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 mother can expect to have some physical changes and symptoms, but they are usually mild and temporary. Severe health issues are rare. Nonetheless, the doctor, hospital staff members, or health care plan usually sets up a program of follow-up office or home visits.
The most common complications after childbirth are the following:
Excessive bleeding (postpartum hemorrhage)
Problems with breastfeeding
Postpartum hemorrhage may occur soon after delivery but may occur up to 6 weeks later.
Hospital (What to Expect)
Immediately after delivery of a baby, the mother is monitored for at least 1 hour. If an anesthetic was used during delivery or if there were any problems during delivery, she may be monitored for several hours after delivery, usually in a well-equipped recovery room with access to oxygen, fluids given by vein (intravenously), and resuscitation equipment.
Staff members check the mother’s pulse rate and temperature. Normally, within the first 24 hours, the mother’s pulse rate (which increased during pregnancy) begins to decline toward normal and her temperature may increase slightly, usually returning to normal during the first few days. After the first 24 hours, recovery is rapid.
Hospital staff members make every effort to minimize the new mother’s pain and the risk of bleeding and infection.
Bleeding
Minimizing bleeding is the first priority. After delivery of the placenta (afterbirth), a nurse may periodically massage the mother’s abdomen to help the uterus contract and remain contracted, thus preventing excessive bleeding.
If women lose a lot of blood during and after delivery, a complete blood count is done to check for anemia before they are discharged.
Urination
Urine production often increases greatly, but temporarily, after delivery. Because bladder sensation may be decreased after delivery, hospital staff members encourage a new mother to try to urinate regularly, at least every 4 hours. Doing so avoids overfilling the bladder and helps prevent bladder infections. Staff members may gently press on the mother’s abdomen to check the bladder and determine whether it is being emptied.
Occasionally, if the new mother 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
The new mother is also encouraged to have a bowel movement before leaving the hospital. But because hospital stays are so short, this expectation may not be practical. Doctors may recommend that if she has not had a bowel movement within 3 days, she take stool softeners or laxatives to avoid constipation, which can cause or worsen hemorrhoids. If the rectum or muscles around the anus were torn during delivery, stool softeners are important to avoid pressure on that area.
Opioids, which are occasionally given after cesarean delivery to relieve severe pain, can worsen constipation. So if an opioid is needed, the lowest effective dose of such drugs is used.
Diet and exercise
A new mother can have a regular diet as soon as she wants it, sometimes shortly after delivery. She should get up and walk as soon as possible.
A new mother can start exercises to strengthen abdominal muscles, often after 1 day if delivery was vaginal. Cesarean delivery is major surgery, and women should not begin exercising until they have had time to fully recover and allow healing, which typically takes about 6 weeks.
Women can resume their prepregnancy exercise routine after approval from their doctor at their postdelivery visit.
Vaccines and immune globulin
(See also Vaccines During Pregnancy, Guidelines for Vaccinating Pregnant Women, and CDC: COVID-19 Vaccines While Pregnant or Breastfeeding.)
Before the mother leaves the hospital, she is given the rubella vaccine if she has never had rubella or never been given this vaccine.
Ideally, the tetanus-diphtheria-pertussis (Tdap) vaccine is given during each pregnancy, preferably between weeks 27 and 36. If a mother has never been given the Tdap vaccine during this or a previous pregnancy nor as an adolescent or adult, it should be given to her before she is discharged 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.
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.
Doctors may recommend other vaccines, depending on the woman's vaccination and health history.
If a new mother has Rh-negative blood and the baby has Rh-positive blood (called Rh incompatibility), she is given Rho(D) immune globulin by injection into a muscle within 3 days of delivery. This drug masks any of the baby’s red blood cells that may have passed to the mother so that they do not trigger the production of antibodies by the mother. Such antibodies may endanger subsequent pregnancies.
Before discharge
Before a new mother leaves the hospital, she is examined. If mother and baby are healthy, they commonly leave the hospital within 24 to 48 hours after vaginal delivery and within 96 hours after a cesarean delivery. Sometimes discharge is as early as 6 hours if no general anesthetic was used and no problems occurred.
The mother is given information about changes to expect in her body and measures to take as her body recovers from having a baby. Regular follow-up visits are scheduled, usually starting at 3 to 8 weeks after delivery. If delivery was cesarean or if problems occurred, the first visit may be scheduled sooner.
Continuing From Hospital to Home
Coping with some changes begins in the hospital, depending on how soon hospital discharge occurs, and continues at home.
Discharge from the vagina
New mothers have a discharge from the vagina. Staff members give them pads to absorb it. Staff members also check the amount and color of the discharge. Usually, it appears bloody for 3 or 4 days. Then it becomes pale brown, and after about 2 weeks, it becomes yellowish white. The discharge may continue for up to about 6 weeks after delivery.
About a week or two after delivery, the scab over the site where the placenta was attached in the uterus comes off, causing vaginal bleeding of up to about a cup. Sanitary pads, changed frequently, may be used to absorb this discharge. Tampons should not be used until the woman's practitioner approves their use. If women are concerned about heavy bleeding, they should contact their doctor.
Drugs
Mothers who are not breastfeeding may safely take drugs to relieve pain.
drugs while breastfeeding should talk to their doctor about it.
Genital area
The area around the vaginal opening is usually sore, and the area may sting during urination. Tears in the perineum or episiotomy repairs can contribute to the soreness and cause swelling.
Immediately after delivery and for the first 24 hours, ice or cold packs may be used to relieve the pain and swelling. Anesthetic creams or sprays can be applied to the skin.
