While the birth of a baby is often the main focus of pregnancy, the mother’s recovery after delivery is just as significant. Also known as the “fourth trimester”, the first few weeks after delivery are as much about healing as they are about bonding with your new baby. Understanding the postpartum recovery timeline in advance can help new mothers cope better, heal faster, and feel more confident in their new role.
Below is a guide to healing after childbirth, including the body changes you can expect, how long it takes perineal tears to heal, and what you can do to help your postpartum recovery.
Postpartum Recovery: How Long Does It Take?
Because each birthing experience is unique and each body heals at its own pace, recovering after childbirth can take anywhere from three to six weeks, maybe longer for some. The pelvic area and vagina are typically sore and inflamed after childbirth, the pelvic organs are also moving back into place, and hormone levels are changing at a rapid pace.
Postpartum symptoms can also vary for each woman, depending on the type of birth or the extent of perineal tearing. After an easy birthing experience without perineal tearing, for instance, the female body and vaginal muscles can recover from the excessive stretching experienced during childbirth within three weeks.
However, third and fourth-grade perineal tears can take as long as six weeks to heal. After a C-section, the body initially requires 2-3 days to recover from surgery and the scar can take four to six weeks to heal.
Common Postpartum Symptoms
Below is a comprehensive list of postpartum symptoms that can be expected. It is important to note, however, that while all of the below-mentioned postpartum symptoms are normal, not all women who give birth will experience all of these symptoms.
- Vaginal swelling and soreness
- Vaginal Bleeding
- Perineal pain
- Mid-back or lower back pain
- Unusual vaginal discharge
- Uterine cramping
- Cesarean Scar Pain/Infection
- Constipation
- Hemorrhoids
- Hair loss
- Incontinence
- Sore breasts & nipples
- Baby blues or postpartum depression
Postpartum Recovery Timeline
The following guide to recovery after childbirth provides a roadmap for new mothers to understand what is normal after delivery and what is not. We’ve also included helpful recommendations to relieve symptoms and speed up your postpartum recovery.
Week 1 After Childbirth
The first week after giving birth is probably the most challenging for new mothers. Depending on the ease of birth, some new mothers might spend one or two nights in the hospital, while others will be free to go home on the same day. Wherever you spend these first few days after childbirth, try to rest as much as you can to allow cortisol levels to drop and encourage healing.
Pelvic Healing
The pelvic area and vagina will be sore and swollen in the first week after birth, vaginal bleeding begins, and perineal pain from stretching or tearing can range from mild to severe. Uterine cramping, which can manifest as pain, also begins after childbirth to shrink the uterus back to its normal size.
Perineal Care
Due to the extent the perineum is required to stretch during childbirth, pain between the vagina and anus is also perfectly normal after delivery. For some, the perineum can simply feel swollen and painful. If tearing occurs or an episiotomy is performed and sutures are required, a stinging or burning sensation is usual until the wound begins to heal.
It’s wise to speak with your healthcare provider about keeping a perineal wound comfortable and clean to encourage healing and prevent infection. Sitz baths, donut cushions, and a spritz bottle for cleaning the area after using the toilet are some tools that help.
Vaginal Bleeding
Heavy vaginal bleeding in the first few days after childbirth is to be expected. This is the lochia - a mucous membrane from the uterus mixed with blood – being discharged from the body. It is normal to experience abdominal and lower back pain during this time. However, if it’s accompanied by fever or wooziness, it's best to call your healthcare provider for guidance.
After a few days, heavy vaginal bleeding typically subsides, but milder bleeding can occur for a few weeks. During this time, sanitary pads are recommended. Using tampons is known to cause infection.
Breast Pain
As your milk ‘comes in’, the breasts can feel engorged and painful, while the nipples and areolas can feel tender and sensitive.
Bowel Movements
Constipation is a common postpartum symptom, typically due to a combination of factors like pushing during delivery, dehydration, hormone fluctuations, medication, and pain from hemorrhoids or perineal tearing.
