The 6 weeks after pregnancy and delivery of a baby is called the postpartum period, when the mother's body returns to its prepregnancy state.
After childbirth, a woman can expect to experience physical changes and many different sensations, some of which are normal and others that may require medical attention. Severe health issues are rare after childbirth. Doctors, midwives, and nurses discuss with women the postpartum changes and what to expect. Usually a follow-up visit with a health care professional is scheduled for 6 weeks after birth (and sometimes also 2 weeks after birth). Women are also given instructions about when to call a clinician about symptoms that may be a sign of a complication.
The most common complications after childbirth are the following:
Excessive bleeding (postpartum hemorrhage)
Breast infection (mastitis)
Postpartum hemorrhage may occur soon after delivery but may occur up to 6 weeks later.
The risk of developing blood clots is increased for about 6 weeks after delivery (see Thromboembolic Disorders During Pregnancy). Blood clot formation in the deep veins of the legs (deep vein thrombosis) can pass to the lungs (pulmonary embolism), which is a life-threatening condition.
After Pregnancy and Childbirth (Postpartum): The Body’s Return to Normal
Area Affected | What Happens |
|---|---|
Uterus | After delivery, the uterus contracts as it returns to a nonpregnant size, which takes several weeks. These contractions cause lower abdominal cramps, which can be painful. |
Vaginal discharge (lochia) | For 3 to 4 days after delivery, a woman has vaginal bleeding and may pass blood clots. The volume of bleeding should be the same or lighter than a menstrual period. After a few days, the bleeding becomes lighter and turns into a blood-tinged vaginal discharge for up to 2 weeks. This becomes lighter in volume and color over time. The discharge turns pale brown for about 2 weeks and eventually becomes yellowish white. Overall, vaginal discharge may continue for up to 6 weeks after delivery. At about 1 to 2 weeks after delivery, women may have a gush of blood from the vagina. Inside the uterus, a scab forms over the site where the placenta was attached. When the scab comes off, about a cup of blood is released by the uterus. |
Vagina, vulva (labia), and perineum (skin between the vulva and the anus) | After vaginal delivery (or after labor and pushing, even if a woman ended up having a cesarean delivery), the vagina and surrounding tissues (vulva and perineum) are usually sore and swollen. Tears of the tissue from delivery or an episiotomy (an incision that widens the opening of the vagina to make delivery easier) are repaired with stitches, which may also make the area sore. The area may sting during urination. Swelling of the vagina and surrounding tissues resolves in 1 to 2 weeks. Complete healing of a tear or episiotomy requires about 6 weeks. Sexual activity is not recommended until at least 6 weeks after delivery. Some women, particularly those who are breastfeeding, may experience vaginal dryness or pain with sexual activity after delivery. If there is severe or persistent pain, a woman should contact her health care professional. |
Fertility | A woman may be able to become pregnant again as early as 2 weeks after delivery. |
Urination | Urine production often increases noticeably after delivery. It usually returns to normal within about 2 weeks. |
Bowel movements | The first bowel movement after delivery may be difficult, sometimes with hard stool or pain in the anal area. This is sometimes because the vulvovaginal area is sore. Also, the first bowel movement may be delayed for a few days, sometimes because a woman is concerned about bearing down and putting stress on stitches. The pushing during delivery or constipation after delivery can lead to or worsen hemorrhoids, which can be painful during bowel movements or in general. Hemorrhoids usually resolve within 2 to 4 weeks after delivery. Women who had a cesarean delivery or other reason to have severe pain may be prescribed opioid pain medications, which can cause constipation. |
Breasts | For the first 2 to 6 days after birth, the breasts produce colostrum, which is thick and usually yellow. The breast then begins to produce milk. When this transition happens (called "when the milk comes in"), the breasts become more full and warm. The milk is white in color and a thinner consistency than colostrum. |
Abdomen | After delivery, a woman's abdomen may initially look like she is still pregnant, but the abdomen gradually reduces in size over about 6 weeks as the uterus contracts and muscle and skin tone increases. Abdominal muscle tone is low after delivery because the muscles have been stretched, but tone gradually increases. In some women, the abdominal muscles separate in the midline and a gap can be felt (diastasis). This gap closes in some women over several weeks to a month, but in some women it is permanent. Abdominal skin tone may return to normal or, in some women, the skin remains looser than before pregnancy. Stretch marks on the abdomen do not go away, but they may fade over a period of years, turning from red or purple to silver. After cesarean delivery, the incision is closed with sutures, staples, or surgical glue. Usually there is a bandage that is removed after a few days. Complete healing of the incision takes 6 weeks. |
