Recovery After Birth

Key Messages

Download and Print the Key Messages
These are the main health messages that should be conveyed to all future and new parents. They have been written in the second person and at a reading level appropriate for the general public so that they can be shared with them directly. They are based on a consensus founded in scientific research and professional practice. Clicking an underlined word or group of words in the text will redirect you to the section in Supporting Evidence that deals with that topic.
key message

After you give birth, your body undergoes a number of normal changes.

It will take time for your body to return to its normal state. It is important to be patient and have realistic expectations of what your body will look like and what it will do after the birth.
Whether you had a vaginal or caesarean birth, you can expect the following changes:

  • Your uterus contracts and returns to its almost pre-pregnant size and shape.
  • The lining of your uterus is shed as a bloody discharge called lochia. This will lighten in colour and decrease in amount over the next six weeks.
  • Breastmilk production will gradually increase as it changes from colostrum to mature breastmilk.
  • If you had a vaginal birth, your perineum (i.e., the area between the vagina and anus) gradually becomes less swollen and tender. If you had stitches, the area heals, and the stitches dissolve.
  • If you had a caesarean birth, the incision heals and the stitches inside dissolve. If your skin was closed with staples, they will be removed by your health care provider. If your skin was closed with stitched, the stitches will dissolve.
  • Your hormone levels stabilize.

key message

Plan to see your health care provider within six weeks after the birth to make sure that your body has healed well.

If you have any concerns about your health before your six-week visit, you can contact your health care provider earlier or speak with a public health nurse. If you have not talked about resuming sex and your options for birth control, you may want to have this discussion during your six-week visit.
If you have a midwife, they will visit you and your baby several times during the first week and then regularly until six weeks after the birth.

key message

You may experience some discomforts as your body recovers from the birth.

In the postpartum period, you may experience some discomfort or concerns including:

  • Breast tenderness as your milk comes in.
  • Abdominal cramps as your uterus returns to its normal shape and size.
  • Lochia (i.e., the vaginal discharge which can last up to six weeks).
  • Swollen, bruised, or tender perineum especially if you had a tear or an episiotomy (i.e., a cut or incision between the vagina and anus at the time of the birth).
  • Pain at the incision site if you had a caesarean birth.
  • Trouble urinating or having a bowel movement.
  • Feeling tired and having a difficult time getting enough rest.
  • Changing emotions because of fatigue and changing hormone levels. Postpartum blues (i.e., baby blues) are experienced by four out of five women.

Contact your health care provider if:

  • You pass blood clots larger than a plum, soak a pad an hour, or you think you are bleeding more than what is normal.
  • The caesarean incision or the stitches in your perineum start to open.
  • You have yellow or greenish discharge from your stitches or vagina.
  • You have foul-smelling vaginal discharge.
  • You don’t think the tissues are healing properly.
  • You have a fever greater than 38o Celsius or 100.4o Fahrenheit.
  • You have flu-like symptoms.
  • You have pain that is not relieved by your pain medication.
  • You have a severe headache that is not better after taking pain medication.
  • You have spots or stars before your eyes, dizziness, and/or sharp upper abdominal pain.
  • One or both of your legs becomes very painful and swollen.
  • You cannot urinate or are having burning or pain when you urinate.
  • You cannot have a bowel movement.
  • You have a red, hot, or swollen breast, or a sore, hard, red or painful area on the breast.
  • The postpartum blues last longer than two weeks.

If you are not able to speak with your health care provider, call Telehealth Ontario at 1-866-797-0000 to speak to a Registered Nurse. This service is available in English and French with translators available for other languages. It is available 24 hours a day and seven days a week.
Call 911 if you have trouble breathing, shortness of breath, chest pain, or a racing or irregular heart rate.

key message

Learn more about recovery after birth.

You can find out more about recovery after birth from the following resources. More suggestions can be found in the Resources and Links section. For information about postpartum mental health concerns see the Mental Health file.

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Supporting Evidence



The supporting evidence is written in third person and is aimed at prenatal education providers. It is not intended to be shared directly with new and expectant families; it is meant to provide the background information and evidence for the key messages.

About Recovery after Birth

Defining recovery after birth

The first six weeks after a vaginal or caesarean birth is known as the postpartum period, sometimes called the puerperium. During this time, the bodily changes that occurred return to the pre-pregnant state. This means that the uterus continues to contract and shrink; the placental site heals as the lochia diminishes; lactogenesis 2 follows lactogenesis 1 as the breasts begin copious milk production; the vaginal, perineal, and abdominal incisional tissues heal as sutures dissolve, and hormone levels change.1,2,3,4

Additionally, lactogenesis 2 follows lactogenesis 1 as the breasts begin copious milk production.