Although having a bowel movement after childbirth can be daunting, it’s helpful to elevate your feet on a low stool when you sit to poop, so your knees are higher than your thighs. Once seated, try to relax, breathe, and not push too much. If you’re still having difficulties, speak with your healthcare provider about a stool softener.
Mood Changes
After giving birth, hormones change rapidly within the first few days and can alter a new mother’s mood in the first week. In addition to these hormone changes and physical postpartum symptoms, new mothers are also caring for their new baby, learning how to breastfeed, creating a sleeping, feeding & changing routine, getting less sleep than usual, and often second-guessing their instincts. Collectively, this can make new mothers feel overwhelmed, irritated, sad, guilty, or blue.
Openly referred to as the ‘baby blues’, new mothers are advised to give themselves a break during this time and accept their feelings with the trust that they will pass. Ensuring you are adequately nourished and hydrated to care for yourself and your baby is important to combat the baby blues.
Week 1 C-Section Recovery
Women who give birth by C-Section can expect to stay in the hospital for two to four days after delivery. Vaginal bleeding, pelvic discomfort, mood swings, and sore breasts as your milk ‘comes in’ are also normal postpartum symptoms with a C-Section.
If you pushed during labor before your C-Section was performed, you can also expect some perineal swelling and pain, maybe even some tearing.
When recovering from a C-Section, it’s important to rest as much as possible, keep the wound clean, and refrain from heavy lifting, swimming, driving & exercising for at least six weeks.
Keeping a stool next to your bed can help you to get in and out without putting strain on the wound. Pain medication is usually provided for the first few days, but once the incision pain subsides, gentle walking is recommended to promote healing.
2 Weeks After Childbirth
Although women typically begin to feel somewhat better in the second week after giving birth, healing is still taking place, and resting when the baby sleeps will help speed up your recovery.
Vaginal Bleeding
Although vaginal bleeding still occurs in the second week after childbirth, it should be lighter. It is also normal for it to change to yellow or pinkish-brown in color.
Pelvic & Perineal Healing
During the second week, a continued sensation of soreness and heaviness in the vaginal and pelvic area is also normal. If you experience perineal tears, the skin around them might feel itchy as the wound begins to heal. Uterine cramping continues in the second week postpartum as the uterus shrinks from the size of a watermelon to the size of an apple.
If perineal sutures are intact and healing well, performing gentle Kegel exercises can help restore muscle strength and flexibility to the pelvic floor and perineum. During week 2 after childbirth, 10 Kegels twice per day will suffice.
Night Sweats
Due to hormone fluctuations and the body flushing pregnancy fluids, approximately 30% of women are known to experience night sweats or hot flashes in the first few weeks after giving birth. Although they do not occur for every woman after giving birth, postpartum night sweats are normal and typically pass within a few days or weeks.
Mood Changes
If you are still feeling blue, irritated, or moody two weeks after giving birth, don’t be afraid to speak openly with family and friends about your challenges. The baby blues are common, and speaking with other mothers who have experienced it, can be considerably helpful in managing them.
Week 2 C-Section Recovery
C-section incisions will still feel somewhat painful during the second week but the most painful part of recovery has passed. At this stage, there should be no seepage from the wound, it should feel pain-free to touch, but a scab will not yet have formed.
Continue to care for the wound as instructed to prevent infection and refrain from any heavy lifting, swimming, driving, or strenuous exercise.
3 to 4 Weeks After Childbirth
Three to four weeks postpartum, women are normally feeling much better physically but also exhausted from caring for a new baby. Vaginal heaviness and pelvic soreness begin to alleviate and scars will likely start to form over perineal wounds and C-section incisions as they heal.
Perineal Healing
It’s normal to feel pain around a perineal tear or episiotomy incision for up to three weeks after giving birth. Continue to use sitz baths, keep the wound clean, and use a donut cushion to alleviate pain when sitting and encourage healing. Sutures may begin to dissolve after three weeks, but healing is still occurring.
