Postpartum Recovery
Everyone’s postpartum recovery is different based on how their birth went and natural variation in our bodies/minds. Below are some of the most common experiences - remember that they are temporary! For C-section specific tips, click here
Note on pre-eclampsia signs:
There are plenty of unpleasant parts of normal postpartum recovery as you’ll see below, but severe headaches, blurry vision, nausea/vomiting, or swelling in your hands, feet or face, are not normal - you should call your doctor right away
These symptoms could be a sign of postpartum pre-eclampsia, a serious condition that causes sudden increases in blood pressure and can be life-threatening if untreated
High blood pressure during pregnancy (or chronically) is a risk factor, but it can still sometimes occur in women without a history
While it typically occurs in the days right after delivery, when you’re still being monitored at the hospital, it is possible for it to develop later, up to 6 weeks postpartum
If you want to be able to monitor your blood pressure yourself at home, consider investing in a blood pressure cuff - anything 140/90 or higher would be concerning
Vaginal Bleeding
This is a universal postpartum experience (including after C-section births), as your body expels the blood, tissues and mucus from your uterus
It lasts several weeks in total, but the first 3-4 days are the most intense - the flow is heavy (soaks through a maxi pad every 2-3 hours), bright red and sometimes includes “clots” - chunks of tissue
I recommend wearing disposable underwear (FridaMom brand) with the MaxiPads, or you can just combine and get “adult diapers” - underwear with built in pads
Never use tampons for this, pads only!
If you usually wear thongs, stock up on some full coverage undies for this postpartum period
Over time, the flow will become less heavy and the color lighter. You can switch to lighter pads and eventually just panty liners for any residual spotting (which can continue for up to 6 weeks postpartum).
Cramping
In the first few days postpartum, you will likely feel period-like cramping - this is your uterus shrinking back to its original size
It may be especially noticeable when you are breastfeeding, during the beginning of a session. The oxytocin that is released during breastfeeding also stimulates the uterus to contract - kinda amazing, it’s like it’s telling your body that we’re switching gears now.
You are now free to take your preferred painkiller (Advil, Tylenol, Motrin) without fear of hurting your fetus!
Perineal Pain
Most women experience some degree of perineal tearing during birth, and will need extra TLC in that area for a few weeks postpartum
The best ways to soothe soreness/pain in this area is with ice packs, witch hazel in your maxi pad, and cleaning after peeing by squirting warm water through a “peri bottle” rather than with toilet paper. You’ll get all these items at the hospital, but you’ll likely need to buy more.
The FridaMom Recovery Kit includes all of this, or you can just buy the individual items separately
Some people also find it helpful to soak in a few inches of warm water in a “sitz bath” (you can use a regular bathtub or get a special tub that goes over your toilet). Also useful if you find yourself with postpartum hemorrhoids.
This pain usually gets better after a week or two, but it may be 4-6 weeks before it’s fully healed, depending on the degree of tearing
Night Sweats
It’s very common to experience night sweats in the first couple weeks postpartum because your body is shedding the excess fluid it had during pregnancy, and also because of fluctuations in your hormones
If you had an IV during birth, it can further increase your night sweats
You can try placing a towel under you to absorb some of the sweat - this can also be help with leaking breastmilk
Postpartum is a very fluid phase: between vaginal bleeding, sweating, leaking boobs, and crying tears! Make sure you are hydrating :)
Constipation
For various reasons, it can be much harder to poop in the days following birth and may take 3-5 days to happen (especially if you’ve had an epidural or a C-section)
In addition to the physical constipation, you might also feel some psychological hesitation or fear because of how sensitive that area is (especially if you had perineum tearing)
To make it easier on your body, drink lots of water, take a stool softener, eat high fiber foods, and try to get a daily walk in to get things moving. If you’re still stuck, try a laxative like Miralax.
When going poo, try sitting in a squat position (use a squatty potty if you have one) and go slowly, don’t force it. The last thing you want is to add hemorrhoids.
Incontinence
Your pelvic floor muscles have been stretched during labor/birth, so it may take some time to regain the control you once had
This means you may accidentally pee a little when you laugh, sneeze, or exercise (especially jumping)
You can continue wearing light panty liners for a while to absorb the pee
This usually goes away after a few weeks as your muscles regain their strength, but if it’s lasting months you may want to see a pelvic floor therapist
Origin Physical Therapy comes highly recommended - locations in Bay Area, LA, Austin, but also can be done virtually from anywhere
Insomnia
This was one of the most surprising postpartum symptoms for me - I knew that sleep would be difficult because of the baby needing to feed every few hours, but even when I had opportunities to sleep, I found it really hard to do so.
There is so much adrenaline and other hormones still coursing through you in the days postpartum, so this insomnia is normal and will go away - you will likely be hit with delayed exhaustion later!
It’s probably evolution’s way of ensuring you stay vigilant to protect the newborn in its most vulnerable first days
Vitamins
After birth, it’s good to continue taking vitamins to help replenish your body of key nutrients; and this is especially true if you are breastfeeding
Fine to just continue taking your prenatal if you like it - there isn’t a huge difference between vitamins marketed as prenatal vs. postnatal. You may switch to a more affordable brand than what you were taking during pregnancy.