It is important to advise a new mother to expect to see her health care provider within six weeks after the birth to ensure that her recovery is normal. Women who were under the care of midwives or family physicians will see their caregivers sooner for ongoing mother-baby assessments. If she experiences any abnormal physiologic findings such as heavy bleeding, fever, leg swelling, headache, or urinary symptoms, a woman should seek medical attention sooner. 4,5

Physical Changes

Uterus

After the birth of the placenta, the uterus is still the size that it would be at 20 weeks of pregnancy. It continues to become firmer and over time shrinks to stop the flow of blood from the healing placental site and eventually it is only slightly larger than it was pre-pregnancy. 1,2,3,4

Normal uterine involution

Immediately after birth, the top of the uterus, or the fundus, is at the level of the umbilicus. The uterus quickly reduces in size, and uterine involution is determined by palpating the fundus and establishing its position in relation to the umbilicus. The uterus is expected to contract down by one fingerbreadth each day and by day 12, it cannot be palpated.

Conditions that can affect normal uterine involution include inadequate emptying of the bladder and/or having retained placental fragments. This latter condition can lead to postpartum hemorrhage or developing an infection of the uterus known as endometritis. 1,2,3,4

Contractions or afterpains

Many women experience discomfort with uterine cramping in the postpartum period. Some women experience painful cramps for a week or two. Women who have had more than one pregnancy are more likely to experience stronger afterpains. 1,2,3,4 Reassure mothers that afterpains are the body’s normal mechanism to involute the uterus thus decreasing the risk of bleeding and infection.

To promote comfort women can use relaxation or deep breathing, take warm baths, and use heating pads or hot-water bottles. Pain medications can also provide relief, and women can be encouraged to use over-the-counter (OTC) medications, suggested by their health care providers, to manage the pain. If a prescription medication is being used, ideally it should not contain codeine since this drug can make babies sleepy. 6 Since breastfeeding stimulates the release of the hormone oxytocin which stimulates uterine contractions women may find it more helpful to use pain relief options prior to breastfeeding. 1,2,3,4


Lochia

Lochia is the name of the bloody vaginal discharge after the birth. It consists of blood, mucus, and tissue from the uterine lining. As the uterus contracts, the placental site is closed off and heals over the course of four to six weeks. The normal shedding of the lining of the uterus is integral to uterine healing.

Lochia is normal with both vaginal and caesarean births. Some women may have less lochia with a caesarean birth. The discharge normally starts as a bright-red flow, like a period, and may contain some small clots no bigger than grapes or dimes. 1,2,3,4

After a few days, the colour of the discharge changes to a pinkish-red or brownish-red and may decrease in amount. 1,2,3,4 At about 10 days, the flow may be a pale pink colour and then it then changes to a whitish-yellow colour. The amount gradually decreases over the next several weeks; however the lochial discharge can last up to six weeks. 1,2,3,4

The vaginal discharge may become red again for a short period during or after breastfeeding since breastfeeding causes mild contractions of the uterus. Some women get bright-red blood again after becoming more physically active. 1,2,3,4

Managing lochia

Women should use good perineal hygiene during the time that lochia is present and should only use sanitary pads, not tampons or menstrual cups, to catch the flow. While lochia is present, the perineal area should be cleansed with warm water from a squeeze bottle after each voiding and wiping should be done from front to back. Women should change the sanitary pad every time they void or have a bowel movement. 1,2,3,4

Heavy bleeding

Women should call their health care provider if the lochia becomes heavy, and they are soaking a pad an hour, or passing clots the size of a plum or larger. These are signs of a postpartum hemorrhage; if not treated, this could be life-threatening. 1,2,3,4


Breast changes

The breasts undergo a number of changes in the postpartum period whether the woman plans to breastfeed or not.7,8

Lactogenesis

Lactogenesis 1 is the initial secretion of colostrum; Lactogenesis 2 occurs two to four days after the birth with the copious secretion of breastmilk. Lactogenesis 2 is often referred to as the “milk coming in,” and is a time when many women experience discomfort as the breasts can become quite full and swollen. Breast fullness can last a couple of days and will diminish as the milk production becomes more regulated to the infant’s needs. Since the baby can have a growth spurt about every three weeks or so, mothers can expect to experience breast fullness due to the increase in milk production at these times. 1,2,3,4,7,8

Fullness/engorgement

Normal breast fullness that improves with infant feeding is not the same as breast engorgement. Engorgement is a pathological condition in which the breasts become hot, swollen, hard, and very painful. 1,2,3,4

The following strategies can help relieve breast fullness and prevent breast engorgement in the first few days:1,2,3,4

  • Support mothers to identify and respond to feeding cues soon after birth.
  • Encourage frequent feedings, at least eight times in 24 hours to establish a good milk supply.
  • Avoid giving any supplemental feedings unless there is a medical need for them.
  • Ensure the baby is feeding well.
  • Encourage skin-to-skin care.

