Postpartum care: your body after birth

Your baby isn’t the only lasting legacy from your pregnancy. From postpartum hair loss to newfound incontinence, carrying a baby can change your body in so many ways. Growing a baby takes a herculean effort, and giving birth doesn’t mean your body has finished changing. Most new moms know to look out for mood changes that might signal postpartum depression, but there’s a lot more to your postpartum recovery.

Here’s what you should know about postpartum care and all of the ways your body changes after giving birth. If you need additional medical advice, you can always use Maple to talk to a Canadian-licensed doctor online in minutes.

What changes can happen after a c-section and vaginal delivery?

Whether you go the caesarian section (C-section) or vaginal birth route, there are many changes that can happen with both. A C-section may seem like the “easier” option since it’s usually around 45 minutes long compared to the typical 12 to 14 hours of vaginal birth, but the recovery certainly isn’t. Changes that happen specifically after a C-section include:

• Postpartum afterpains, also known as contractions
• Pain in your lower belly and around your incision
• Difficulty moving around

A vaginal delivery comes with its own set of challenges from vaginal tears during the delivery. This includes:

• Vaginal soreness
• Vaginal swelling
• Vaginal pressure

There are many more changes that occur after you give birth to your baby vaginally or via C-section. The list is long and might seem scary, but there are ways to relieve your symptoms. Here’s what happens to your body after giving birth.

Your uterus after pregnancy

During pregnancy, your uterus grows to accommodate your baby. So it follows that after your baby is born, your uterus will be larger than normal. This is part of the reason you’ll still look pregnant for a while after you give birth. For the first few days postpartum, you’ll feel small contractions or cramping, especially while breastfeeding (if you are). These cramps are actually your uterus shrinking back to its pre-pregnancy size. The uterus starts shrinking within minutes of giving birth, but it takes about six weeks to fully return to its previous size.

If you’re concerned that your uterus is not shrinking after pregnancy or you still look pregnant after the two-month mark, speak to your doctor or your local pelvic floor physiotherapist. You may have diastasis recti — a common post-pregnancy condition in which a gap appears between the two sides of the abdominal muscles.

Bleeding and perineum care

Whether you deliver vaginally or have a C-section, you’ll experience vaginal bleeding and discharge after giving birth, otherwise known as lochia. This bleeding is how your body gets rid of any extra tissue and blood left over from pregnancy. Lochia is bright red but turns brown and eventually yellow after a few days or weeks.

You may also pass clots during the initial phase — this is completely normal as long as they’re smaller than a golf ball. But if you find that clots are larger than that or that you soak through a pad in under an hour, contact your doctor — this might mean there’s another issue. Also, you shouldn’t use tampons or menstrual cups for lochia — vaginal postpartum care is important and using tampons or menstrual cups can introduce harmful bacteria as well as irritate the area.

Vaginal deliveries can cause tearing (in some cases you may have had an episiotomy). Either of these will make your perineum — the area between your vagina and your anus — quite tender as it heals.

Perineal care after birth is important to help give you relief. For a sore, swollen perineal after giving birth, you can use ice packs or frozen pads in your underwear to soothe the area. You can also upgrade your pads with witch hazel and aloe to help speed up the process of healing the perineum.

Postpartum body

While you may be anxious to lose your pregnancy weight, you’ll want to wait for your doctor or midwife’s go-ahead before you start exercising. Pregnancy causes significant changes in your body and beginning an exercise regime too soon after delivery can cause more problems than it solves. Counter-intuitively, abdominal exercises like crunches are the most damaging exercise after giving birth and can actually worsen conditions like diastasis recti.

Try not to focus on post-pregnancy weight loss. It took nine months to put the weight on, so give yourself at least that much time to lose it and don’t let questions like “why is postpartum weight loss so hard” or “why can’t I get rid of stretch marks” cloud your mind. And, stay away from restrictive dieting if you’re breastfeeding — not only can it affect your energy levels and contribute to mood swings, but you need all the nutrients you can get to stay healthy and feed your baby, too.

In fact, if you’re a fan of coconut water, feel free to drink it up! Drinking coconut water postpartum is good for you because it’s low in sugar and full of electrolytes which can promote the production of antimicrobial protection for your baby. If you feel like you need extra guidance in navigating a postpartum diet, a registered dietitian can create a customized meal plan for you that’s suited to your postpartum needs.