Heart rate | The heart rate, which is increased during pregnancy, starts to decrease within the first 24 hours and returns to normal soon thereafter. |
Temperature | Body temperature may increase slightly during the first 24 hours after delivery, usually returning to normal during the first few days. If a woman has fever of 100.4° F (38° C) or higher and/or chills at any time during the first 6 weeks after delivery, and especially during the first week, she should call her doctor. Many women get night sweats for a few weeks after delivery. These are due to hormonal changes, particularly the decrease in estrogen levels. However, if night sweats continue after 4 weeks post-delivery, a woman should contact her health care professional. |
Weight | Many women do not lose weight immediately after delivery, and weight may even increase during the first few days. Although the baby and placenta have been delivered, the uterus is still enlarged. Also, increased fluid in the blood from pregnancy and sometimes additional intravenous fluid received during labor are still present, and breast milk may add weight. Extra fluids leave the body through urination during the first 2 weeks. A return to prepregnancy weight usually takes 6 to 12 months, with healthy eating and exercise habits. |
Hair | Many women are concerned about hair loss in the first several weeks after delivery. However, this is actually the loss of excess hair that was retained during pregnancy. In a nonpregnant state, about 50 to 100 hairs fall out per day. During pregnancy, higher estrogen levels result in fewer hair follicles entering the resting phase (hair falls out during this phase). So, during pregnancy, hair is thicker than normal. However, after delivery the estrogen levels and hair growth cycle return to normal, so the additional hair falls out. |
Mood | Many women feel blue or mildly depressed in the first 6 weeks after giving birth. The sad mood (called "postpartum blues" or "baby blues") usually passes after about 2 weeks. Some women also feel anxious about themselves or the baby. If depression or anxiety is severe or does not resolve after 2 weeks or if there are any other mental health symptoms, a woman should call her health care professional. |
Care During the First 2 Days After Childbirth
For 1 to 4 hours after giving birth, a woman is monitored closely by a doctor, midwife, or nurse. If she was given anesthesia (such as an epidural) or if she had any problems during labor and delivery, she may be monitored for longer, usually in a well-equipped hospital room with access to oxygen, fluids given by vein (intravenously), and medications, if needed.
During the close monitoring period, a woman's blood pressure, heart rate, and temperature are checked. Normally, within the first 24 hours after childbirth, a woman's heart rate begins to decline toward normal and her temperature may increase slightly, usually returning to normal during the first few days.
Hospital staff members make every effort to minimize pain and the risk of bleeding and infection.
Vaginal bleeding
Immediately after delivery, the main way that bleeding is controlled is through contractions of the uterus. The uterus is made mostly of muscle, and when it contracts the muscle squeezes the blood vessels which slows down bleeding.
The health care team takes steps to prevent excessive bleeding
After delivery of the placenta (afterbirth), a nurse may periodically massage a woman’s abdomen to help the uterus contract and remain contracted.
If a woman loses a lot of blood during and after delivery, a blood test is done to check for anemia.
Pain or swelling of the vagina, vulva, and perineum
The area around the vaginal opening is usually sore, and the area may sting during urination. Tears in the perineum (area between the vagina and anus) or episiotomy repairs can contribute to the soreness and may also cause swelling.
Immediately after delivery and for the first 24 hours, ice or cold packs may be used to relieve the pain and swelling. Numbing creams or sprays can be applied to the skin if needed. Using a spray bottle of warm water may also be soothing.
Women should be careful when sitting down and, if sitting is painful, sit on a pillow (a pillow with a hole in the middle, like a doughnut, can be helpful).
Urination
Urine production often increases noticeably after childbirth but returns to normal after a few days.
Bladder sensation may be decreased due to pressure on the bladder from the fetal head during delivery, so a woman is encouraged to try to urinate regularly, at least every 4 hours. Doing so avoids overfilling the bladder and helps prevent bladder infections.