If breasts become so full or swollen that it is difficult to latch the baby:

  • Prior to feeds, massage, or manually express the breasts to help the milk to flow. Manually express the breast to soften the areola to make it easier for the baby to latch, especially if the breasts are full. Warm compresses applied to the breasts before massage is comforting and can improve milk flow.
  • Ensure the infant is well-latched and feeding well. The mother should hear the infant frequently swallowing during the feed.
    Encourage women to offer both breasts at each feeding. If the baby does not feed on the second side, the mother can manually express for a few minutes to make it more comfortable.
  • Encourage mothers to wear a supportive bra that is not too tight.
  • Apply ice packs or cold compresses after feeds to help to reduce any swelling and/or pain.
  • Offer support and advise mothers to seek help if things are not improving with the engorgement or infant feeding. The most important thing is to feed the baby. Mothers can express their milk and feed it to their babies with a small cup, spoon, or bottle if necessary.
  • If the mother develops signs of mastitis, which includes localized or generalized breast pain, redness, heat, red streaking in the breast, along with fever and flu‐like symptoms, she should seek medical help immediately.

Women may also experience nipple tenderness with breastfeeding, and it is important for the breastfeeding mother to have reliable breastfeeding resources and assistance. This may include their family physicians or midwives, a breastfeeding clinic, in-home assistance through the Public Health Department, or through a peer support group such as La Leche League. 5,7,8 Please see the Breastfeeding file for more information about engorgment.

Mothers who are not breastfeeding

Lactogenesis2 will start to occur regardless of a woman’s intention to breastfeed or not. There are some simple interventions to offer women who choose not to breastfeed to increase their comfort level. In the past, medications and herbal remedies were used to attempt to “dry up the milk” but these have not proven to be effective. Physicians and midwives do not prescribe any medications to stop Lactogenesis. 2,7,8

Women may find it helpful to do the following: 7,8

  • Wear a supportive but non-stretchy bra.
  • Apply ice packs or cold compresses to breasts frequently.
  • Avoid the application of hot packs or hot compresses as this encourages swelling and more discomfort.
  • Take pain medication as recommended.
  • Express small amounts of milk to relieve the discomfort associated with engorgement. Expressing small amounts of milk should only be done for a few minutes.
  • Be patient as it takes a few days to a few weeks for the milk to dry up.


Perineum

The perineum may be sore, swollen, and bruised from the birth. Women might have stitches in the perineum if they had a tear or an episiotomy. The stitches usually dissolve around two to four weeks, and the tissues heal over six weeks. It is normal for women to find small pieces of the sutures on their pads or in their underwear as the stitches dissolve. 1,2,3,4

Women may find relief from perineal pain and swelling by: 1,2,3,4

  • Applying ice packs to the perineal area for the first 24 hours. Ice packs and cold compresses should be removed after 10 – 20 minutes and reapplied every hour as needed.
  • Ice packs should be wrapped in a towel or facecloth and not applied directly to the skin.
  • Women can use cold compresses, a bag of ice or frozen veggies, or a frozen, water-soaked maxi pad or baby diaper to place in their underwear.
  • Resting as much as possible.
  • Letting the perineum air-dry while resting.
  • Using a pillow or an inflatable ring when sitting. Inflatable rings are available at most drugstores.
  • Soaking the perineal area in warm water a few times a day and after bowel movements. A sitz bath filled with a few inches of water and placed on the toilet seat is convenient. Sitz baths can be purchased at the drug store or home health store. If a woman is using her bathtub for perineal soaks, she should have it cleaned first and ensure that someone is present to help her in and out of the tub for the first few times.
  • Taking OTC pain medications recommended by her health care provider.

Pain that is not improving, or stitches that are opening or oozing are situations where the women should contact her health care provider. 1,2,3,4

Perineal hygiene

It is important to keep the perineal and anal area clean by always wiping carefully from the front to the back after urinating or having a bowel movement. Women can use a squeeze bottle with warm water to clean the vulva and perineum. Wipes or hemorrhoid pads can be gentler than toilet paper. Using soft, undyed, unscented toilet paper is preferable. 1,2,3,4

Having a sitz bath can help provide hygiene after having a bowel movement. 4


Urination and bowel function

Return of normal bladder function

As hormone levels stabilize, it is normal to have increased urination; this occurs as the body eliminates extra fluids that have been stored in the circulation to supply the placenta. Extra fluids may be seen as swelling in the feet and legs. As the swelling decreases, urination will increase to eliminate the fluids. 1,2,9

For the first few days after birth, it may be difficult to initiate urination due to swelling of the perineum, a tear near the urethra, or having had a urinary catheter. 1,2,9

Some women find it helpful to do the following to return to normal bladder function: 1,2,9

  • Turn on the taps while attempting to urinate.
  • Urinate while in the shower.
  • Squirt warm water over the vulva and perineum.
  • Ensure good pain management to decrease perineal pain.
  • Place ice packs on the perineum to reduce perineal swelling.
  • Try to avoid constipation and prolonged pushing.

