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Key takeaways

• Your body will experience many changes after birth, including afterpains, vaginal bleeding, and breast changes.
• Your womb gradually returns to its pre-pregnancy size in the weeks after birth.
• Gentle movement and pelvic floor exercises can support your recovery.
• Know warning signs that need urgent medical advice.

What to expect in the first few days

Afterpains

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

Afterpains are often stronger after your second 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.

Postpartum bleeding (lochia)

Vaginal bleeding after birth is called lochia. It is a normal part of recovery as your womb heals and returns to its usual size.

Bleeding is usually heaviest in the first few days and is bright red at first. It gradually becomes lighter, changing to pink or brown, then yellowish-white before stopping.

Bleeding may become slightly heavier or redder when breastfeeding or after increased activity. This happens because your womb contracts.

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.

Perineal care after a vaginal birth

After a vaginal birth, the area between your vagina and your anus (your perineum) may feel uncomfortable or painful. This is because it can be swollen and bruised. If you have stitches from repairing a cut (episiotomy) or a tear, they can also be uncomfortable.

Your stitches will dissolve on their own, so they do not need to be removed. Keep the area clean and dry to help prevent infection. Pat gently to dry. If your stitches are sore or uncomfortable, speak to your midwife. Pain relief such as paracetamol can help with the discomfort. A cold pack wrapped in a towel may help reduce swelling and discomfort in the first few days.

Caesarean section recovery

After a caesarean section, you will be given pain relief to reduce any discomfort. A catheter is usually left in your bladder for at least 12 hours. Your wound will be covered with a dressing for at least 24 hours.

You will be encouraged to move around and eat and drink as soon as you feel able. You will be supported to care for your baby and start breastfeeding if you choose.

Key bodily changes in the first few weeks

Your womb after birth

After birth, your womb (uterus) will shrink back to its pre-pregnancy size. This process is called uterine involution and can take around 6 to 8 weeks. You may feel some abdominal pain and cramping during this time.

Breast changes and milk production

In the first few days after your baby is born, your breasts will produce a yellowish fluid called colostrum. Colostrum is a concentrated first milk that is rich in protein, vitamins, and antibodies that help protect your baby from infection. Your baby only needs small amounts of colostrum in the first few days.

Around 2 to 4 days after birth, your milk will ‘come in’. Your breasts may feel fuller and heavier as your milk supply increases.

Breast engorgement

Your breasts may become overly full (engorged) when your milk comes in. They may feel full, firm, tender, or uncomfortable.

It can help to feed your baby often. Wearing a well-fitting breastfeeding bra may also help. A warm compress, bath, or shower before feeding may help milk flow. Paracetamol is safe while breastfeeding and can help with discomfort.

If you are not breastfeeding, express just enough milk to ease any discomfort. Do not express any more than necessary, as this will increase your milk supply.

Your core and pelvic floor recovery

Separated abdominal muscles (diastasis recti)

It is common for the abdominal muscles to separate during pregnancy. This is called diastasis recti, or divarication. It happens because your growing womb pushes the muscles apart, making them longer and weaker. This separation often improves over the first few months after birth.

If you're still concerned about the gap after eight weeks, speak with your GP. They can check if you need a referral to a physiotherapist. This is especially important if you're also having back pain. The physiotherapist will give you specific exercises to try to reduce the separation.

Pelvic floor weakness

Your pelvic floor muscles help control your bladder and bowel. They also hold your bladder, womb, and bowel in place. These muscles form a supportive layer across the base of your pelvis.

During pregnancy, your pelvic floor muscles support your growing baby and stretch during labour. This can weaken them, so they may not work as well after birth. Weaker pelvic floor muscles can sometimes lead to issues like leaking urine when you cough or sneeze (stress incontinence). You might also notice less sensation during sex.

In some cases, you might feel a heaviness in your vagina. This could be a sign of the pelvic organs moving down (a prolapse). If you feel this, or if you still have issues with stress incontinence after six weeks, speak to your GP, midwife, or health visitor as there is support available.

Strengthening your pelvic floor muscles can help with all of these issues. You should start doing pelvic floor exercises as soon as you can. To help you remember, link them to a daily activity such as waiting for the bus or preparing a meal.

Read the Nala article on pelvic floor problems for detailed instructions on how to do pelvic floor exercises.

Starting exercise after birth

Gentle activity, such as walking or stretching, can support your physical and mental recovery. If you had an uncomplicated birth, you can start gentle exercise as soon as you feel ready.

It is usually best to wait until after your six-week postnatal check before starting any high-impact exercise, such as running or aerobics. This is especially important if you had any complications or a caesarean birth.

Important considerations for exercise

Your lower back and core abdominal muscles may be weaker than before. Your ligaments and joints are also more flexible for a few months after birth. Be gentle and avoid overstretching to prevent strains.

If your lochia gets heavier or changes colour after activity, you could be overdoing it. You may feel very tired. Listen to your body, pace yourself, and rest when you need to.

When to seek medical attention

Seek urgent medical advice if you have:

• Heavy vaginal bleeding,especially if you also feel faint or have a rapid heartbeat. This could be a postpartum haemorrhage (call 999 if severe).
• A high temperature, shivering, offensive-smelling vaginal discharge, or worsening pain in your abdomen, pelvis, or genital area. These could be signs of an infection.
• Signs of pre-eclampsia, such as a severe headache, vision problems (like blurred vision or flashing lights), or pain just below your ribs.
• DVT symptoms, such as pain, swelling, warmth, or redness in one leg.
• Chest pain or breathlessness. This could be a blood clot in the lungs (pulmonary embolism). Call 999 if severe.
• Perineal wound infection, such as increased pain, redness, or an offensive smell.
• Caesarean wound issues, such as swelling, redness, leaking, or discharge from your wound.
• Thoughts or feelings about harming yourself or your baby, or feeling unable to cope. Seek urgent help from your midwife or GP. If you are in immediate danger, call 999.