Nurses or other medical staff may gently press on a woman's abdomen or use a portable ultrasound device to check the bladder and determine whether it is full.
Occasionally, if a woman cannot urinate on her own, a catheter must be inserted temporarily into the bladder to empty the urine. Infrequently, an indwelling catheter (a catheter that is left in the bladder for a period of time) is needed.
Bowel movements
Women are encouraged to have a bowel movement within the first 3 days after delivery. If this does not happen, doctors may recommend that a woman take stool softeners or laxatives. If the skin or muscles around the anus were torn during delivery, stool softeners are important to avoid pressure on that area.
The first bowel movement after delivery may be difficult, sometimes with hard stool or pain in the anal area or perineum. Women who had a cesarean delivery or other reasons to have severe pain may be prescribed opioid pain medications, which can cause constipation.
Also, the first bowel movement may be delayed for a few days, sometimes because a woman is concerned about bearing down and putting stress on stitches or because the vulva or perineum feel sore or swollen.
The pushing during delivery or constipation after delivery can lead to or worsen hemorrhoids, which can be painful during bowel movements or in general. Pain can be relieved by warm sitz baths and/or applying a topical anesthetic. Hemorrhoids usually resolve within 2 to 4 weeks.
Diet and activity
Usually, women may eat and drink any time after delivery, unless they are nauseous.
Women should get up and walk as soon as possible.
Showering and bathing
After vaginal delivery, a woman may take a shower as soon as she is able to stand without dizziness.
After a cesarean delivery, a woman may take a shower after the bandage is removed and she is able to stand in the shower without feeling dizzy. Care should be taken not to scrub the incision site. Baths should be avoided until any staples or sutures have been removed and the incision is completely healed, at about 6 weeks after delivery.
After a vaginal or cesarean delivery, nothing, including tampons and douches, should be put in the vagina for at least 2 weeks. Strenuous activity and heavy lifting should be avoided for about 6 weeks.
Medications
After delivery, women often have pain of the vulvovaginal area or the cesarean incision and may take medications to relieve pain as advised by their clinician.
medication while breastfeeding should talk to their doctor before taking it.
Immunizations
(See also Vaccines During Pregnancy, CDC: Guidelines for Vaccinating Pregnant Women, and CDC: COVID-19 Vaccines While Pregnant or Breastfeeding.)
Vaccinations are recommended for some women after giving birth and are usually given within the first 2 days (or before discharge from the hospital). A woman may be vaccinated if prenatal testing showed she does not have immunity to a certain infection or if she is due for a routine immunization. Some vaccines (for example, live or live attenuated vaccines) cannot be given during pregnancy, so they are given after delivery, if needed. Most vaccines, with some exceptions (such as smallpox vaccine and most uses of yellow fever vaccine), are safe to receive if breastfeeding.
Women are given the measles-mumps-rubella vaccine if they are not immune to 1 or more of these viruses (sometimes a person has been vaccinated before, but immunity did not develop).
Pregnant women who have never had chickenpox or been given the chickenpox (varicella) vaccine should be given the first dose of the chickenpox vaccine after delivery and the second dose 4 to 8 weeks later.
Ideally, the tetanus-diphtheria-pertussis (Tdap) vaccine is given during each pregnancy, preferably between 27 and 36 weeks. If a woman has never been given the Tdap vaccine during this or a previous pregnancy or as an adolescent or adult, it should be given to her within the first few days after childbirth, whether she is breastfeeding or not. If family members who will have contact with the newborn have never been given the Tdap vaccine, they should be given Tdap at least 2 weeks before they have contact with the newborn. The Tdap vaccine immunizes them against pertussis (whooping cough) and thus reduces the risk of spreading pertussis to unprotected newborns.
Women who are eligible for the human papillomavirus vaccine and have not been vaccinated or have not completed the vaccine series may be vaccinated after delivery.
Rh-negative blood type
If a woman has Rh-negative blood and her baby has Rh-positive blood (called Rh incompatibility), the woman is given Rho(D) immune globulin by injection into a muscle within 3 days after delivery. This medication masks any of the baby’s red blood cells that may have passed to the mother so that the red blood cells do not trigger the production of antibodies by the mother. Such antibodies may endanger subsequent pregnancies.