If there is perineum stinging or pain while urinating, this can be alleviated by the woman drinking lots of fluids to dilute the urine and by squirting warm water over the area when urinating. 3

If a woman has any of the following symptoms, she should see her health care provider to ensure she does not have a urinary tract infection or postpartum urinary retention. 1,2,9

  • Urinating in very small amounts.
  • Increasing urinary frequency.
  • Having a slow or an intermittent stream of urine.
  • Painful urination or pain in the bladder.
Urinary incontinence

The pelvic floor muscles are stretched during pregnancy and childbirth, and the muscles surrounding the urethra can be weakened. It is common for women to have a small leakage of urine when they sneeze, cough, or laugh. Women should be encouraged to urinate at least every three to four hours.1,3,4,

Kegel exercises are simple exercises that strengthen and tone the pelvic floor muscles. A 2010 Cochrane Review supports the use of pelvic floor muscle training as first line of treatment for urinary incontinence and recommends that pelvic floor strengthening be taught by a physiotherapist using techniques that include internal assessment. 15 It can be difficult for women to know if they are doing Kegel exercises effectively, and proper performance can be confirmed by vaginal examination and/or biofeedback. 16

Return of normal bowel function

Many women will not have a bowel movement until two to three days after birth since the abdominal muscles have stretched and are less effective, and many women have had decreased food and fluid intake during labour. It is important to increase fluids and eat high-fibre foods to avoid constipation and painful bearing down for a bowel movement. 1,2,3,4

Bowel movements should be formed stool that is soft and easy to pass. It may help to take OTC stool softeners or bulk-forming laxatives to make the first bowel movement easier to pass. Women need to be aware that they have to increase their fluid intake when taking bulk-forming laxatives. 1,2,3,4

Women should talk to their health care provider if they are unable to have a bowel movement. 1,2,3,4

Hemorrhoids

Hemorrhoids are swollen veins around and in the rectum that often appear during or after the birth. They can be quite painful and itchy and may bleed during a bowel movement. To reduce the discomfort of hemorrhoids, women can use any of the perineal comfort measures along with applying witch hazel soaks or OTC products such as hemorrhoid wipes to the anal area. Having soft and easy-to-pass bowel movements helps reduce discomfort as well. 1,2,3,4


Abdominal incision

Care of the incision

Women who have had a caesarean birth will be given instructions as to whether they need their stitches or staples removed. Stitch or staple removal is usually done a few days after the caesarean birth either at the hospital, in the health care provider’s office, or during a midwife home visit. Some women will have dissolvable stitches that do not require removal. The incision may have small pieces of tape on it which can be removed in the shower after a few days. 1,2,3,4

The incision should be left to air dry and not covered with a dressing unless instructed to do so.

Any redness, swelling, opening or gaping of the incision or discharge from the incision should be reported to the health care provider. 1,2,3,4 Tissues take about six weeks to heal from any surgery. 1,2,3,4

Pain management

Women who have had a caesarean birth will be discharged from the hospital with pain relief instructions and often a prescription for pain medication. It is important for women to take their medication as needed since controlling their pain makes them more comfortable moving around and caring for themselves and their babies. It can be normal for some women to feel numbness around their incisions for a period of days to months. 1,2,4


Fatigue

Recovering from birth

Recovering from a vaginal or caesarean birth takes about six weeks. Women need to give themselves permission to rest and take the time to relax. They can gradually increase their activities, however, in the first few days and weeks most of their time will be spent on taking care of themselves and their babies. 1,2,4

Women should plan to see their health care provider at six weeks after the birth to ensure that they are making an appropriate physical recovery and to ensure there are no mental health concerns such as postpartum depression (PPD) or anxiety. If women have concerns about their health, they should be encouraged to contact the health care provider sooner. 1,2,4

Rest

Women often feel very tired with the demands of a new baby and the need for their body to heal. It is important to encourage new mothers and families to rest as much as possible and to sleep when their baby sleeps. Since babies need to feed at least every two to three hours, there is no opportunity for women to have long stretches of uninterrupted sleep. Having frequent rest periods during the day may help to decrease the fatigue experienced when parents have a limited amount of sleep and are up at night tending to their babies.

Some strategies to help encourage rest are: 2,3,4,7

  • Asking friends and family members to help with food preparation, housework, and childcare.
  • Purchasing prepared food and housekeeping services.
  • Placing a sign on the front door stating that mother and baby are resting.
  • Discouraging long visits from friends and families.
  • Limiting visitors to certain times of the day.
  • Encouraging visitors to bring a meal the family can use later.
  • Planning for only one outing or activity per day. In the first few weeks, this may be a doctor or clinic visit.
  • Having a baby change area on both floors if there are stairs in the house.

