Your Guide to Postpartum Recovery

The first six weeks after giving birth are known as the postpartum period. This period is an intense time that requires all sorts of care for you and your baby.

During this time, which some researchers believe actually lasts up to six months, your body will experience a number of changes, from healing after childbirth to hormonal mood swings. All of this in addition to the added stress of tackling breastfeeding, sleep deprivation, and the overall monumental adjustment to motherhood (if this is your first child).

In short, it can feel like a lot. It's not uncommon for the first year to feel like a tidal shift.

That said, the recovery period can vary wildly. If you're on your third baby and only pushed for 20 minutes, your recovery will look different than if you labored for 40 hours, pushed for 3, and had an emergency c-section. 

Yet while everyone's experience is different, there are some recovery milestones that you should ideally hit. To help give you a sense of where you should be in your postpartum timeline, this article highlights what you can expect from your body and your mind.

Week 1

Physical status, post-vaginal delivery

If you had a hospital delivery, you'll most likely stay there for at least part of this week after a vaginal delivery. The usual stay is 24 hours after delivery. Depending on whether or not your tore (and how much), your vagina may hurt quite a lot.

Perineal soreness is normal, as is bleeding. This first week, blood should be bright red, but will eventually turn brown like at the end of your period. You'll also probably feel little contractions, especially when breastfeeding, as the uterus contracts back to its pre-pregnancy size.

Physical status, after C-section

After a cesarean delivery, most movement will be difficult and your incision can be painful. A lot of women have trouble getting in and out of bed, but it's important to move around at least a little bit to avoid blood clots.

Mental Health Status

Day 3 in particular is infamous for being emotionally difficult (although this can occur anywhere between days 3-5). At this point there is a massive drop in estrogen and progesterone, and oxytocin and prolactin levels fluctuate widely throughout the day while breastfeeding. Combined with the sleep deprivation and exhaustion from birth, this makes for a lot of weepiness and feeling like nothing is going right.

​Suggestions for aiding your recovery:

• If you had a vaginal delivery, use an ice pack or frozen pads with witch hazel on your perineum. Use a spray bottle of warm water during or after peeing.
• Take Tylenol or Advil at regular intervals. Pain begets pain, so do your best to get ahead of it.
• Take a stool softener and drink lots of water. Many hospitals won’t let you leave unless you’ve pooped, so make it a little easier on yourself.
• Again, for C-section moms: Your major job the first week is to keep your incision clean and dry. Give it fresh air after a shower, pat it down with a towel, and set your hair dryer to cold and point it at your scar.
• Some doctors and midwives say it’s very important to take your temperature 2 to 4 times a day for the first 72 hours, to catch a uterine or kidney infection quickly.

Week 2

Physical status, post-vaginal delivery

For some women, bleeding will start to taper off. For others, it can last up to six weeks. Both are totally normal.
At this point though, the bleeding shouldn’t be heavy. You may start to feel vaginal itchiness, which is caused by the area starting to heal. The sutures — which swell with fluid when they disintegrate — may also be bugging you.

Physical status, after C-section

​You’ll still likely feel quite sore but it will probably feel a little easier to move around. Your scar might become a little itchy as the incision site is healing.

Mental health status

Baby blues are totally normal. In fact, most women are said to get them. Postpartum depression (PPD), however, is something else entirely.
If you’re feeling overcome with sadness an anxiety — if you can’t eat or sleep, aren’t bonding with your newborn, or are having suicidal thoughts or thoughts of hurting anyone else — talk to your doctor.

​Suggestions for aiding your recovery:

• If you’re breastfeeding, you’ll be deep into it by now. Make sure to have lanolin on hand for sore nipples and keep an eye out for clogged ducts. A lactation consultant can make an enormous difference here, so make sure to see one if you’re having trouble.
• Incorporate a little bit of movement into your day — whether that’s a walk around your house or the block.
• Continue to eat well. Foods with potassium can help keep your energy up.

Week 6

Physical status, post-vaginal delivery

This is when the uterus goes back to pre-pregnancy size and the bleeding stops. Most people are cleared for exercise and sexual activity, but many don’t feel ready for the latter for a long time.
Around six to eight weeks, bleeding may have stopped many days ago, but mysteriously started up again. This is because your uterus is involuting so much that the placental scab is getting pushed off, so there’s a brief few days of bright red bleeding.