Before discharge from the hospital or birthing center
Before leaving the hospital or birthing center, the mother is examined. If she and the baby are healthy, they commonly are discharged within 24 to 48 hours after vaginal delivery and within 96 hours after a cesarean delivery. Sometimes discharge is as early as 6 hours after delivery, if no general anesthetic was used and no problems occurred.
Regular follow-up visits are scheduled, usually starting at 2 to 8 weeks after delivery. If there were complications during pregnancy or delivery, the first visit may be scheduled sooner.
Care During the First 6 Weeks After Childbirth
After childbirth, women experience many physical, and sometimes emotional, changes. Clinicians provide guidance to women about what changes to expect, give instructions about how to manage these changes at home, and explain when women should seek medical help.
Vaginal bleeding and discharge
For up to 6 weeks after delivery, a woman will have vaginal bleeding and then discharge that decreases in volume and changes color. The mix of blood and discharge after childbirth is called lochia, which has 3 stages: lochia rubra, lochia serosa, and lochia alba. Vaginal bleeding is normal after childbirth, but it is important to recognize when bleeding is too heavy or when it may be a sign of a problem (such as if bleeding stopped for a week and then starts again). A woman concerned about heavy or unexpected bleeding should contact her doctor.
The bleeding may be heavy during the first few hours, then flow decreases to the volume of a heavy period. Bleeding continues for 3 to 4 days (lochia rubra).
Vaginal discharge then transitions to a pink or brown vaginal discharge (lochia serosa), which lasts for about 14 days. About 1 to 2 weeks after delivery, the scab over the site inside the uterus where the placenta was attached comes off, causing a gush of bleeding and then light bleeding that lasts about 1 to 2 hours.
Next, discharge becomes yellowish white (lochia alba), which lasts for up to 14 days.
Sanitary pads, changed frequently, may be used to absorb bleeding or discharge. Tampons should not be used until 6 weeks after delivery.
Care of the vulva, vagina, and perineum
After vaginal delivery, especially if there was a tear or episiotomy and stitches were placed, women usually have pain or swelling of the vagina, vulva, and perineum.
Warm sitz baths can help relieve pain. Sitz baths are taken in a sitting position with water covering at least the perineum and buttocks. After a sitz bath, the area should be allowed to dry fully before putting on underwear.
Care of a cesarean incision
If a woman had a cesarean delivery, the bandage is usually removed after 1 to 2 days. Surgical staples or non-absorbable sutures are usually removed within 1 week. Absorbable sutures or surgical glue do not need to be removed.
The skin incision site should be kept clean and dry. If there is any redness around the incision or drainage of blood or fluid from the incision, a woman should call her doctor.
Women should avoid heavy lifting (usually defined as anything heavier than a baby) for 6 weeks after a cesarean delivery.
Changes in other parts of the body
The uterus
The skin and muscles of the abdomen are stretched and loose after delivery, and the tone gradually returns over several weeks. However, the abdominal skin and muscle tone usually does not return to a prepregnancy state for several months, regardless of exercise. Even after several months, in many women, the abdomen continues to protrude more than prior to pregnancy.
Stretch marks in the skin of the abdomen or breasts do not go away, but they may fade gradually over a year.
Many women lose hair in the first several weeks after delivery. They may see hair come out on a comb or brush or in the shower drain. During pregnancy, the higher estrogen level results in fewer hair follicles entering the resting phase (hair falls out during this phase), so hair feels thicker than normal. However, after delivery, the estrogen levels and hair growth cycle return to normal, and the additional hair falls out.