Women who have had a caesarean birth should not lift anything heavier than the baby for the first six weeks to encourage healing of the abdominal incision. 2,3

Activity

Our popular culture and the media tend to promote and exalt celebrities who have achieved their pre-baby bodies in record time. These are unrealistic goals for the majority of women. 10

It is recommended that women limit activity and increase rest particularly for the first few days to weeks postpartum in order to recover from the birth. However, women can be encouraged to spend short periods of time engaged in some movement to encourage a slow and gentle return to activity. 1,2,11

Women can engage in the following activities.1,2,11

  • Have a short walk around the block or a shopping mall with the baby in the stroller.
  • Do Kegel or pelvic floor exercises.
  • Begin gentle abdominal exercise such as pelvic tilts.

Women should follow directions from their health care provider about increasing their activity slowly. A gradual return to the pre-pregnancy activity level is important as the first three months after birth is a time when the ligaments and joints may still be less stable due to the effects of the hormone relaxin. Women should avoid activities such as weight lifting and high-impact sports that put a strain on the ligaments and joints. 2,3,11

If a woman was accustomed to a high level of exercise before pregnancy and she continued her physical activity level during the pregnancy, her body may recover more quickly. She should still take the initial return to exercise slowly since that will decrease the likelihood of sustaining injury. 11

Women may be interested in information on postpartum exercise programs that can be done with their babies. This is a great way to get out of the house, get fit, and meet other mothers. 2,4


Nutrition

Losing the baby weight

After birth, women usually lose about 4.5 – 7 kg or 10 – 15 lbs from the combined weights of the baby, the placenta, and loss of blood and fluid. They may retain fluids and notice that their legs and feet remain quite swollen. Excess fluid is stored in the tissues and will be reabsorbed and lost in more frequent urination over the following three weeks. 1,2,3,4

After the six-week visit with their health care provider, women may begin to watch their calorie intake and use strategies to slim down. Just as weight gain in pregnancy was slow and steady, weight loss will likely be the same and the total weight loss may take up to a year. This rate of weight loss depends on a woman’s individual metabolism, activity levels, body types and food choices. Breastfeeding uses 500 calories per day so breastfeeding mothers may notice a quicker weight loss than mothers who do not breastfeed. 1,2,3,4,7 The recommended weight loss is no more than or 0.45 kg or 1.0 lb per week.

Women who are overweight or obese, or those who are underweight, should speak to their health care provider about their individual weight loss or management plans. 1,2,3,4

Nutritious eating

Just like in pregnancy, it is advisable for women to eat a variety of healthy foods with an emphasis on whole grains, fruits and vegetable, lean protein, adequate sources of calcium, and good fats. Women should make their calories count and try to limit or avoid eating foods that supply calories with no nutrition, foods that are highly processed, and foods high in salt. 2,3,4

With the demands of the new baby, there may not be a lot of time for food preparation. Many frozen or prepared meals can be high in fat and sodium. However, there are stores that sell healthier versions of these meals. Fresh fruits and vegetables can be purchased already cut up and ready to eat. A less expensive alternative is frozen fruits and vegetables that are also high in nutrition. The new parents can suggest that friends and family members bring home-cooked meals and prepared foods on a regular basis. 2,3,4

Most new mothers will find snacking and eating smaller meals more time-efficient as they manage to care for themselves and their baby in the first few weeks. Women should be encouraged to drink plenty of water. 7For more information on nutrition during breastfeeding, refer to the Breastfeeding file.

Women should be encouraged to continue taking a multivitamin after the birth, since there is still a need for iron and folic acid supplements if they are breastfeeding.12 Health care providers may also encourage them to increase their intake of iron-rich foods such as meat or legumes or take iron supplements. 7,8


Postpartum Sexuality

Fertility

Women may be advised to delay having sexual intercourse or vaginal penetration until there has been sufficient healing of the tissues, and there is no more lochia. This usually takes place four to six weeks after the birth.2,3,4 Women may wish to discuss options for birth control with their health care provider prior to resuming sexual activity.

