Body Changes in the Immediate Postpartum

SONY DSCToday’s post is all about the changes a woman’s body may undergo in the days immediately after giving birth.  A lot is happening in those early days postpartum—your body is beginning to heal from the incredible experiences of pregnancy and birth, your hormones are shifting, your body is gearing up to produce milk, you may be sleep deprived, you are getting used to a whole new little being that needs you 24/7, you and your partner are adapting, your daily life looks completely new, and much more.

Some of the physical changes that happen after birth may be surprising to some women.  It’s important to know what is common and how to manage these changes at home.  It is also good to know the reasons you’d want to call Health Foundations (of course, you can call or page us at any time if you have questions in the postpartum).

Physical changes for mama in the immediate postpartum

Tears and tender places

While many women do not experience tearing in childbirth, some women do.  Even if you did not tear, it is likely that your bottom (perineum, labia, vagina, anus) is sore from all the stretching and pushing it took to move your baby into the world.  It may sting to urinate for the first few days.

We recommend that women use a peri-bottle (a squirt bottle designed to help you clean your sensitive parts in the bathroom instead of toilet paper) in the days after labor.  You can use plain water (most women prefer to warm it up) or you can use sitz bath/postpartum herbs.

Icing your bottom can also help to ease the pain from tears and other tender places and reduce swelling, especially in the first 24 hours after delivery (heat can be used thereafter).  You can use an ice pack, or you can get some big pads wet, freeze them, and then place inside your underwear.

Sitz baths are also very helpful in soothing and healing tears and tender bottoms.  We encourage women to take at least one to three baths each day in the postpartum period.  Epsom salts and sitz herbs can do a lot to soothe your body as you recover.   You can even soak a hot washcloth or a pad in sitz herbs and place between your legs at times when you cannot bathe or in addition to bathing.

Arnica can promote healing.

Make sure you are getting enough protein during the early postpartum period, as it helps to repair and rebuild tissues.

After pains

Not all women experience after pains, but they can be surprising when they do occur.  The uterus shrinks in size by 95% in the first 6 weeks postpartum.  This process—called involution—occurs via uterine contractions, which are felt to different degrees by different women (some do not feel them at all).  After pains typically begin about 12 hours following the delivery, some may be just as strong as labor cramps for some women (especially with subsequent births).  Most after pains subside within 72 hours following delivery if not much sooner.

Do not use aspirin, though you may speak with your midwife about the use of ibuprofen or acetaminophen.  Hot rice packs or a hot water bottle over the low belly or low back can be helpful.  Warm baths can also be soothing. Frequent breastfeeding, keeping an empty bladder, and lying face down with a small pillow or towel under the low belly can also help.


Postpartum bleeding, called lochia, occurs for 2 to 6 weeks (or even longer).  Lochia is a shedding of the endometrium, or uterine lining, which was beefed up in pregnancy to provide nourishment for your baby, and the eschar, or scar tissue that builds over the placenta site.  Physical activity level and uterine tone affect how long women experience lochia.  We encourage women to rest A LOT in the postpartum, as bleeding increases with even moderate activity.  Bleeding is actually a good gauge of safe activity levels in the postpartum—if your bleeding increases, it is a sign that you’ve had too much activity in the prior days.  Lifting, pushing, and other physical activity can cause increased bleeding anytime in the postpartum period.  Don’t lift anything heavier than your baby and lay in bed as much as you can for the first couple of weeks.  We also encourage women to avoid stairs in the first week postpartum.

During the first days following birth, lochia is likely to resemble a heavy period.  We want our patients to call us right away if they pass a clot the size of a golfball or bigger (smaller clots are usually normal), soak more than two large menstrual pads in 30 minutes, or experience fever, foul smelling discharge, or severe abdominal tenderness.

After the first week or two, bleeding will begin to lighten and eventually stop (though it may take another month to stop completely).

To minimize clotting in the first few days, you can firmly massage your abdomen before standing up after a period of rest or wear an abdominal wrap (which has other benefits to your healing uterus). Be sure to keep your bladder empty.

Avoid tampons and use unbleached menstrual pads or adult diapers, especially in the early days.

It is important to keep consuming iron-rich foods in the postpartum, such as red meat, red beans, lentils, dark leafy greens, and dried apricots, figs, raisins, and cherries.

Aching Muscles

You may be surprised in the days postpartum that your muscles are sore—perhaps muscles in your arms, back and legs.  You may not realize that those positions that helped you through labor were a real workout for your body!  An herbal bath, rest, and perhaps a massage (from your partner or support person) in the days after birth can help soothe aching muscles.

Sweats and Shaking

In early postpartum, some women experience excess sweating or episodes of intense shaking. This is the result of the body’s effort to eliminate the extra fluids built up during pregnancy and because of hormonal shifts.  You may also find you are urinating more frequently than normal.  Sipping warm ginger tea, keeping the room temperature comfortable (try not to let yourself get cold, however) can help.  If you experience shaking, your partner can hold or massage you if that feels good.  If you have any other accompanying signs of illness, please call us.  These symptoms often resolve quickly when they are the result of normal postpartum changes.

Bowel Function

Because of hormonal changes, you may not have a bowel movement for 2 or 3 days following birth.  Do not be afraid to have a bowel movement, even if you had stitches (they will not tear out).  Make sure to keep hydrated and get enough fiber to avoid constipation.


Due to the pressure of a growing baby in the third trimester and/or the effects of pushing during childbirth, some women experience hemorrhoids, or swelling/protrusion of the anal tissues in the postpartum period.  Often hemorrhoids resolve on their own, though there are things you can do to help.  A high fiber diet, plenty of water, and taking a Calcium-Magnesium supplement (available at Health Foundations) can help women stay hydrated and avoid constipation, which is really key in healing hemorrhoids.  Witch hazel is useful in treating hemorrhoids (you can soak a compress and place them over the area.  There are also homeopathics, herbal balms and suppositories available to help you heal (you can speak to your midwife for details).

Do avoid over the counter laxatives and stimulating herbal laxatives (e.g. buckthorn and senna) if you are breastfeeding.

If you have any questions or concerns during the postpartum period, please do not hesitate to contact us.

Stay tuned for our post on breastfeeding in the early days and mood changes in the postpartum.

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