Postpartum Symptoms and Solutions by Karen Pallarito
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Now that you’ve delivered, it's good-bye baby belly (in a few weeks) and so long urgent bathroom breaks. But just as you get used to seeing your feet again, you're likely to experience a range of postpartum symptoms instead. Bloody discharge? Tender breasts? Painful poops or swollen perineum? It’s all normal stuff after giving birth. Other symptoms, however, like nausea, fever or chills, can be warning signs of something more serious.
Here’s what to expect when it comes to postpartum symptoms and how to treat these common after-birth problems, plus red flags that may signal something requiring immediate medical attention.
How long do postpartum symptoms last?
The first six weeks after birth is known as the postpartum recovery period, also known as the “fourth trimester.” It’s when your body recoups from childbirth and revs up for breastfeeding.
Most, if not all, symptoms during this time will be temporary, gradually easing up within a week. Some symptoms (like backaches, sore nipples and possibly pain in the perineum) continue for weeks, while others (like leaky breasts and fatigue) may not get better until your baby is older.
If you’re longing for your body to feel normal again, remember that postpartum symptoms don’t last forever, and there are steps you can take to ease your discomfort.
Top postpartum symptoms you might experience
Your postpartum symptoms will depend on the type of delivery you had (easy or difficult, vaginal or cesarean) and other individual factors, such as the shape you were in when you were pregnant and whether this is your first baby.
Below are some of the most common symptoms as well as strategies for dealing with them.
Postpartum bleeding is a normal part of the delivery process. Your body is ridding itself of the excess blood, tissue and mucus that lined your uterus while you were pregnant.
Expect a bright red and heavy flow for three to 10 days before it eventually tapers off, changing color from bright red to pinkish, and then eventually becoming white or yellowish. Be prepared to deal with light bleeding and spotting for up to six weeks.
How to treat it: Have a pile of pads (not tampons) on hand to absorb the flow.
When to get help: Call your doctor right away if you’re soaking two pads an hour for more than an hour or two. It can be a sign of postpartum hemorrhage, a dangerous type of bleeding.
As your uterus shrinks back to its normal size, you’re likely to have up to seven to 10 days of cramping pain, which tends to be the strongest on days two to three postpartum. These “afterpains” may be more noticeable when you’re breastfeeding.
How to treat it: A heating pad placed on your abdomen can help soothe the discomfort. Nonsteroidal anti-inflammatory drugs, like ibuprofen (Advil, Motrin) and naproxen sodium (Aleve), are safe choices for breastfeeding moms and have been shown to be more effective than acetaminophen (Tylenol) for pain relief. Of course, if all you have is Tylenol, that can be helpful too.
When to get help: Pain or discomfort not letting up? Time to make a call to your doctor.
Pushing out a baby can really be a pain in the perineum. That’s the area between your vulva and anus, and it can swell or tear under pressure. In certain situations, it’s necessary for the doctor to snip that tissue to make way for your little one’s entry into the world. Bottom line: It could take up to a week to heal, and you may be sore for weeks.
How to treat it: Keep the perineal area clean. Try using chilled witch hazel pads or a cold pack; take a warm sitz bath; use a local anesthetic spray, cream, ointment or pad; lie on your side when you sleep; wear loose clothing; and take ibuprofen. Kegel exercises can also help get the circulation going and speed the healing process.
When to get help: Worsening pain, swelling and foul odor are signs of infection. If this happens to you, call your doctor.
During your pregnancy, it's likely that you made frequent bathroom runs. Now, not so much. In the first day or two after delivering, it’s not at all unusual to have some difficulty urinating. Either you don’t have the urge to pee — or you do, but you can’t get relief, or it hurts when you go.
There are lots of reasons for this. For one, you no longer have a growing baby pressing on your bladder; the organ has more room now, so you don’t have to go as often. It’s also possible that the catheter or epidural you had in the hospital disrupted the normal signals that tell your brain that your bladder is full. Maybe you’re afraid to go because of the pain you anticipate, or you’re dehydrated.
How to treat it: Drink plenty of fluids and go for a stroll. Pour some warm water over your perineal area, take a sitz bath or apply an ice pack to your perineal area to induce urgency. You can also simply try turning on a water faucet while you're trying to urinate.
When to get help: Contact your doctor if your pain or burning is severe or lasts more than several days, or you’re not passing much urine. You could have a UTI.
Pooping problems? You’re not alone. It can take a few days for regular bowel movements to resume. Your GI tract can be sluggish after giving birth, and you may not feel up to the task of defecating after pushing out a baby. Not only are your abdominals weak, but your mind may be preoccupied by fears of aggravating your perineum pain or causing a hemorrhoid flare-up.