It may take women one to four months or longer for the return of menses. Breastfeeding can delay the return of menses for several months. Women should know that they may still ovulate and get pregnant before their period returns if they are having sexual intercourse. Some women may choose to not use birth control and try for another pregnancy while other women will delay a subsequent pregnancy for personal or health reasons. It is recommended that women space their pregnancies at least 18 months apart to reduce the incidence of having adverse perinatal complications such as preterm labour and infants with low birth weight. 13 Women who have had infertility or required assisted reproductive technologies to achieve pregnancy may spontaneously conceive more easily after a pregnancy. 1,2,3,4

It is important to discuss issues of fertility control with all women in the postpartum period. 1,2,3,4

Birth control

If women are having sexual intercourse and do not want to get pregnant right away, they must use birth control even if they breastfeeding.
There are many methods of birth control to choose from, and women who are breastfeeding are advised to use the following: 1,2,3,4

  • Barrier methods such as condoms.
  • If women used a diaphragm in the past, she should have it re-fitted at the six-week visit since the size may change.
  • Intrauterine devices, including the levonorgestrel-releasing intrauterine system.
  • Progesterone only pill. The combined oral-contraceptive pill is not recommended as it may interfere with lactation.
  • Injectable progesterone contraceptives.
  • Tubal ligation for women or vasectomy for men.
  • Lactational Amenorrhea Method (LAM). The Lactational Amenorrhea Method is 98 percent effective only if there is complete amenorrhea, the woman is fully or very nearly fully breastfeeding with spacing between feeds being less than six hours at night and four hours during the day and the infant is no more than six months old. 14

Birth control methods that are suitable choices for women who are not breastfeeding include all those for breastfeeding women in addition to the use of combined estrogen and progesterone oral contraceptives or hormonal ring-type inserted methods. 1

Body image and sexuality

The changes and functions of the body during pregnancy and postpartum may affect or alter a woman’s image of herself as a woman and sexual being. 1,2,3,4

Many women are surprised with their postpartum bodies. Initially, the abdomen may be distended and flabby, breasts may be swollen and leaking milk, the perineum or abdominal incision may be tender, and if women are breastfeeding, the lack of estrogen makes the vaginal tissue drier and more sensitive. It is important to reassure women that it takes time to return to the pre-pregnancy weight and state, and women should not judge themselves for anything other than just having given birth. Some women will end up with slightly wider hips, a larger waistline, and a softer abdomen as normal permanent changes after childbirth. 1,2,3,4

The Western cultural ideal that all women can become slim and svelte once their baby is a few weeks old is an inaccurate and unachievable goal for the majority of women. Again, it is important for women to have realistic expectations about changes in their bodies related to structure, function, and hormonal influences.

Sexual activity

New mothers may be unsure or not interested in resuming sexual activity with their partners for a number of reasons. 1,2,3,4

  • They may be exhausted from interrupted sleep and constantly meeting the demands of a newborn.
  • Hormone levels are fluctuating and may cause women to feel sad or become easily upset, especially in the first few weeks. These feelings can also be exacerbated by fatigue.
  • They may be worried that vaginal penetration will be painful.
  • They may be worried that the vagina is stretched and is not tight anymore.
  • Women who are having sexual intercourse may be worried about becoming pregnant again.
  • They may be worried that their partner is not aroused by their postpartum body.
  • They may worry that their baby will cry and interrupt during sexual activity.
  • They may be concerned that their breasts will leak during sexual activity.

It is important to encourage women to speak to their partners about their concerns relating to sexual activity and intimacy. They can explore other ways of sharing intimacy, including kissing, cuddling, and fondling. 1,2,3,4

When the couple is ready to resume sexual activity that involves vaginal penetration, it is helpful to: 1,2,3,4

  • Wait until the stitches have healed, and there is no more lochia.
  • Wait until the woman feels emotionally ready.
  • Consider birth control if the couple is having sexual intercourse and not planning to get pregnant right away.
  • Use positions where the woman can have some control over the depth of penetration.
  • Use a position where there is no pressure on the abdomen for women who had a caesarean birth.
  • Use generous amounts of a water-soluble lubricant in the vagina.
  • Choose a time when the infant is less likely to wake (e.g., right after a feed).
  • Wear nursing pads and a bra if the woman is uncomfortable with the possible leakage of milk.
  • Keep a sense of humour and remember that things don’t always work perfectly the first time!

If women repeatedly experience pain or discomfort during vaginal penetration or sexual intercourse, they should see their health care provider. 2,3,4

Emotional Changes

Hormonal Changes

As the hormone levels stabilize, the body attempts to excrete excess fluids by sweating and increasing urination. Women can reduce the discomfort and inconvenience of excessive sweating by: 1,2,3,4

  • Drinking more fluids to replace what they lose.
  • Wearing lightweight clothes for sleeping.
  • Keeping a fan near the bed.

