The first 6 weeks after giving birth is a time of major change for your body and your emotions. You may be in a hurry to get back to your pre-pregnancy state. But taking the time to care for yourself and bond with your partner and new baby will help you make a full, strong recovery as a new mother.
What to Expect
Here’s an overview of what to expect during those first 6 weeks after birth:
Abdomen. You may be surprised that your abdominal area still looks pregnant for a few weeks after birth. Your uterus is still enlarged and the muscles supporting it need time to become taut again. Within 6 weeks, your uterus will contract back to its normal state — about the size of a small pear. During this process, you’ll experience mild cramping, also called afterbirth pains, that are important in clamping off blood vessels and reducing postpartum bleeding. If you are breastfeeding, you may feel these after pains as your baby nurses, since this activity stimulates oxytocin, the same hormone that causes the uterus to contract.
Cesarean incision. If you had a cesarean birth, your recovery process will take longer and you will need more help. You’ll need plenty of rest to recuperate and will probably be prescribed pain medication that may make you groggy. Your incision should heal on the outside in 2 to 3 weeks, but may remain sore and sensitive for up to 2-6 months. Some new moms may also experience itching around the incision site. Keep moving to promote circulation and speed up the overall healing process.
Vagina. The amount of blood in your body doubled during pregnancy. Now that it’s no longer needed, the excess blood will be released through vaginal discharge, called lochia. For the first 4 to 5 days, the flow will be bright red and heavy, and may contain clots of blood. The color will gradually lighten, and may change to yellowish-pink, then creamy white. The flow should taper off within 2-3 weeks. Occasionally, it may return to a reddish color, especially when breastfeeding or after a lot of physical activity. If the discharge becomes heavy, remains red in color, or has an unpleasant odor, contact your midwife or physician. Other stored fluids are eliminated through your urine. Some new mothers experience heavy perspiration — another way that your body chooses to eliminate excess fluids.
Perineum. The area between your vagina and rectum, called the perineum, also takes time to heal, whether you have a laceration or received stitches. The discomfort shouldn’t last more than a week or 2, although recovery time does vary and can be several weeks for some women. To provide relief and reduce the risk of infection, spray the area often using a peri-bottle filled with warm water. A warm bath or an ice pack will also relieve some of the discomfort. You can also use a clean washcloth soaked with witch hazel, or prepared witch hazel pads from the pharmacy.
Constipation. Constipation can affect new mothers for at least a few days, maybe even weeks. A number of factors are responsible for this sluggish intestinal behavior, including out-of-shape abdominal muscles, swollen tissue from the birth process, bed rest and use of anesthesia, epidurals, and some pain relievers. New mothers are also leery of putting pressure on the stitched perineal area and may inadvertently further complicate constipation. To lessen your chance of problems from constipation, keep moving, don’t sit for long periods of time, drink plenty of water, eat high-fiber foods like raw fruits and vegetables, and choose whole grains.
Breasts. Your breasts have just spent more than 9 months preparing themselves for nourishing your newborn. As they prepare for breastfeeding, they may feel achy, full, and tender to the touch. Your nipples may be sore. Wearing a supportive bra after childbirth, morning and night, will help protect the tender breast tissue and ease the achy feeling. Eager for the job ahead, your breasts may fill themselves to overcapacity. Once engorged, they’ll feel rock hard, and possibly hot to the touch. If your breasts are too full, your baby may have trouble latching on. Express a little milk manually or with a pump to soften the areola. Engorgement will occur less often once your baby establishes a more regular feeding routine.
Skin. Coupled with fatigue and a host of other physical changes, your skin may feel drier and less radiant after pregnancy. Rest assured, your skin will regain its normal tone once your menstrual cycle begins again. Any skin discoloration that occurred during pregnancy, such as pregnancy mask or linea nigra, should disappear about 3 months after birth. Eliminating sun exposure to these areas will keep the color from darkening. Stretch marks will also begin to fade.
Hair. If your hair is falling out at such a rate that baldness suddenly seems feasible, don’t panic, the condition is only temporary. Prior to pregnancy, you probably lost an average of 100 hairs per day. Pregnancy hormones essentially put a hold on this hair loss rate, causing your locks to feel thicker and healthier. Now that hormone levels have drastically dropped, your hair must make up for lost time. All should be back to normal by the end of baby’s first year.
Exercise. You probably haven’t yet been given the green light to enter into a full-fledged exercise program (and mustering the energy to even think about it is unlikely right now), but starting with simple movements soon after childbirth will boost your energy and speed your recovery. Begin with Kegel exercises as you did during pregnancy. These will help strengthen the pelvic floor, increase blood flow to the perineum, and promote healing. They will also help prevent incontinence and help your body to regain vaginal tone. Core exercises can strengthen the abdominal muscles, and taking your baby on a walk is a perfect warm-up to more aerobic exercise later.
Nutrition. Good nutrition is especially important now that your body is on the rebound. Careful food selection will help speed your physical recovery, keep your energy level up, and help with milk production. Unfortunately, with your new and demanding responsibilities, grabbing a quick bite may encourage unhealthy food choices. Eliminate this temptation by keeping cut-up fruit and veggies in the refrigerator for between-meal munchies. Stock up on yogurt, cheese, and other quick fixes that offer essential healing nutrients. Dieting to lose extra weight before your baby is weaned from breastfeeding could affect your milk supply. Losing weight too quickly can also slow the recovery process and lead to postpartum depression. Be sure to drink plenty of water during this time, especially when breastfeeding.
Sex. It may take a while for your desire for sex to return. Because your hormones are still at work, you may be experiencing perineal tenderness, vaginal dryness, and fatigue, and your thoughts are likely to be preoccupied with caring for your baby. In most cases, midwives tell women to resume sex whenever they feel ready and have stopped bleeding. It’s important to have open communication with your partner about your sex drive. Even if you do not feel like having sex, it is important to have time and intimacy with your partner. Some women prefer to wait until 6 weeks after birth to resume sex. This gives your uterus time to heal and reduce the risk of infection. However, depending on the type of labor you had, this time frame may be altered. Ask your midwife if you have questions or concerns, or experience pain.
Contraception. While breastfeeding may delay ovulation, it is still important to use some type of birth control in the postpartum period if you are sexually active with a person of the opposite sex. Ovulation occurs about 2 weeks before your period returns, so it’s especially important to use birth control each time you and your partner have sex. Commonly recommended forms of contraception during this 6-week time frame are Depo Provera, progesterone-only pills, an intrauterine device (IUD), or the condom used in conjunction with spermicidal jelly. Consult your midwife for alternate suggestions and to help select what is best for you.
Your midwife will typically schedule you for a 4- to 6-week checkup after birth. By this time, your body is on the mend, and you’ve had time to adjust, though not fully, to your new lifestyle. Any concerns, both physical and emotional, should be discussed now, if not sooner. You should call your midwife if you have concerns at any time.
The physical examination will include checks of:
- Shape, size, and location of uterus
- Episiotomy or cesarean birth stitches
- Vaginal discharge
- Blood pressure
- Cervix, vagina, ovaries, fallopian tubes, and perineum
- Abdominal wall if you had a cesarean birth
- Birth control
- Urine sample
- Legs for swelling or varicose veins
- Pap test (if it has been more than 1 year since your last test)
You’ll be encouraged to discuss parenting and relationship issues, social support, sex, birth control, exercise, diet, breastfeeding, and emotional concerns. Prior to your visit, write down questions of concern so that you won’t forget them.