Understand Postpartum Period (Puerperium)

What’s known as the postpartum period starts the moment your baby is born and lasts for up to 12 weeks. Sometimes referred to as the puerperium or the “fourth trimester,” this is an important time for both you and your baby. During this period it’s normal to experience a range of physical and emotional symptoms as your body adapts after having a baby and you adapt to certain lifestyle changes. Read on to discover all about the postpartum period, how to adapt after pregnancy and birth, and the important postpartum care you’ll receive.

What Is the Postpartum Period?

First of all, what is the definition of “postpartum”? Postpartum means after birth—referring to the period after childbirth. Therefore, the postpartum period—sometimes referred to as the puerperium—starts with the birth of your baby and extends until about twelve weeks after childbirth. Keep in mind that some of the effects of your pregnancy and the delivery of your baby may last longer. The postpartum period is a time of adjustment. It’s a time to adjust to your new life as a parent and how your days are filled. It’s also a time to adjust as a couple while parenting a newborn, physically as your body recovers from pregnancy and childbirth, and emotionally as you get used to all these changes.

Postpartum Vs. Postnatal

The terms postpartum and postnatal are often used interchangeably for the period following childbirth. However, occasionally postpartum is used when referring to the mother after birth and postnatal when referring to the baby after birth.

How Long Is the Postpartum Period?

The duration of the postpartum period was typically considered to last 6 to 8 weeks after childbirth; however, The American College of Obstetricians and Gynecologists now considers it to last up to 12 weeks. They also recommend individualized care and more frequent checkups based on your health needs in the postpartum period.

When Can You Start Doing Household Work After Delivery?

When it comes to physical activity (including exercise) after having a normal vaginal delivery, it’s best to wait a few days before starting, and start slowly and gradually build up. If you had a cesarean birth or any complications, you should ask your healthcare provider when it’s safe to perform certain tasks again. It’s important to take it easy after delivery and avoid strenuous activities or heavy lifting for a few weeks, or until your healthcare provider says it’s ok for you. It’s also important to listen to your body as postpartum is a period of rest and healing after pregnancy and childbirth. Ask for help whenever possible, and share the load with your partner or family members—especially when it comes to more strenuous housework. You might also have friends or family who are happy to bring you home-cooked meals, and you could share night-time bottle feeds with your partner to have some extra sleep.

Postpartum Symptoms: Physical Changes

During the weeks and months after you give birth, your body will go through many changes as it adjusts post-pregnancy. Here are some physical symptoms you might experience during the postpartum period.

The First Few Days After Giving Birth

Your little one has finally arrived! In addition to feeding your newborn and giving them lots of skin-to-skin contact, you’ll start to recover from labor and childbirth. Here are some of the physical changes you may experience in the first few days as you heal 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 might 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. If you had a vaginal birth, 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 filled with milk. Once you settle into a regular breastfeeding routine, the discomfort may 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 extra 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 postpartum body has been through a lot during pregnancy, labor, and delivery, and it takes time to recover and return to “normal” after having a baby. 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 people 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 people 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. According to experts, now is not the time to diet though, as your body needs all the nutrients 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 people experience urinary incontinence after giving birth. Factors 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.

For some recovery tips after labor and childbirth, read our informative article dedicated to postpartum healing.

How to Cope With Emotional Changes

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—changes in hormones cause this. Feeling a little down doesn’t mean you’re a bad parent or are ungrateful for what you have; it just means your body is adjusting after the big and wonderful task of childbirth. 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 help lift your mood. These emotions typically go away after 1 to 2 weeks, but if they don’t—or if these feelings of sadness become more intense—consult with your healthcare provider, as it may be something like postpartum depression. If you have postpartum depression, your healthcare provider will work with you to find the best treatment to help relieve your symptoms. Being a new parent can also be a stressful and tiring time, so taking care of yourself, body and soul, is important. Share how you’re feeling with friends and family and ask for help when needed. If you ever feel so stressed that you think you might take it out on your little one, leave your baby in their crib and leave the room. Give yourself a moment to take a breather. Never shake your baby out of frustration. Find out from your healthcare provider what community services may be available in your local area to give you more of a support network.

Postpartum Checkups

Postpartum care is very important for every parent after giving birth. You’ve just been through pregnancy and childbirth, and now there’s a new tiny person in your life—so these checkups are vital for your physical and mental well-being. Your postpartum checkups are a chance for you to ask any questions, share any concerns, and for your healthcare provider to ensure there are no health problems or complications. Your postpartum checkup schedule may go as follows:

• Your healthcare provider will likely want to see you for a checkup within 3 weeks after giving birth. This can be in person, by phone, or via video chat.

• 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.

• Within 12 weeks of giving birth, you’ll also have a full, in-person postpartum checkup for your physical, mental, and emotional health.

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. If you had gestational diabetes during pregnancy, you may need a checkup 3 to 10 days after birth and an additional blood glucose test may be recommended. At your first postpartum checkup, your provider will likely check your weight, blood pressure, breasts, and abdomen, and do a pelvic exam. They are also there to answer any questions you may have. 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. 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 people 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 people 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 is usually because the uterus did 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 discuss your treatment options. Contact your healthcare provider if you notice heavy bleeding at any time during the postpartum period or beyond.

• Postpartum thyroiditis. After giving birth, some experience 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 parent; however, if your symptoms seem unusual or don’t go away with time, consult your healthcare provider.

• 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 houror 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.

The Bottom Line

The postpartum period 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. Make sure you attend all your checkups to receive the best possible postpartum care for you and your baby and seek help and support when needed.

If you have some spare time, you might find the parenting life section of our website very informative. We’ll answer all your questions, such as when you might get your first period after having a baby, and information on postpartum weight loss, as well as some great postpartum workout ideas to help you get back in shape over time.

And to make your postpartum period a little easier, download the Pampers Club App for rewards on all your diaper purchases.

_{How We Wrote This Article The information in this article is based on 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.}