Women many also find that there are hair and skin changes associated with the postpartum period. There can be noticeable hair loss since the normal rate of hair loss, which is about 100 a day, is much slower in pregnancy. This hair loss will stabilize in the first few months postpartum. 1,2,3,4 Women who developed skin changes such melasma  (the darkening of the skin on the forehead and cheeks)or who had acne during pregnancy will notice that these improve. It is common for women to experience dry skin and dry hair for a few weeks. 2,3,4


Postpartum Mental Health

Postpartum moods

During the postpartum period, women may experience a variety of conflicting emotions such as feeling happy one minute and overwhelmed the next or feeling energetic some of the time and exhausted other times. Women may feel teary or sad for no reason. There can be changes in sleeping or eating patterns. This stage is referred as the baby blues and usually occurs within a few days after birth and passes by two weeks. Baby blues are hormonal in nature. 2,3,4

Baby blues are experienced in some form by four out of five (i.e., 80 percent) of mothers. The baby blues usually subside without any treatment. 2,3,4

During this time, new mothers can be encouraged to ask their partner, family, and friends for needed support with housework, limiting visitors, or taking the time to listen to her concerns. 1,2,4

If the baby blues continues for more than two weeks, the mother may have postpartum depression and her health care provider should be contacted. Postpartum depression is treatable but may require medical intervention.1,2,3,4 If she feels anxious and unable to care for her baby or has feelings that she wants to harm herself, her health care provider should be contacted immediately. If her health care provider cannot be reached, she should go to an emergency department. She may have a severe postpartum mood disorder requiring immediate intervention.

For more information about postpartum depression refer to the Mental Health file.


Role transition

New parents may have prepared for parenting through classes, reading, and speaking with other parents. However, it may still be hard for them to imagine what life will be like once they bring the baby home. Life with a newborn can be both exhilarating and exhausting, and parents can benefit from support while learning to adjust and integrate new role functions as parents. 1,3,4

It is important for parents to continue to speak about their feelings, both positive and negative, on a regular basis. Public health and Ontario Early Years Centres (OEYC) are excellent resources for information related to parenting, changing roles, and family relationships. 1,3,4

Please see the Transition to Parenthood file for more detailed information.

Medical care after Birth

Routine health care provider visit within six weeks postpartum

Women should plan to see their health care providers within six weeks after the birth to make sure that the perineum or abdomen has healed properly, that the uterus has involuted, and that lochia has stopped. Health care providers should ask women how they are coping with their babies and whether there are any mental or physical concerns. 1,2,3,4

Women receiving antenatal care from a midwife or family physician will see their health care providers sooner and more frequently. Midwifery clients will be seen for six weeks after the birth and then will need to see a physician for routine care for mothers and babies.

At the six-week visit, women can discuss their birth experience and ask questions about procedures or issues for a subsequent pregnancy. If they have not already had a discussion about resuming sex and their options for family planning and birth control, these can be discussed at the six-week visit. If women have any concerns about their health before this visit, they can speak to a public health nurse or their health care provider. 1,2,3,4

When to seek immediate medical care

Women should contact their health care provider for any of the following conditions: 1,2,3,4

  • Passing blood clots larger than a plum, soaking a pad an hour, or believing they are bleeding more than what is normal.
  • If they have foul-smelling, bloody vaginal discharge.
  • If there is abdominal pain or tenderness that is not improving.
  • If the caesarean incision or the stitches in the perineum start to open.
  • If they have discharge from the incision or the stitches in their perineum.
  • If they have a fever greater than 38o Celsius or 100.4o Fahrenheit.
  • If there is abdominal pain or tenderness that is not relieved by taking pain medication.
  • If they have a severe headache that is not better after taking pain medication.
  • If they see spots or stars before the eyes or have dizziness and/or sharp upper abdominal pain.
  • If one or both of the legs becomes very painful and swollen.
  • If they cannot urinate or are having burning or pain with urination.
  • If they are unable to have a bowel movement.

If they are not able to speak with the health care provider, women may call Telehealth Ontario at 1-866-797-0000 to speak to a Registered Nurse. This service is available in English and French with translators available for other languages. It is available 24 hours a day and seven days a week.

Women or their family members should call 911 for anyone having trouble breathing, shortness of breath, chest pain, and/or a racing or irregular heart rate.

Referrals

When to refer

Consider a referral to outside resources if there is a concern about a woman’s ability to manage her postpartum recovery. This may include:

  • First-time mothers.
  • Newly-arrived immigrant mothers.
  • Mothers with limited social support.
  • Mothers with low income.
  • Mothers with multiples.
  • Mothers with more than one young child.
  • Mothers with a history of mental or physical illnesses.
  • Mothers with PPD or at risk of developing PPD.
  • Mothers with infant-feeding concerns.
  • Mothers with children with special needs (i.e., premature babies or babies with a medical conditions).


Where to refer

Women who require further assistance with managing postpartum recovery should be encouraged to contact one of the following resources:

  • Their local public health department.
  • Their local Ontario Early Years Center.
  • Parents of Multiple Births Association.
  • Hospital or community-based breastfeeding clinics.
  • Hospital or community-based mental health clinics.

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Resources & Links


Please note this is not an exhaustive list of available resources, nor should any of these resources be used in place of seeking professional advice. The resources cited throughout this resource are not necessarily endorsed by the Best Start Resource Centre or the Government of Ontario. When in doubt, professionals should contact the organization responsible for issuing a specific recommendation/practice guideline.