Physical status, after C-section​

Same goes for the uterus and being cleared for sex and exercise. You’re now permitted to drive and lift something other than the baby — but try not to overdo it. The scar probably won’t hurt anymore, but you might still be numb (or even itchy) around the incision.
You should be fully recovered from the surgery and will probably only feel the incision if you bump into something. Walking is great, but go slow on more intense exercise.

Mental health status

If you have any lingering worries about your emotional or mental health, bring them up with your doctor at your six-week checkup. It’s normal to feel exhausted and overwhelmed, but deeper feelings of depression, hopelessness, or anxiety can be treated.

Suggestions for aiding your recovery:

• Although this is technically when the postpartum period ends, many women don’t feel remotely like themselves for a full year, so be gentle with yourself.
• If you’re ready to resume exercising, start slowly.
• Same holds true for sexual activity: Just because you’re cleared doesn’t mean that you feel ready. Listen to your body above all else. Very few women experience painless sex this early after giving birth. 
• Pelvic floor physical therapy is highly effective at aiding in recovery on all fronts.
  
• The exhaustion at this point can be overwhelming. Nap as often as possible.

Six Months

​Physical status, post-vaginal delivery

If your hair was falling out after your delivery, it should stop now. You should also have full bladder control again, if this was a problem before now.
Depending on your work schedule, milk may be drying up. Your period may come back anytime (or not for a year or more).

​Physical status, after C-section​

One study found that women who had C-sections were more tired after six months. This, of course, depends on how well your baby is sleeping.
Just as with post-vaginal delivery, your milk may be drying up depending on your work schedule and your period may come back anytime.

Mental health status

If you’re getting into the swing of motherhood — and the baby is sleeping more — your mental state might be more positive around this time.
Again, any lingering feelings associated with PPD should be addressed.

​Suggestions for aiding your recovery:

• Exercise is very important at this stage, for both mental and physical health.
• You can do abdominal strengthening exercises in earnest, which should help alleviate some back pain.

One Year

​​Physical status, post-vaginal delivery

You may be feeling back to yourself, but your body may still feel slightly different — whether it’s a few extra pounds, or just weight distributed in different places.
Depending on whether you’re still breastfeeding, your breasts will appear different than they did pre-pregnancy.

​​Physical status, after C-section​

Your scar will have faded, but it might still be a little numb. If you want another baby soon, most doctors will recommend (or insist on) a C-section if the babies are 18 months or less apart, this is due to the risk of uterine rupture during labor and vaginal delivery.

Mental health status

This will probably hinge on how comfortably you’re adapting to motherhood and how much sleep you’re getting. If you can, continue to nap on weekends when the baby naps to catch up on sleep.

​Suggestions for recovery:

• If you’re still having painful sex, prolapse, or urinary incontinence, speak with your doctor. Ask for a referral to pelvic health physical therapy if you haven't already done so.
• It’s important to maintain a healthy diet and continue to exercise. Depending on your baby’s sleep patterns, consider sleep training.

Sources:

• Mayo Clinic Staff. (2018). C-section.
  https://www.mayoclinic.org/tests-procedures/c-section/about/pac-20393655
• Mayo Clinic Staff. (2018). C-section recovery:
  What to expect.
  https://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/in-depth/c-section-recovery/art-20047310
• Mayo Clinic Staff. (2018). Vaginal tears in
  childbirth.
  https://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/multimedia/vaginal-tears/sls-20077129
• Mayo Clinic Staff. (2018). VBAC: Know the pros
  and cons.
  https://www.mayoclinic.org/tests-procedures/vbac/in-depth/vbac/art-20044869
• Postpartum depression. (2018).
  https://www.womenshealth.gov/mental-health/mental-health-conditions/postpartum-depression
• Romano M, et al.
  (2010). Postpartum period: Three distinct but continuous phases.
  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3279173/
• Woolhouse H, et al. (2012). Physical health and
  recovery in the first 18 months postpartum: Does cesarean section reduce
  long-term morbidity?
  https://www.ncbi.nlm.nih.gov/pubmed/23281904