Later, washing the area around the vagina with warm water 2 or 3 times a day may help reduce tenderness. Warm sitz baths can help relieve pain. Sitz baths are taken in a sitting position with water covering only the perineum and buttocks.
Women should be careful when sitting down and, if sitting is painful, use a doughnut-shaped pillow.
Hemorrhoids
Pushing during delivery can cause or worsen hemorrhoids. Pain caused by hemorrhoids can be relieved by warm sitz baths and applying a gel containing a local anesthetic.
Breast engorgement
The breasts may be enlarged, tight, and sore because they are engorged with milk. Engorgement occurs during the early stages of milk production (lactation).
For mothers who are not going to breastfeed, the following can help:
Wearing a snug-fitting bra to elevate 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.
For mothers who are breastfeeding, the following can help until milk production adjusts to the baby’s needs:
Feeding the baby regularly
Wearing a comfortable nursing bra 24 hours a day
If the breasts are swollen and very uncomfortable, expressing milk by hand in a warm shower or using a breast pump between feedings (however, this measure tends to stimulate milk production and prolong engorgement)
If the breasts are very swollen, the mother may have to express her milk just before breastfeeding to enable the baby’s mouth to fit around the areola (the pigmented area of skin around the nipple).
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Mood
Sadness (baby 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 disappear after 7 to 10 days. However, if these symptoms continue for longer than 2 weeks or interfere with taking care of the baby or doing daily activities, new mothers should talk to their doctor. In such cases, postpartum depression or another mental health disorder may be present.
Home (What to Expect)
A new mother may resume normal daily activities when she feels ready. Eating a healthy diet and exercising regularly can help a new mother recover and feel healthy.
She may resume sexual activity as soon as she desires it and it is comfortable. Sexual activity should be delayed until the affected area heals if
Delivery caused tearing.
An episiotomy was done.
The delivery was cesarean.
A new mother may take showers, even if the delivery was cesarean. Baths should not be taken until healing is complete. The genital area should be washed from front to back. If the area is sore, using a spray bottle of water or taking sitz baths may be more soothing. Women should not douche until they ask their doctor about it at their first postdelivery visit.
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. Sexual activity should also be avoided for 6 weeks. The incision site should be cared for in the same way as other surgical incisions. Showering can typically be resumed 24 hours after surgery. Care should be taken not to scrub the incision site. Baths should be avoided until the wound is completely closed and any staples or sutures have been removed. The incision site should be kept clean and dry. Any evidence of increasing redness or drainage from the incision should be brought to the doctor’s attention. Pain around the incision site can last for a few months, and numbness can last even longer.
Abdomen
Normally, after 5 to 7 days, the uterus is firm and no longer tender but is still somewhat enlarged, extending to halfway between the pubic bone and the navel. By 2 weeks after delivery, the uterus returns to close to its normal size, and after 4 weeks, it usually returns to its normal size. However, the new mother’s abdomen does not become as flat as it was before the pregnancy for several months, even if she exercises.
Stretch marks do not go away, but they may fade, but sometimes not for a year.
Breastfeeding
Doctors recommend that women breastfeed without supplementing with other foods for at least 6 months. Then women should continue to breastfeed for another 6 months while introducing 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 for various reasons, bottle-feeding can be done instead.
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. 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. This maneuver can prevent the breast from being damaged and becoming sore.
When a mother breastfeeds, the breasts may leak milk. Cotton pads can be worn to absorb the milk, but plastic bra liners can irritate the nipples and should be not be used.
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. They 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 seafood, they should choose seafood that is low in mercury. See Mercury in seafood for more information.
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Family planning (birth control, or contraception)
Use of birth control is recommended when sexual activity resumes because pregnancy is possible as soon as the mother begins to release an egg from the ovary (ovulate) again.
Mothers who are not breastfeeding usually begin to ovulate again about 4 to 6 weeks after delivery, before their first period. However, ovulation can occur earlier.
Mothers who are solely breastfeeding tend to start ovulating and menstruating somewhat later, closer to 6 months after delivery. However, sometimes a mother who is breastfeeding ovulates, menstruates, and becomes pregnant as quickly as a mother who is not breastfeeding. Mothers who are breastfeeding should talk to their doctors about when to start using contraception.
Full recovery after pregnancy takes time. So doctors usually advise a new mother to wait at least 6 months and optimally 18 months before becoming pregnant again (although she may choose not to follow that advice). At her first doctor’s appointment after delivery, a new mother can discuss birth control options with her doctor and choose one that suits her situation.
A woman can start asking her doctor about birth control during pregnancy. Some forms of birth control can be started within a few days after giving birth. These forms include tubal ligation (permanent contraception) or placement of an intrauterine device (IUD). Whether a mother is breastfeeding affects the choice of contraception used. Birth control pills or contraceptive patches or vaginal rings that contain estrogen and progesterone can interfere with milk production and should not be used until milk production is well-established. Progesterone-only contraceptives, , progestin implants, or IUDs can be used, but methods that do not use drugs, such as condoms, a diaphragm, or some IUDs, do not interfere with breastfeeding. A diaphragm can be fitted only after the uterus has returned to normal, usually after about 6 to 8 weeks. Before that, foams, jellies, and condoms can be used.
A new mother (or any woman) who has just been vaccinated against rubella and/or chickenpox (varicella) must wait at least 1 month before becoming pregnant again to avoid endangering the fetus.
Women who have completed their family may choose permanent contraception. These surgical procedures involve cutting or blocking the fallopian tubes to prevent sperm from reaching the egg and fertilizing it.. These procedures can be done after the baby is delivered, when a cesarean delivery is done, or after the postpartum period (the 6 weeks after the baby is delivered). These procedures are considered permanent and irreversible.