Giving birth is physically strenuous. You’ll want to avoid doing certain things until you’re cleared by your doctor or midwife at your six-week appointment, such as:

• Lifting anything heavier than your baby
• Crunches, sit-ups, or other abdominal exercises
• Strenuous exercise
• Restrictive dieting (even after your check-up)
• Having sex
• Inserting anything into the vagina, including tampons and menstrual cups

You can do a less strenuous exercise like walking. The benefits of walking postpartum are plenty, like helping to strengthen muscles, raising energy levels, and even improving your mood. This should only be done when you feel up to it, however, so don’t feel pressured to jump up right away and go for a stroll around your neighbourhood.

In the case of exercising after C-section delivery, you’ll want to walk within 24 hours of your procedure. This can be uncomfortable, but it’s beneficial to get your blood flowing and your bowels moving. After that, see how you feel. You don’t need to walk for hours on end — a healthy, satisfying walk can be as little as 20 minutes.

Kegel exercises after giving birth are also an excellent way to improve circulation and stimulation. To do a Kegel, start with emptying your bladder. Then, squeeze your pelvic floor muscles and hold for three to five seconds, release, and repeat.

You don’t want to overdo the amount of Kegels either. A good number would be roughly ten Kegels three times a day but check with your healthcare provider first to see if this number is safe for you. You should also consider seeing a pelvic floor physiotherapist to help rehabilitate the pelvic floor muscles. This will help you get the most out of your Kegels.

In the case of vaginal birth, you might still feel numb down below so if you don’t feel anything, don’t worry — do your Kegels anyway! And even though there’s no vaginal delivery with a C-section, pregnancy affects the pelvic floor so it’s also a good idea to do kegel exercises after giving birth too.

Breast changes

Your body begins producing colostrum (the first thick, nutrient-dense milk newborns eat) before your baby is even born. Colostrum becomes milk three to five days after delivery, and your breasts will feel more full as your milk comes in. You may sometimes feel engorged, experiencing breast and nipple pain as your body figures out how much milk your baby actually needs.

While engorgement usually gets better on its own after a day or two, it can be quite painful while it lasts. Ice packs and ibuprofen can help, as can applying heat and hand expressing some milk to relieve the pressure.

But be warned — your body will replace any expressed milk. So pumping or expressing milk can ultimately prolong engorgement. And prolonged engorgement can lead to clogs and mastitis, which can be extremely painful.

Mood changes and postpartum depression

Your hormones will fluctuate in the days after you give birth. These fluctuations kick off a number of physical changes from getting your uterus to contract and shrink to producing breast milk for your baby. These hormones can affect your mood, and so can the effects of sleep deprivation.

Many new moms experience “the baby blues,” a period of emotional intensity in the weeks following the birth of their child. This is totally normal and can include feeling more sad, teary, angry, irritable, or sensitive than usual. But the baby blues usually resolves within a few weeks.

It’s also normal to have worries as a parent, but sometimes worrying takes over and negatively impacts new mothers — this can include losing sleep or not wanting to leave home. Not all mothers who are anxious are depressed, but identifying postpartum anxiety can help with treatment.

How to know if you have postpartum depression, however, is if the feelings don’t go away within a few months. Without intervention, symptoms of postpartum depression can become more severe and recur chronically.

There isn’t one single cause of postpartum depression, but the physical and hormonal changes along with sleep deprivation and the intense feelings that come with having a baby can trigger it. Postpartum depression is similar to regular depression, but the feelings tend to center around being a parent and concern for your newborn. Postpartum depression can strike anytime within the first year after your baby is born. Symptoms of postpartum depression can include:

• Severe anger and irritability
• Bouts of crying, feelings of extreme sadness, or both
• Difficulty or lack of bonding with child
• Brain fog, difficulty concentrating, or thinking clearly
• Feelings of hopelessness
• Feelings of inadequacy as a parent
• Thoughts of self-harm or suicide
• Thoughts of harming your baby

Getting help for postpartum depression includes counselling, medication, and support from family and friends. Left untreated, postpartum depression has negative effects on both mom and baby. The cycle of being sad, angry, and unsure of competence trickles down into the overall health and wellbeing of the baby. So you’re doing yourself and your baby a favour by taking care of your mental health if you’re experiencing postpartum depression.

In the long run, getting treatment and being healthy, happy, and a confident mom will all be worth it. A mental health therapist can provide you with comfort and guidance through talk therapy as you navigate postpartum depression. If you feel you may need a bit more than talk therapy, there are also medications that are safe to take while breastfeeding. A mental health physician can provide you with this as necessary, so you can get back to feeling like yourself again.

Bowel movement problems after birth

While uncomfortable, bowel movement problems after giving birth are extremely common. Postpartum constipation, diarrhea, or pain during bowel movements after giving birth could be caused by many things, including hormones, stress, and even hemorrhoids.

