During pregnancy, you focus on your health, your baby, and preparing for birth. What comes after birth is just as important, and often overlooked. Your body needs time to recover from nine months of pregnancy, labor, and the early demands of breastfeeding and caring for a newborn. Many postpartum changes are entirely normal, yet they are rarely discussed. In this episode, let’s change that. I will walk you through what to expect physically and emotionally in the weeks after birth, so you are not caught off guard. We will also cover the warning signs to watch for to help ensure your recovery is on track.

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The Fourth Trimester

The postpartum period is often referred to as the fourth trimester of pregnancy. The first three months after your baby is born can be one of the most significant adjustment periods in your life. This time is filled with healing, hormonal shifts, sleep deprivation, and the steep learning curve of caring for a newborn. While many people expect to bounce back quickly, the reality is that recovery often takes longer, and that is completely normal. Your birth, your body, your baby, and your circumstances will shape your experience. It is a significant transition, both physically and emotionally, and it is essential to know what to expect.

Your Hospital or Birth Center Stay

The length of your stay after birth can vary depending on where you have your baby and how you and your baby are recovering. If you give birth in a hospital, you will likely stay for one to three days, depending on whether you had a vaginal or cesarean birth. Birth center stays are typically much shorter, and you may go home the same day. With a home birth, you are usually caring for your baby on your own the same day. Every situation is different, so discuss the timeline with your care provider in advance to be better prepared for the transition to caring for your baby at home.

Postpartum Instructions

Your doctor or midwife should provide instructions for your care before you leave the hospital, birth center, or after a home birth. This typically happens just before discharge or once your midwife has completed your care at home. It is a good idea to have your partner or another support person present when your care provider goes over these instructions. Having someone else present ensures that important information is not missed and that your support person knows what signs to look out for. Postpartum instructions are often brief and may not cover all details. If you have any questions, please don’t hesitate to speak up. Always trust your instincts. If something feels off, contact your care provider. It is always better to ask early rather than wait, as catching a minor issue quickly can help prevent more serious complications.

Postpartum Visits

The American College of Obstetricians and Gynecologists states that postpartum care should be an ongoing process, with services and support tailored to each woman’s individual needs. ACOG recommends that all women contact their care provider within the first three weeks postpartum. This initial assessment should be followed up with ongoing care as needed, concluding with a comprehensive postpartum visit no later than 12 weeks after birth. The number and timing of your postpartum appointments will depend on your recovery and your care provider’s practices. If you feel the need to be seen sooner than scheduled, do not hesitate to ask. You should also have a way to contact your provider outside of regular office hours in case an urgent issue arises.

Up to 40% of women do not attend a postpartum visit. For many new moms, the idea of leaving the house with a newborn can feel overwhelming. It can be hard to pack everything you need and time the outing around naps, feedings, and diaper changes. Despite the challenges, prioritize attending these visits. Even if you feel well, it is reassuring to confirm that you are healing properly. It also provides an opportunity to discuss any physical or emotional issues you’re experiencing, receive support with breastfeeding, and address any concerns you may have about your baby.

Be Prepared for Medical Bills

Medical bills can be an unwelcome surprise in the weeks after birth. Between your insurance provider and any hospital or provider billing, it is normal to feel overwhelmed. If something does not make sense, ask questions. If you are concerned about the cost, ask about available payment plans. Many providers are willing to work with you to make bills more manageable. Insurance and medical billing can be confusing, so do not hesitate to advocate for yourself if something seems unclear. Understanding your coverage and determining whether you qualify for any tax deductions or savings can help alleviate your financial burden and prepare you for upcoming expenses.

Physical Recovery: What’s Normal

Many physical changes take place after birth, and some of them may catch you off guard. In the early weeks postpartum, you are already navigating healing from birth, caring for your baby, and adjusting to a new routine. The last thing you need is to wonder whether what you are feeling is normal or to struggle to find relief. Let’s discuss some of the most common physical changes you can expect after birth.

Lochia

After you have your baby, you will experience a vaginal discharge called lochia. This is made up of excess blood, mucus, and tissue from the lining of your uterus. Even if you have a cesarean birth, lochia is still part of the normal healing process. Bleeding is usually heaviest during the first three to ten days postpartum and gradually tapers off over the following weeks. You should not insert anything into your vagina during this time. Use pads instead of tampons or menstrual cups to avoid the risk of infection.

You may feel gushes of blood when breastfeeding due to the release of oxytocin, which causes your uterus to contract. This can also happen when you stand up after sitting or lying down. You may notice small clots which are perfectly normal. The color of lochia will change over time. It typically begins as bright red, then shifts to brownish-red or light pink, and eventually becomes white or yellow. If you notice your bleeding gets heavier after being more active, it could be a sign that you are overdoing it and need to rest.