Professional Guidelines

Professional Associations

Websites

Helplines

  • Telehealth Ontario: 1-866-797-0000

Prenatal Education Provider Tools

Apps

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References

  1. Best Start Resource Center. Best Start prenatal education program: Postpartum changes. Retrieved from http://www.beststart.org/resources/rep_health/Modules/10_PostpartumChanges/Postpartum%20Changes_Notes_Small_Final_English.pdf
  2. Case-Lo C. (2013). Healthline postpartum care. Retrieved from http://www.healthline.com/health/postpartum-care#Definition1
  3. Fraser, D. & Cooper, M. (2003). Myles text book for midwives 13th ed. Edinburgh: Churchill Living Stone.
  4. Region of Peel. (2014). Health after pregnancy. Retrieved from http://www.peelregion.ca/health/family-health/after-pregnancy/
  5. Cargill, Y. & Martel M. (2007) Postpartum Maternal and Newborn Discharge Policy Statement Journal of Obstetrics and Gynaecology Canada. 29(4):357-363. Retrieved from http://sogc.org/wp-content/uploads/2013/01/190E-PS-April2007.pdf
  6. Madadi, P., Moretti, M., Djokanovic, H., Bozzo, P., Nulman, I., … Koren, G. (2009). Guidelines for maternal codeine use during breastfeeding. Retrieved from http://www.motherisk.org/prof/updatesDetail.jsp?content_id=918
  7. Morhbacher N. and Stock, J. (2003). The Breastfeeding Answer Book 3rd edition. Schaumberg: La Leche League Press.
  8. Walker, M. Ed. (2002). Core Curriculum for Lactation Consultant Practice. Boston: Jones and Bartlett.
  9. Lim, J. (2010). Post-partum voiding dysfunction and urinary retention. Australian and New Zealand Journal of Obstetrics and Gynaecology, 50, 502–505.
  10. Dobrovits, C. (2010). Postpartum fitness…and beyond. New Beginnings, 13(1), 4-8.
  11. Davies, G., Wolfe, L. Mottola, M. & MacKinnon, C. (2003). Joint SOGC/CSEP Clinical practice guideline: Exercise in pregnancy and the postpartum period. Journal of Obstetrics and Gynecology Canada, 25(6), 516-529. Retrieved from http://sogc.org/wp-content/uploads/2013/01/129E-JCPG-June2003.pdf
  12. Health Canada. (2009). Prenatal nutrition guidelines for health professionals. Retrieved from http://www.hc-sc.gc.ca/fn-an/alt_formats/hpfb-dgpsa/pdf/pubs/guide-prenatal-eng.pdf
  13. Conde-Agudelo, A., Rosas-Bermúdez, A. & Kafury-Goeta, A. (2006). Birth spacing and risk of adverse perinatal outcomes: A meta-analysis. Journal of the American Medical Association, 295(15), 1809-1823. doi:10.1001/jama.295.15.1809.
  14. Labbok MH, Hight-Laukaran V, Peterson AE, Fletcher V, Von Hertzen H, Van Look PFA.(1997). Multicenter study of the Lactation Amenorrhea Method (LAM): Efficacy, duration and implications for clinical applications. Contraception. 55, 327-336.
  15. Dumoulin C, Hay-Smith J. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database of Systematic Reviews 2010, Issue 1. Art. No.:CD005654. Doi:10.1002/14651858.CD005654.pub2.
  16. The Society of Obstetricians and Gynaecologists of Canada. (2006 December). Conservative management of urinary incontinence (No. 186). Retrieved from http://sogc.org/guidelines/conservative-management-of-urinary-incontinence/

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Health Before Pregnancy

Health Before Pregnancy

Routine Prenatal Care

Routine Prenatal Care

Physical Changes

Physical Changes

Healthy Eating & Weight Gain

Healthy Eating & Weight Gain

Active Living

Active Living

Alcohol

Alcohol

Smoking

Smoking

Medications & Drugs

Medications & Drugs

Safety During Pregnancy

Safety During Pregnancy

Abuse

Abuse

Mental Health

Mental Health

Pregnancy & Infant Loss

Pregnancy & Infant Loss

Preterm Labour

Preterm Labour

Labour Progress

Labour Progress

Labour Support

Labour Support

Interventions in Labour

Interventions in Labour

Pain Medications in Labour

Pain Medications in Labour

Caesarean Birth

Caesarean Birth

Vaginal Birth After Caesarean

Vaginal Birth After Caesarean

Breech Birth

Breech Birth

Newborn Care

Newborn Care

Newborn Safety

Newborn Safety

Breastfeeding

Breastfeeding

Recovery After Birth

Recovery After Birth

Transition to Parenthood

Transition to Parenthood