common after birth, affecting up to 1 in 3 women. It is more likely after a vaginal birth. It often happens when you cough, laugh, exercise or move suddenly.

Pelvic floor exercises can help with urinary incontinence. Other helpful tips include cutting down on caffeine and drinking 6 to 8 glasses of fluid a day. Avoid lifting heavy things. If you are still having issues after 6 weeks, talk to your GP or health visitor. They may refer you to a physiotherapist.

Pelvic floor exercises

Pelvic floor muscles support your womb, bowels, and bladder. Pregnancy and birth can stretch and weaken these muscles. You can start gentle pelvic floor exercises as soon as you feel comfortable after birth. If you had a catheter, you should wait until it has been removed. Your midwife or a physiotherapist who specialises in pregnancy and birth can show you how to do the exercises correctly. If you are worried about your pelvic floor after your 6 to 8-week postnatal check, speak to your GP.

Bowel function

It can take a few hours or days for your bowels to return to their usual pattern after giving birth. This can cause trapped wind, bloating, and constipation. If you are taking opioid pain relief such as dihydrocodeine, your midwife or doctor may recommend a laxative to help prevent constipation. If you have stitches, it is very unlikely you will break them when opening your bowels, but might feel better to hold a pad over the stitches for reassurance.

To help prevent or manage constipation:

• Drink 6 to 8 cups of fluid a day.
• Eat regular meals, including fibre-rich foods such as fruits, vegetables, wholemeal bread, and oats.
• Some people find chewing gum, drinking peppermint tea or prune juice helpful.
• Move around as much as you comfortably can.
• Do not ignore the urge to open your bowels.
• Place your feet on a footstool when sitting on the toilet to help you empty your bowels more easily.

Less commonly, you may have problems controlling your bowels (anal or faecal incontinence). This is more likely after a tear involving the back passage (anus). This is known as a third- or fourth-degree tear, also called obstetric anal sphincter injury (OASI). Symptoms include sudden urge to open your bowels, difficulty controlling wind, or leaking stool. If you have these symptoms, you should be referred to a specialist.

When to seek medical attention

Contact your midwife, GP, or attend your local maternity unit straight away if you have any of the following symptoms after birth:

• Severe pain, or pain that is getting worse.
• Pain that is not controlled by your pain relief.
• Difficulty or pain when passing urine.
• Heavy vaginal bleeding (soaking a pad in an hour or passing large clots), or bleeding that gets heavier after the first week.
• Vaginal blood or discharge that has an unpleasant smell.
• Your perineum becomes more red, painful, swollen, hot, starts producing pus, or foul-smelling discharge.
• High temperature (fever) or chills.
• Feeling generally unwell, for example, with nausea, vomiting or diarrhoea
• Cough, chest pain, or shortness of breath.
• Swelling, redness, or pain in one of your lower legs.
• A persistent or severe headache.
• Breast redness, pain, or swelling that is getting worse or not improving after 24 hours, or you develop flu-like symptoms.
• Sudden shortness of breath, severe chest pain, or coughing up blood.