After Pregnancy and Childbirth (Postpartum): When to Call the Doctor
Area | Symptoms | Possible Cause |
|---|---|---|
Vaginal bleeding or discharge | If blood soaks a sanitary pad every hour for more than 2 hours If very large clots (larger than a golf ball) are passed If discharge smells foul | Bleeding (hemorrhage) |
Temperature | If the temperature is 100.4° F (38° C) or higher | |
Urination | If urination hurts (not just stings) or women have an urge to urinate very frequently If the bladder cannot be emptied completely | |
Lower abdomen | If pain or discomfort is felt in the lower abdomen (above the pubic area) after the first 5 days | Infection of the uterus or bladder |
Back | If pain is felt in the back or side just under the rib cage, particularly if fever is also present or urination is painful | Kidney infection |
Breast | If a firm lump is felt in the breast after engorgement has subsided | A blocked milk duct |
If the breast is painful, swollen, or red or feels hot or tender | ||
Mood | If any of the following symptoms persist for more than 2 weeks:
| |
Incision from a cesarean delivery | If pain increases If this area turns red or becomes swollen or hard to the touch If there is any blood or fluid leaking from the incision | Wound infection |
Leg or chest | If the leg is swollen or painful If sudden, sharp chest pain occurs or chest pain worsens when inhaling If breathing becomes difficult | |
General | If light-headedness, fainting, or shortness of breath occurs | A blood clot in the lungs Severe anemia |
Mood
Sadness (postpartum blues) is common during the days after delivery. Women may also feel irritable, moody, or anxious and may have difficulty concentrating or sleep problems (too much or too little). These symptoms usually resolve after 1 to 2 weeks. However, if these symptoms continue for longer than 2 weeks or interfere with taking care of the baby or doing daily activities, women should talk to their doctor. In such cases, postpartum depression or another mental health disorder may be present.
Weight
Many women do not lose weight immediately after delivery, and weight may even increase during the first few days. Although the baby and placenta have been delivered, the uterus is still enlarged. Also, weight may be added from increased fluid in the blood from pregnancy, increased fluid from any intravenous fluid received during labor, and breast milk.
Extra fluids leave the body through urination during the first 2 weeks. Return to prepregnancy weight usually takes 6 to 12 months, with healthy eating and exercise.
Exercise
Women may usually start exercises to strengthen abdominal muscles or pelvic floor muscles (Kegel exercises) within a few days after a vaginal delivery, if there was no injury to the anal sphincter during delivery.
Cesarean delivery is major surgery, and women should not begin exercising until they have had time to fully recover and allow healing of the surgical incision, which typically takes about 6 weeks.
Women can resume their prepregnancy exercise routine after approval from their doctor at their postdelivery visit.
Sexual activity and family planning (birth control, or contraception)
Sexual activity may be resumed as soon as desired and comfortable, although common advice is to wait until at least 6 weeks after delivery or until healing of any tear or episiotomy repair is complete. Sexual activity after cesarean delivery should be delayed until the surgical incision has healed.
If sex is painful, a woman should stop sexual activity and contact her doctor for an evaluation. Sometimes vaginal sex is uncomfortable if a woman is breastfeeding because breastfeeding can lower levels of estrogen, which can result in vaginal dryness.
Women who are not breastfeeding usually begin to ovulate again about 4 to 6 weeks after delivery. Once ovulation occurs, they will get a period about 2 weeks later. However, ovulation can occur earlier; women have become pregnant as early as 2 weeks after delivery. Women who are exclusively breastfeeding (feeding their baby only breast milk) tend to ovulate and menstruate later, usually closer to 6 months after delivery, although a few ovulate and menstruate (and become pregnant) as quickly as those who are not breastfeeding.
To minimize the chance of pregnancy, women who have sex with men should start using contraception before resuming sexual activity. Health care professionals recommend waiting to conceive another pregnancy for at least 6 months but preferably 18 months after delivery.
Women who have just been vaccinated against rubella and/or chickenpox (varicella) must wait at least 1 month before becoming pregnant again to avoid endangering the fetus.
Doctors commonly discuss birth control options prior to and after delivery.
Did You Know...
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Some contraceptive methods may be started immediately after delivery, including:
Progestin-only methods (implants, injections, or pills): May be started immediately after a vaginal or cesarean delivery
Intrauterine devices: Immediate insertion is possible after vaginal delivery, within 10 minutes after the placenta is delivered
Female sterilization: May be done during the same procedure as a cesarean delivery or within 1 to 2 days after a vaginal delivery
Most types of contraception can be used even if a woman is breastfeeding, although birth control pills (or rings or patches) that contain estrogen should not be started until 3 weeks after delivery because estrogen may increase the risk of blood clots (deep vein thrombosis or pulmonary embolism). Also, birth control with estrogen may temporarily decrease the amount of milk a woman produces. Some women prefer to wait to start these methods until after breastfeeding is well-established.