Afterpains

After you give birth, you will likely experience postpartum contractions known as afterpains. These are most noticeable during breastfeeding, which triggers the release of oxytocin, the hormone that causes your uterus to contract. These contractions help minimize blood loss and support your uterus in returning to its pre-pregnancy size. The discomfort is usually temporary, with the most intense cramps easing within the first week.

Afterpains are often stronger with each subsequent birth. This is because the uterus has less muscle tone and must contract more forcefully to control bleeding. If the discomfort is bothersome, you can use any techniques that helped you during labor, such as deep breathing, visualization, or meditation. Holding and cuddling your baby can also be a wonderful distraction.

Healing an Incision or Tear

During birth, it is very common to tear your perineum. Research shows the rates of tearing with your first baby are 90% and decrease to 69% in subsequent births. According to the American College of Obstetricians and Gynecologists, the rate of some laceration during all vaginal births is between 53-79%.

If you have an episiotomy or a tear during birth, the wound will probably be sore for a few weeks, and this is especially true when you walk or sit. If the incision or tear is extensive, tenderness may persist for a more extended period. Fortunately, there are several steps you can take to alleviate your symptoms and promote healing. There is an in-depth episode on vaginal tearing, episiotomy, and recovery that goes into detail on healing.

If you do not feel that you are consistently healing, please bring this to your care provider’s attention. There is a condition called granulation tissue that occurs when the tissue becomes stuck in the healing process. If this does happen, your care provider can use remedies to speed up the healing process.

Hemorrhoids

Technically everyone has hemorrhoids, also called piles, and these are clusters of veins lining the lower part of your rectum and your anus. We refer to the condition of these being swollen (they are actually varicose veins) as hemorrhoids, and there are two types. Internal hemorrhoids are swollen veins in your rectum, and external hemorrhoids occur in your anus. Both can cause bleeding, but internal hemorrhoids tend not to be bothersome. External hemorrhoids can be very painful and can also come with itching and burning. People often described them as a small cluster of grapes, which is reasonably accurate. They tend to be soft and very tender.

Hemorrhoids are estimated to affect around 40% of pregnant women. Even if you escape your pregnancy without hemorrhoids, you could get them after birth. You strain during the pushing stage, very much like you would if you were trying to make a bowel movement. One study found that a significant predictor of hemorrhoids after birth is straining during delivery for more than 20 minutes. The pushing or second stage of labor typically lasts more than 20 minutes, especially for a first-time mom.

Going to the Bathroom

It is very common to feel nervous about having your first bowel movement after giving birth. Constipation is prevalent after using pain medications in labor. There is an episode of constipation with a breakdown of over-the-counter remedies. If you are concerned, taking a stool softener can help make things easier and more comfortable.

Some new mothers worry about irritating stitches or a sore perineum. If this is a concern, you can gently press a clean, flat cotton pad against the area for support while having a bowel movement. If you feel anxious about going to the bathroom, you are not alone. The anticipation is often worse than the reality. Most moms find it is not nearly as bad as they feared.

Soreness

Giving birth is an intense physical event that can leave nearly every muscle in your body feeling sore and strained. This general soreness usually improves within a few days. If you had a vaginal birth, you may also feel soreness in your perineal area. If you had a cesarean birth, you can expect some discomfort around your incision site. The most important thing you can do to support your recovery is to rest. If the soreness is bothering you, consult your healthcare provider about medications that are safe to take while breastfeeding.

Fatigue and Sleep

It is completely normal to feel exhausted after giving birth. Labor is one of the most physically demanding experiences your body can go through. In the early weeks, your baby is adjusting to life outside the womb and will not have a consistent sleep schedule. This can make it difficult for you to get the rest you need.

Adjusting your expectations around sleep can help you cope with the fatigue. Researchers consider a baby sleeping through the night to be six hours of continuous sleep. Many newborns, especially those who are exclusively breastfed, are not capable of sleeping even six hours at a time. While feeling tired is expected, it is essential to prioritize rest whenever possible.

The advice to sleep when your baby sleeps may not always be practical, but it is helpful, especially during the early days when your baby sleeps in short stretches. Even short naps can help support your recovery. Although you will be getting less sleep than usual, it is essential for both your physical healing and mental well-being.

