By Alanna Nunez
For many people, giving birth is magical, wondrous, and life-altering — and painful as hell. Your body goes through a lot during childbirth, so it’s hard to know what’s normal—no matter how many baby books you read or Google searches you do—until you experience it firsthand.
The truth is, some postpartum pain is completely normal for at least the first six weeks after you give birth, along with a few other unpleasant and surprising symptoms. That said, it’s important to listen to your body (and mind!) and stay on top of your health. I spoke to three expert OB-GYNs to find out what's actually expected postpartum, and when you should pay a visit to your doctor.
In addition to being fatigued (no surprise there!), you might also notice your boobs hurt or are engorged, says Alyssa Dweck, a New York-based gynecologist. Most likely that will subside as you start breastfeeding, but it can take some trial-and-error to find the perfect latch or position for you and your baby — after all, this is a new experience for both of you!
Uterine cramping is another one: once your body has realized that it no longer needs to push out a baby, your uterus will “contract, expel residual blood and fluid, and shrink back to its normal size over time,” Dr. Dweck notes. You may feel something akin to period cramps — this is pretty normal (if uncomfortable).
You’ll also probably also bleed on and off for a few weeks. It’s called lochia, and according to the Mayo Clinic, it’s your body’s way of shedding the mucus membrane that lines your uterus during pregnancy. It will probably resemble your period and initially be bright red in color, though it’ll eventually taper off into a darker brown. Most people find that it subsides around week six, though it can go up until about week 10.
However, while it may seem like a nonstop period, you shouldn’t be bleeding through more than two pads per hour, cautions Dr. Dweck. If you find that’s the case, call your doctor immediately.
In addition, “Bleeding that smells bad or starts to increase after it’s lessened is a symptom that something is going on that should be evaluated,” Heather Bartos, a Texas-based OB-GYN and author of Mindshift Medicine, notes. Keep an eye out for a fishy smell or other changes to discharge down there that could be an indication of a bacterial infection like BV.
if you had a C-section
You’ll want to keep a close eye on your scar, advises Mary Jane Minkin, OB-GYN and clinical professor of obstetrics, gynecology, and reproductive services at Yale. If it looks a little red, she recommends washing it gently with warm water. Don’t be alarmed if your scar initially looks angry and puffy (it’s normal for it to be a little sore for up to four to six weeks) but do watch out for a foul smell, discharge, or pain that worsens. “If it stays red and gets redder or you have a fever, call your provider,” Dr. Minkin adds.
if you had a vaginal delivery
Similar to C-sections, the signs you’ll want to watch out for with vaginal delivery are pain and fever, according to Dr. Minkin. Most people start to feel physically “normal” again around week six, though your mileage will vary, and what’s normal for your sister or best friend may not be normal for you.
the baby blues vs. postpartum depression
Regardless of how you delivered, there are two common postpartum changes that might impact you: the baby blues and postpartum depression. The symptoms of both are similar, but the first, which occurs in around 75 to 80 percent of people postpartum, is characterized by generally feeling down or depressed—Dr. Dweck says fatigue also contributes to this—and usually subsides within two or three weeks.
In contrast, depression that does not go away or worsens is usually a sign of postpartum depression (PPD). It’s normally accompanied by a severe loss of interest in activities you used to enjoy, a lack of appetite, feelings of being overwhelmed, changes in your sleeping patterns (usually a sudden inability to sleep, though some people find themselves suddenly so tired they could sleep all the time), and a lack of interest in your baby. It’s sometimes accompanied by anxiety and obsessive compulsive symptoms as well, Dr. Bartos adds.
PPD is common, impacting around 15 percent of moms. It’s also never your fault. If you’re worried that you may be experiencing PPD, tell your partner, friend, or a family member. While postpartum depression can be really scary, you definitely don’t have to live with it forever. It’s extremely treatable with talk therapy or medication. Don’t be afraid to reach out for help – it’s the first step toward feeling like yourself again.
when to call your doctor
Some water weight and swelling, especially in your hands and feet, is normal immediately following birth, Dr. Dweck says. However, this should dissipate quickly. Swelling that persists can be a sign of postpartum preeclampsia (characterized by high blood pressure and high levels of protein in your urine). According to the Cleveland Clinic, if you experience any of the below red flag symptoms, call your doctor immediately:
- Severe persistent headache that worsens
- Nausea or vomiting
- Blurry vision
- Swelling in your face, hands, or feet
- Fast weight gain
Again, postpartum preeclampsia is rare, but if it’s not treated quickly, it can be fatal. While it tends to come on quickly (between 24 and 48 hours after childbirth), it can also occur in the weeks after leaving the hospital, so if you’ve given birth in the past six weeks and experience any of the above symptoms, call your practitioner immediately.
Another red flag sign never to ignore: pain and swelling in your calf. Why? Thanks to changes in the way your blood clots during pregnancy, your risk of deep vein thrombosis (DVT) increases in the first three months after birth (for this reason, your doc may recommend you avoid certain types of birth control for at least three to four weeks after giving birth). Blood clots are often asymptomatic but can also be accompanied by the following symptoms, says the CDC:
- A shortness of breath
- Calf swelling
- An irregular heartbeat
- Skin that’s warm and tender to the touch
- Skin that’s red
- Chest pain
- Coughing up blood
A DVT is a medical emergency, so if you think there’s a chance at all this is what’s behind your symptoms, get help immediately.
the bottom line
There’s no way around it: pregnancy is intense even after the main event, and it’s normal to undergo some physical, mental, and emotional changes. Most likely, everything you’re experiencing is completely normal, but don’t hesitate to reach out to your doctor. In early 2018, The American College of Obstetricians and Gynecologists (ACOG) updated its official postpartum guidelines to recommend that people check in with their doctors around week three and that they have a comprehensive postpartum exam by week 12.
Your doctor will be able to walk you through any questions you have, so know that whatever it is you’re feeling or experiencing, you don’t have to suffer in silence.
Did you experience any of the above symptoms when you gave birth? What do you wish you had known about pregnancy and life postpartum before you went into labor?
Alanna Nunez is a writer and editor living in New York. Her work has appeared in or on Cosmo, Shape, Well + Good, Women’s Health, Prevention, and more. When she’s not baking or taking photos of her dog, she’s trying (and failing, most days!) to write her first novel.