How to treat it: Your first post-birth BM can be a bit slow-coming. In the meantime don't try to force things. Drink fluids and eat fiber-rich foods like whole grains, fresh fruits and veggies. Go for walks and do Kegel exercises, avoid straining and use stool softeners.
When to get help: Still blocked up? Ask your doctor about taking a laxative.
Straining to push out a baby (or to pass your first poop after childbirth) can cause painful swelling of veins in and around your rectum or anus. If you already have hemorrhoids, all that pressure can exacerbate the problem.
How to treat it: Take a warm sitz bath or try using topical anesthetics. Cooling witch hazel pads or hot or cold compresses may provide some relief. Sitting on an inflatable, donut-shaped cushion may ease the pressure on your achy bottom. Talk to your doctor about taking a stool softener.
When to get help: If the pain doesn’t ease up after several days, it’s worth checking in with your doctor.
Having a baby is exhilarating and, quite frankly, exhausting. Beyond the sheer physical toll of labor and delivery or surgery, new moms often struggle with sleepless nights and the stress of caring for a newborn (or multiples!). It can take a while to get your groove back.
How to treat it: Share the load with your partner, family, friends or even hired help. Don't get too caught up in keeping your home immaculate, returning emails or writing thank you cards. For now, just focus on the most important stuff. If you need something from the store or you're too tired to cook a meal, get it all delivered. Sleep when your baby sleeps. And don't forget to eat regularly!
When to seek help: Overwhelming fatigue that comes with persistent sadness and loss or appetite are warning signs of postpartum depression. Tell your doctor right away if you’re having such symptoms or if your thoughts turn to harming yourself or your baby.
Delivering a child is like running a marathon — with a sprint to the finish line. You’re going to be achy, especially if you did a lot of pushing that strained your chest muscles or tailbone. Or maybe you’re sore all over.
How to treat it: Pop ibuprofen or Aleve and relax sore muscles with hot baths, showers or a heating pad. If you've never had a massage before, there's never been a better time to book one.
When to seek help: If you develop pain, tenderness or swelling in a calf or thigh, elevate your leg (don’t massage it) and call your doctor. These could be signs of deep vein thrombosis (DVT), a blood clot that can pose life-threatening consequences. Your doctor will likely put you on a blood thinner.
If you were straining your face during delivery, your eyes may appear red or swollen. Another plausible explanation: you’re severely sleep-deprived!
How to treat it: Apply cold compresses to your eyes for 10 minutes a few times a day. Try to sleep when you put the baby down for a nap.
When to seek help: Blurriness or loss of vision can be a sign of postpartum preeclampsia. This rare but serious condition can occur in the days or weeks after childbirth. Contact your doctor immediately if your eyesight isn’t normal.
Now that you’re no longer pregnant, your body is flushing out excess fluids, often during the night. No wonder you’re sweaty. Scientists believe declining hormone levels also play a role, but exactly why this makes some, but not all, women perspire is unclear. It may take several weeks for your sweaty situation to resolve.
How to treat it: Cover your pillow with an absorbent towel and drink plenty of fluids to help compensate for the water you're losing.
When to get help: Excessive sweating can be a sign of postpartum thyroiditis — inflammation of the thyroid — causing your body to produce excess thyroid hormone. It often begins one to six months after giving birth and usually resolves on its own after several weeks. But some women go on to develop low hormone levels (hypothyroidism), requiring thyroid medication. Tell your doctor if you have low-thyroid symptoms (dry skin, feeling cold, aching muscles and weight gain).
Expect your breast milk to come in three to four days postpartum — whether or not you intend to breastfeed. All of a sudden, your breasts are tender, swollen, sore and hard. Breastfeeding your baby can take care of that! Severe breast engorgement should diminish within days. If you’re not breastfeeding, it can take a day or two for your swelling to subside.
How to treat it: Apply cold packs to relieve your discomfort. If you’re nursing, gently massage your breasts to get the milk flowing. And make sure you're wearing a well-fitting nursing bra.
When to get help: A lactation consultant can help guide you through any breastfeeding difficulties you might have.
Nipple soreness is a rite of passage for many moms who are learning the ropes of breastfeeding. It’s often the result of poor positioning. Breast engorgement can make it all the more difficult for your little one to latch on. The irritation should ease with subsequent feedings. It can take a couple days for your nipples to toughen up.
How to treat it: Make sure your breasts are positioned the right way, and vary your nursing positions. Expose your nipples to air briefly after breastfeeding. Let your breast milk dry on your nipples to help heal them, try applying ultra-purified medical grade lanolin to your nipples (avoid petroleum-based products), or wet regular tea bags with cool water and place them on your nipples. Taking an over-the-counter pain reliever like ibuprofen or acetaminophen before nursing may also help ease soreness.