Hormonal methods that are progestin-only, such as some types of birth control pills, , and progestin implants, have little to no effect on blood clot formation and do not affect milk production.
An intrauterine device (IUD) may be placed immediately after vaginal delivery or at any other time postpartum.
Women who do not wish to become pregnant in the future may choose female sterilization. These surgical procedures involve cutting or blocking the fallopian tubes to prevent sperm from reaching and fertilizing an egg. Female sterilization can be done within 1 to 2 days after a vaginal delivery (through a small incision below the belly button [umbilicus]), during the same procedure as a cesarean delivery, or after the postpartum period (the 6 weeks after the baby is delivered). These procedures are considered permanent and irreversible. Male partners may also choose male sterilization (vasectomy).
A diaphragm can be fitted only after the uterus has returned to a nonpregnant size, usually after about 6 to 8 weeks. If a woman used a diaphragm prior to pregnancy, she should have a fitting after childbirth, because a different diaphragm size may be needed. If she engages in sexual activity before then, foams, jellies, and condoms can be used.
Breastfeeding
Doctors recommend that women breastfeed for at least 6 months without supplementing with other foods. Then women should continue to breastfeed for another 6 months while the baby is also introduced to other foods. After that, women are encouraged to continue breastfeeding until they or the baby is no longer interested.
If mothers cannot breastfeed or choose not to, babies can be bottle-fed with infant formula instead.
Many women find that learning about breastfeeding before delivery is helpful. Information about breastfeeding may be from books or websites or through a local hospital, breastfeeding support organization, or lactation consultant. Often after delivery, a nurse or midwife can help a women learn how to breastfeed.
Initiating breastfeeding
For the first 2 to 6 days after giving birth, the breasts produce colostrum, which is thick and usually yellow. The breast then begins to produce milk. When this transition happens (called "when the milk comes in"), the breasts become full and warm, and the milk is a white color and a thinner consistency than colostrum.
Breast care
Mothers who are breastfeeding need to learn how to position the baby during feeding. If the baby is not positioned well, the mother’s nipples may become sore and cracked. For example, sometimes the baby draws in its lower lip and sucks it, irritating the nipple. In such cases, the mother can ease the baby’s lip out of its mouth with her thumb. To remove her nipple from the baby's mouth, the mother should first slide her finger into the baby's mouth to break the suction caused by sucking.
When a mother breastfeeds, the breasts may leak milk. Cotton pads can be worn to absorb the milk. Plastic bra liners can irritate the nipples and should not be used.
Diet during breastfeeding
While breastfeeding, mothers need to increase their caloric intake by about 300 to 500 calories per day. They should also increase their intake of most vitamins and minerals, such as calcium. Usually, eating a well-balanced diet (including enough dairy products and green, leafy vegetables) and continuing to take a prenatal vitamin with folate once a day are all mothers need to do. Prenatal vitamins should contain at least 400 micrograms of folate. Breastfeeding women should drink enough fluids to ensure an adequate milk supply. Mothers on special diets should consult their doctor about the need for other vitamin and mineral supplements, such as vitamin B12 for vegetarians.
If breastfeeding women eat fish, they should choose types of fish that are low in mercury. See Mercury in seafood for more information.
Breast engorgement
The breasts may be enlarged, hard, tight, and sore if they are too full of milk (engorgement). Engorgement can occur at any stage of milk production (lactation).
For women who are breastfeeding, the following can help if breasts become engorged:
Feeding the baby regularly
Wearing a supportive nursing bra 24 hours a day
Expressing milk by hand or using a breast pump between feedings (however, this tends to stimulate milk production and prolong engorgement)
If the breasts are very swollen, a woman may have to express some milk just before breastfeeding to reduce the firmness of the breast and enable the baby’s mouth to fit around the areola (the pigmented area of skin around the nipple).
Did You Know...
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For women who are not going to breastfeed or have stopped breastfeeding, the following can help:
Wearing a snug-fitting bra to apply pressure to the breasts and thus help suppress milk production
Refraining from manually expressing milk, which can increase milk production because expressing milk tells the body more milk is needed