Postpartum Hair Loss 

Many new moms fret about postpartum hair loss. Evidence shows that hormones can affect your hair’s growth cycle during pregnancy. The increase in estrogen lengthens the growth phase, resulting in less hair entering the resting phase or shedding. The less you shed, the fuller and thicker your hair seems during pregnancy. After your birth, as the estrogen levels drop and return to normal levels, the growth phase isn’t prolonged, and more of your hair than usual enters the resting or shedding phase. This typically occurs between 3 and 6 months postpartum. 

The technical term for this excessive shedding is postpartum alopecia. It may seem like your hair is falling out. It is more likely that you are shedding the hair you should have shed during your pregnancy. As you shed excess hair and new hair grows, it may seem like you have a lot of short hair. This can be particularly noticeable around your face. These newer hairs will grow out, and by 9-12 months postpartum, your hair growth cycles should return to normal. 

Breastfeeding Challenges

Breastfeeding is a significant part of your postpartum period and can be challenging as you and your baby navigate your breastfeeding relationship. We assume that breastfeeding will come naturally; if it does for you and your baby, that is fantastic. It certainly doesn’t feel easy for many new mothers. I recommend attending a breastfeeding support group in those early days and weeks. Also, seeking the help of a lactation consultant preventatively or as soon as you have trouble can make a world of difference. For more resources on breastfeeding, click here.

Some challenges with breastfeeding can be warning signs that something is not quite right. The earlier you address these issues, the easier it is to resolve them and continue breastfeeding without interrupting your milk supply. Minor problems, if left untreated, can quickly grow into more serious complications that may make breastfeeding more difficult or even lead to weaning before you are ready. Paying attention to early signs and getting support when needed can make a big difference in your breastfeeding experience.

Sore or Cracked Nipples

You may hear that breastfeeding is not supposed to hurt. Although it should not be painful, it is quite common to experience sore or sensitive nipples during the first few days. This part of your body is not used to such frequent stimulation. Soreness is often a sign of a poor latch. As with most breastfeeding challenges, it is crucial to correct the underlying issue rather than treat the symptoms. The sooner you address latching problems, the easier it will be to prevent more serious discomfort or nipple damage.

If your nipples become cracked or damaged, there are several ways to promote healing and get some relief. Because a baby’s sucking is often strongest at the beginning of a feeding, try starting on the less sore side. After each feeding, apply a saline solution (8 ounces of warm water mixed with ½ teaspoon of salt) for about a minute. Then, gently pat your nipples dry and express a few drops of breast milk to apply as a natural healing agent. Breast milk contains anti-inflammatory and antibacterial properties that can support healing.

When you are not nursing, allow your nipples to air out when possible. You can use mild soap once a day if your skin is chapped or cracked. Nipple cream can also provide short-term relief, but it should not be relied upon as a long-term solution. With proper latch correction and care, sore and cracked nipples usually improve quickly. If you need more support, the Kelly Mom blog offers helpful tips on Healing Tips for Nipple Cracks or Abrasions.

Plugged Ducts and Mastitis

Your breast contains many ducts that carry milk to your nipple. If one of these ducts becomes blocked, it may not drain properly, causing part of the breast to feel hard, swollen, red, or warm to the touch. This is known as a plugged duct. It often results from milk not being effectively removed, which can happen if your baby is not nursing well or if you become engorged. A poorly fitting or tight bra can also contribute by placing too much pressure on the breast. Choose comfortable clothing that does not restrict or compress your chest.

To treat a plugged duct, continue breastfeeding and try to empty the affected breast fully. Before nursing, use a warm compress or take a warm shower to encourage milk flow. Gently massage the area from the plugged duct toward your nipple while feeding to help release the blockage.

If a plugged duct is not resolved, it can progress to mastitis. This condition shares similar symptoms but often feels more intense, and may also include fever, body aches, and chills. Mastitis may develop into an infection, especially if bacteria enter through a cracked or damaged nipple. Treatment consists of the same steps used for a plugged duct, along with plenty of rest. Try to stay in bed and keep your baby close for frequent nursing. If symptoms worsen or a fever develops, contact your healthcare provider. They may prescribe antibiotics to treat an infection. Plugged ducts and mastitis are very similar, and an excellent article on Kelly Mom compares and explains the two.

In my most recent breastfeeding journey with my daughter, I got mastitis, which progressed into a full-blown abscess that landed me in the hospital. This was not a pleasant experience, and you can visit this episode if you would like to hear more about my experience and the lessons I learned from breastfeeding the second time around. It is critical to take great care of your health at any time, but definitely when breastfeeding, especially when mastitis is most common in the first few weeks. If you have anything you can do to strengthen your immune system, now is the time to do it. My go-to is AG1 and lots of rest.