If you do want to switch to one that’s especially geared towards breastfeeding moms, try MegaFood Baby and Me2
Perinatal Mood and Anxiety Disorders (PMAD)
This is what was formerly known as postpartum depression - it has been renamed because 1) anxiety can be just as common as depression, plus OCD, PTSD and psychosis can also occur during this period 2) these disorders can arise during pregnancy and postpartum, which is jointly known as the “perinatal” period
What people call the “baby blues”are distinct from PMAD in a few ways:
Baby blues are experienced by 60-80% of new moms, whereas 15-20% have a PMAD
Baby blues are mood swings that are characterized by feelings of sadness, exhaustion and overwhelm. PMAD symptoms are more intense and can include the following:
Feelings: shame; rage; numbness; hopelessness, loss of joy or pleasure in things you once enjoyed; lack of interest/connection/love; isolation/loneliness
Behaviors: prolonged/frequent crying; changes in appetite; challenges bonding with baby; avoiding/fearing being alone with baby or leaving them alone with others; obsessive internet research on baby; compulsive checking on baby
Baby blues begin soon after birth and only last a few days or weeks. PMAD can arise at any point in the first years postpartum and last longer than a few weeks
There are many genetic, biological and personal factors that can contribute to PMAD. Some risk factors include:
Personal/Family history of anxiety or depression
History of miscarriage, baby loss or fertility problems
Traumatic birth experience, baby in NICU
Social isolation or lack of support in caring for baby
The best way to treat a PMAD is through psychotherapy and/or psychiatric medication, ideally beginning as early as possible
This directory allows you to search for therapists in your area who specialize in treating these disorders
A few Bay Area recs: Anna Glezer, Michele Cilia, Erica Rath, Minton Family Therapy
Additional steps that can help include:
Joining a new mothers group to feel less alone in your new postpartum life; in SF, Natural Resources and KinSpace offer these types of groups
Seeking more support at home, whether that’s hiring a postpartum doula to give you some hours off and practical guidance, asking for more help from family or your partner, etc.
Trying to make time for things that made you happy and healthy before baby (yoga, dance, meditation, drinks with friends)
Resuming Exercise
How quickly you can go back to exercising depends upon the circumstances of your birth and the type/intensity of exercise
Almost everyone can begin taking walks within a day or two of giving birth - this is actually really good for your physical and mental health (plus a walk outside is often the trick to soothing a fussy baby)
You can also begin to reintroduce upper body workouts, but hold off on lower body as you heal down there. Most important is to listen to your body and not push it, even if you’re eager to lose the pregnancy weight - the last thing you want is to undo any healing that has happened.
Typically your 6-8 week followup appointment with your OB is when you’ll get clearance to resume your levels of pre-pregnancy exercise, like more intense aerobic workouts, running, etc.
If you’ve had a C-section, there are certain ab exercises you’ll need to avoid for up to 12 weeks as you heal - planks, crunches and situps. You may want to ease back into aerobic exercise with lower impact options like swimming and cycling rather than running.
There are some awesome “baby and me” exercise classes in SF where you can bring you little one: Jane Austin’s postnatal yoga class in Noe and Steph Forster’s postnatal pilates in the Mission;
These classes suggest you be at least 6 weeks postpartum (or 8 weeks if C-section)
The Lotus Method - which has locations in the Bay Area and NY - is personal training specifically designed for postpartum. This could be a great option to explore if you’re having continued pelvic floor/incontinence issues or diastasis recti.
Resuming Sex
The typical guidance is to wait 4-6 weeks to resume sex to give your vagina time to heal (especially if you’ve had a tear); many people wait until they’ve gotten the green light from their OB at that 6-8 week postpartum checkup
Honestly, it’s likely you and your partner are also very exhausted during this period, so you might not have much remaining energy for sex anyway! I think of this as more of a cuddly time - read more about other ways to keep the romance alive here
Breastfeeding can sometimes inhibit your libido because it affects estrogen levels, so have some patience with yourself if you’re not rearing to go right away!
Once you are feeling ready to have sex again, it’s normal to worry about how it will feel:
Everyone is different but typically your vagina may feel tender and sensitive, so sex could be a bit painful for some time - I’d recommend just going slow and communicating extra clearly about what positions feel too intense
Vaginal dryness is also common as your hormones are readjusting, so consider using lube if this is the case
A little bleeding after sex is normal for the first few times, but ask your doctor if it continues
If you’re worried whether it will still feel as good for you and your partner after a baby just came through you, know that most people find that it does - in fact, since it’s been some time since you were able to have sex, it can feel even better than before.
That said, if you feel like you’ve lost some sensation and strength in your pelvic floor muscles, you can do exercises like Kegels or see a physical therapist to regain tightness
Birth control:
The official guidance is that you should wait at least 6 months, and ideally up to a year, before getting pregnant again, so your uterus can fully recover from the first pregnancy
If you aren’t breastfeeding, your period typically returns 6-8 weeks postpartum, so you’ll need to use another method of birth control after that
If you are breastfeeding (or, to a lesser extent, pumping), it can be much longer before your period returns
Technically still possible to get pregnant even if your period hasn’t returned (since you could get pregnant after the very first ovulation, before your first period) so consider birth control if you want to avoid that small chance
Opt for progestin-only birth control pills (sometimes called the “mini-pill”) since they won’t affect your milk supply, unlike the typical combination pill that includes estrogen. IUIs are also safe.
Hair Loss (peaks 4-5 months postpartum)
This is a weird one because it is so delayed, but it’s quite common - you’ll start to notice disturbingly large clumps of hair coming out in the shower or when you brush
It usually resolves by 12 months postpartum; there isn’t much you can do in the meantime, except take vitamins that promote hair growth, avoid tight hair ties/hairstyles, and brush more gently than normal