Hemorrhoids can appear because your uterus puts pressure on the veins in your anus. You don’t typically feel internal hemorrhoids, but external ones can make you feel painful and itchy. You may also see blood in your stool from the hemorrhoids’ bleeding, whether they’re internal or external.

For prevention, eat a high fibre diet postpartum that includes fruits, nuts and seeds, legumes, and whole grains. Fibre and good hydration can help soften your stools so that they pass easier — a good reason to start eating more fibre along with it being really good for your overall health.

Caring for postpartum hemorrhoids if you do have them is doable, however, and they’ll usually resolve in days or weeks. You can treat hemorrhoids at home by using witch hazel, soaking in a warm bath, taking ibuprofen, and applying an ice pack to your backside to help ease the pain. If you can’t get any relief on your own and need to get in touch with a doctor, they may prescribe stool softeners or other treatments for hemorrhoids.

When is it safe to have sex again?

There’s no required amount of time you have to wait, but doctors advise against anything being inserted into the vagina for at least four to six weeks to give your body time to heal. It’s not uncommon to have a yeast infection postpartum either as a result of antibiotics during or after delivery. Yeast also thrives in a moist environment, so it’s important to stay on top of changing pads each time you use the bathroom to help stay dry.

Also, if your libido isn’t back soon, it’s nothing to worry about. Your body has undergone a major physical change, your hormones are imbalanced, and you’re seriously lacking sleep, so don’t be too hard on yourself.

When do you get your period after giving birth?

So you’ve given birth, now do you get more time off from having your period? Not exactly. If you’re not breastfeeding, your period can come back roughly around six weeks, although it may take more than that for some women.

If you are breastfeeding, you may get an even longer break from your period. It could take as little as six weeks to return, or as long as 24. This is because the hormone that helps you make milk stops you from ovulating and having your period. And, if you breastfeed only some of the time, your period may return sooner — within six to twelve weeks.

How long does it take to recover after giving birth?

There’s no one-size-fits-all when it comes to recovering after giving birth. Just know that it’ll be an ongoing process and patience is key. With that being said, here’s a handy list of some of the items mentioned above as well as some others that you may want to keep on hand:

• Ibuprofen — for vaginal soreness, postpartum headaches, and more, ibuprofen is great to have on hand when taken as directed
• Maternity pads — for bleeding and discharge. You can also get incontinence pads for postpartum since bladder incontinence postpartum is common. This can also be treated with pelvic physiotherapy.
• Cotton underwear — purely for comfort. Sexy underwear can wait.
• Witch hazel — to help ease the pain of hemorrhoids, vaginal tears, and swelling
• Ice packs — also to ease the pain of hemorrhoids, vagina tears, and swelling
• Peri bottle (squirt bottle) — to clean keep your perineal area clean after going to the washroom
• Fibre-rich foods and stool softeners — to allow stool to pass through your rectum easily and help prevent hemorrhoids
• Nursing bras and pads — for easy access to breastfeeding and to prevent leakage
• Heating pad — for cramps, joint, or muscle pain
• Lanolin-based creams — for cracked nipples from breastfeeding
• Compression socks and leggings — to help provide relief from postpartum swelling

The long-term outlook

The long-term effects of pregnancy on the body are varied and might even seem odd. Everything from bigger feet to hair loss and skin changes (which is temporary — hair growth returns and skin issues tend to sort themselves out, thank goodness). If you delivered your baby preterm (before 37 weeks), long-term effects also mean you’re at greater risk of heart problems. Your pelvic floor can also suffer long-term consequences, which can lead to urinary incontinence and pelvic pain during sex.

But the long-term effects of pregnancy aren’t all bad. If you breastfeed, for every 12 months you nurse your baby, you cut your risk of developing breast cancer by four percent. And each full-term pregnancy that a woman carries reduces her risk of developing ovarian and endometrial cancer.

If you find you’re in need of extra care, you can always get in touch with a Canadian-licensed doctor on Maple. Whether it’s in the middle of the day or at 1am when you can’t sleep because of pain or discomfort, our doctors are available 24/7 and can help you from your phone, tablet, or computer

Having a baby puts your body through a lot. You grow another human being inside of your body, deliver it, and make food for it. And you do most of that on little to no sleep. Your body works overtime to do this, and your after-pregnancy care should reflect that.

So let those dishes pile up and feel free to leave those emails unanswered for a while. Having a baby is hard work, your first priority is taking care of them and yourself.