When to get help: Cracked nipples can introduce germs that lead to mastitis. This breast infection can cause fever, redness, and muscle and breast pain. Call your doctor, who will likely prescribe an antibiotic to clear up the infection.
Postpartum back pain is one of those symptoms that can linger for weeks. Pregnancy hormones relax your muscles and loosen your ligaments for childbirth, so don’t be surprised if it takes a while for your back muscles to regain their strength and stability.
In the meantime, you’re adjusting to a new, post-baby-belly posture, and you’re doing a lot more lifting and carrying than you’re used to. No wonder you've got a backache!
How to treat it: Try focusing on bending from your knees when you pick up your baby, and use a footrest to elevate your feet when breastfeeding or sitting.
When to get help: Pain in your lower back or side along with an urgent need to pee or pain with urination can be a sign of a kidney infection or UTI. In either case, you may need an antibiotic.
Your body only makes the milk your little nurse needs, but it can take some time (even weeks) for your milk production and baby’s feeding schedule to sync up.
In the meantime, expect your breasts to drip or spray. Pumping won’t solve the problem; in fact, it may stimulate your milk production, leading to more leakage.
How to treat it: Invest in nursing pads and opt for dark patterned tops that will help hide any wet spots.
When to get help: If you’re delivering too much milk too fast, your baby may gag and push away from your breast. A lactation consultant can help you manage “overactive let-down,” also known as “overactive milk ejection reflex.”
Postpartum symptoms after a C-section
You’ve made it through surgery and delivery. Now comes the tough part: giving yourself time to heal while caring for your little one.
You’ll be dealing with all the usual postpartum symptoms of childbirth: fatigue, abdominal pains, lochia, perineal pain (especially if you attempted a vaginal delivery before surgery) and more. Plus, you’ll be tending to your surgical incision.
Healing your abdominal incision doesn’t happen overnight. It can take your body up to six weeks to recover and fully heal, and it may take a few weeks for the pain to subside. You may even have occasional twinges for months. Some numbness and itching around the incision is also normal and will fade away over time.
How to treat it: Take prescribed pain relievers as directed. If pain continues for weeks, try over-the-counter pain relief medications and discuss dosages with your doctor. Avoid heavy lifting for the first few weeks after surgery.
When to get help: Worsening pain or redness around the incision or oozing that’s brown, yellow or green are signs of infection. Alert your doctor if this happens to you.
Signs of postpartum depression or another mood disorder
The joy of motherhood can quickly give way to feelings of sadness. If you have a case of the “baby blues,” know that it’s a normal and common side effect of childbirth caused by hormonal changes. And this too shall pass, usually within a few weeks.
But if those feelings linger or worsen over time, you could be experiencing postpartum depression (PPD), a more serious and prolonged condition.
PPD symptoms to watch for include:
- Persistent feelings of sadness, guilt, emptiness, hopelessness
- Irritability, restlessness
- Difficulty concentrating
- Loss of interest or pleasure in activities
- Sleep problems
- Lack of appetite or wanting to do nothing but eat
- Trouble bonding with baby
- Thoughts of death, suicide or harming yourself or the baby
If symptoms persist for longer than a couple of weeks, talk to your doctor. Many moms have been there before, and with help they got past their depression to truly enjoy parenting. It's crucial to your future and your family's that you speak up.
Postpartum symptoms that could be something more serious
You’re tired and achy, and that’s to be expected. But there are other postpartum warning signs and symptoms that you should know about, just in case. They may be signs of more serious health issues, such as postpartum hemorrhage, DVT blood clots, postpartum preeclampsia and peripartum cardiomyopathy.
If you develop any of these symptoms, call your doctor right away:
- Heavy bleeding that doesn’t slow or stop; for example, soaking more than one pad an hour for several hours in a row
- Blurry vision, light sensitivity or temporary loss of vision
- Unexplained cough
- Chills, clammy skin
- Rapid heartbeat
- Feeling dizzy, faint or confused
- Fever of 100 degrees Fahrenheit or higher
- Nausea or vomiting
- Severe headache
- Leg pain, redness or swelling
Call 911 immediately if you experience:
- Chest pain
- Difficulty breathing
- Severe pain or swelling in the legs
- Thoughts of death, suicide or harming yourself or the baby
- Severe pain in the lower abdomen
Though the postpartum period presents lots of new challenges, you’ll get through this. If you’re concerned about any symptom you may be having, don't be afraid to speak up. Your doctor has heard it all before and is there to help you, but only if you tell her what's on your mind!