Mental and Emotional Health

After having your baby, it is essential to be aware of how hormonal changes can impact your mental and emotional well-being. Hormone levels shift rapidly after birth. A significant drop in estrogen and progesterone can lead to chemical changes in the brain that may trigger mood swings. Hormones produced by your thyroid can also decrease suddenly, which may cause fatigue, low energy, or feelings of depression. Thyroid changes are common after pregnancy, and if you have a personal or family history of thyroid issues, it is a good idea to have your thyroid levels checked after birth. When you combine these hormonal shifts with sleep deprivation, physical recovery from birth, and the stress of caring for a newborn, it is the perfect storm to struggle with your mental health. Recognizing that these changes are common and treatable can help you determine when to seek support.

Baby Blues

Many new mothers will experience what is often referred to as the “baby blues” after their baby is born. The baby blues include mood swings, crying spells, anxiety, and difficulty sleeping. Other signs include sadness, irritability, feeling overwhelmed, reduced concentration, and decreased appetite. The baby blues are estimated to occur in about 50% or more of women. Some studies indicate a prevalence of nearly 80%. The baby blues typically begin within the first two to three days after birth. The good news is that it disappears quickly, within one to two weeks. 

Postpartum Depression

One in seven new moms will experience a more severe, long-lasting form of depression known as postpartum depression. 40% of mothers who experience postpartum depression will have an onset after birth. Postpartum depression can be mistaken for the baby blues at first, but the signs and symptoms will be more intense and last longer. Eventually, it can interfere with your ability to care for your baby and handle other daily tasks.

If you’re bummed out after your baby’s birth, you may be reluctant or embarrassed to admit it. Don’t be! It is essential to know that baby blues and postpartum depression are not due to anything you did wrong; they are birth complications. Many women struggle with some signs of depression, and very few openly talk about it. If you experience any symptoms of baby blues or postpartum depression, contact your care provider. Getting help early can make it easier to manage your symptoms and allow you to return to feeling like yourself and enjoying your baby sooner. Learn more about the baby blues and postpartum depression in this episode.

Body Image in the Postpartum Period 

Many new mothers are surprised to find that they still look pregnant after giving birth. While you do lose a significant amount of weight at birth, it is entirely normal for your body to take time to adjust. There is often a strong cultural focus on returning to your pre-pregnancy weight, and it can be challenging to cope with the physical changes that remain after birth.

Your primary focus during the postpartum period should be on your health and your baby’s well-being. This is a significant life transition, whether you are a first-time parent or adding to your family. It is easier to navigate this time with grace and confidence when you are not overly preoccupied with your appearance. If healthily reaching your pre-pregnancy weight is a goal for you, that is completely valid. If it’s not your priority right now, that’s also okay. It took nine months to grow your baby, and it is unrealistic to expect your body to change overnight.

A review that included 19 studies looked at body image and how it affected postpartum depression. The majority of studies found that body image dissatisfaction is consistently but weakly associated with the onset of prenatal and postpartum depression. Some studies even looked at the reverse and found that depression contributed to negative body image. It makes sense that when you are unhappy with your body, it can affect your mood. Remember how hard your body has worked to build and birth a human, and have patience with the recovery process.

When to Contact Your Doctor or Midwife

Your care provider is trained to recognize signs of more serious postpartum complications, but they are not with you around the clock. That means you are the one who will notice the first signs that something may not be right. It is important to follow any instructions given at discharge, but also to trust your instincts. If something feels off, reach out to your doctor or midwife. Even if it turns out to be nothing, you will have peace of mind knowing you checked in.

There are a few red flags that always warrant a call to your doctor or midwife. Signs of infection can include fever, flu-like symptoms, swelling, vomiting, or pain that worsens instead of improves. If you experience anything that doesn’t seem right, please speak up. It is better to ask and find out if everything is okay than to ignore a symptom that could become more serious.

Postpartum hemorrhage is another condition to be aware of. This refers to heavy bleeding, most commonly within the first 24 hours after birth, but it can also happen up to six weeks later. Though relatively rare, it is the leading cause of maternal mortality worldwide. If you are soaking a pad in less than an hour, passing large clots, or experiencing blurred vision, faintness, chills, nausea, pale skin, or swelling or pain in your vaginal area, contact your provider immediately or call 911.

When it comes to your recovery, you are never overreacting by asking questions or getting help. You deserve support, and catching something early can make all the difference.

The fourth trimester is a time of incredible change, and while it may feel overwhelming, knowing what to expect can help you feel more confident and supported. From physical healing and breastfeeding challenges to mental health and body image, this is a reminder to be gentle with yourself and reach out for help when you need it. In the next episode, we will shift gears to discuss how to prepare ahead of time to make your recovery and transition to motherhood as smooth as possible.

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