Vaginal Bleeding
Vaginal bleeding is typically much lighter at this stage. If it’s not, schedule an appointment with your healthcare provider to discern why.
Uterine Cramping
Uterine cramping has also usually subsided to mild pain for most women in the fourth week. Although some women are genetically prone to intense uterine cramping as late as week four or five postpartum, it’s a good idea to have it assessed by a healthcare provider if it occurs. Uterine cramping at this stage can also indicate infection.
Starting Exercise
In most cases strenuous exercise should still be avoided, but walking and gentle core strengthening exercises are recommended by week 4. If perineal or episiotomy incisions continue to heal well, it’s also a good time to increase your Kegel exercises and improve your pelvic floor strength. During weeks 3 and 4 postpartum, it’s safe to increase 10 reps of Kegels twice per day to 10 reps three times per day.
Mood Changes
It’s common to still feel weepy as the body adjusts to hormonal fluctuations and life changes after childbirth. In fact, many women find themselves feeling elated one minute and down the next. If you are feeling overwhelmed about being a new mom or guilty about missing your old life, it can help to speak with other moms about it.
Weeks 3-4 C-Section Recovery
If the wound continues to heal and close with no apparent redness or secretions, it’s safe to begin gently massaging your C-section scar at week three or four. Even though you may feel better, it’s important to refrain from driving, swimming, strenuous exercise, and not lifting anything heavier than your baby to allow the abdominal muscles to heal.
4-6 Weeks After Childbirth
By now, the vaginal muscles have normally relaxed after the excessive stretching during a vaginal birth.
Pelvic & Perineal Healing
Vaginal soreness and pelvic pain have usually reduced significantly by this stage, but a new mother’s vagina would not be ready for intercourse quite yet. The size of the belly normally reduces as the uterus continues to shrink back to its normal size.
Gently massaging the perineum after week 4 with lubricated thumbs for 5-10 minutes per day will improve blood circulation to the area and reduce the risk of tight scar tissue forming. Perineal massage also reduces the development of raised bumps along the scar, which can help new mothers feel more confident about the appearance of their new bodies.
Vaginal Bleeding
Vaginal bleeding should be very light at this stage and typically end by week six. If heavy bleeding returns, contact your healthcare provider for a check-up. It’s important to rest to minimize bleeding and encourage healing.
Mood Changes
Sometimes, the emotional unsteadiness from hormonal fluctuations, body changes, and having a new baby to care for can become difficult to manage in the weeks after pregnancy. If your low mood or lack of interest in your baby feels unmanageable, there is no shame in speaking to your healthcare provider about managing postpartum depression.
4-6 Week C-section Recovery
At this stage, your C-section incision normally feels less painful and often numb along the line of the scar. Because the incision cuts through abdominal nerves and muscles, this is to be expected. Although most of these connections will recover, it is also normal that some of the abdominal nerves might never reconnect. But it’s also safe to say that women rarely notice once normal life resumes.
By week 6, women who have undergone C-sections can normally start to return to other light physical activities besides walking. Postnatal yoga and mobility exercises are recommended at this point.
6 Weeks to 6 Months After Childbirth
Six weeks after giving birth, new mothers typically have a scheduled check-up with their healthcare provider. This is mainly to check that postpartum recovery is progressing, and perineal tears, episiotomy scars, or C-section scars are on track and healing well.
If you are given the all-clear to return to sex and pre-pregnancy levels of exercise, it’s wise to take things slow and ease yourself back in.
Treating Bladder Control & Painful Sex After Childbirth
Sometimes, tight scar tissue that forms around perineal tears or episiotomy wounds can cause pain during sex (dyspareunia) in the aftermath of childbirth. Weakened or overstretched pelvic floor muscles along with perineal stretching during labor can also contribute to postpartum dyspareunia as well as urinary and/or fecal incontinence.
Performing regular perineal massage from week 4 postpartum can help reduce the chance of dyspareunia and incontinence after childbirth. After week eight, when perineal wounds feel less tender, a pelvic massage wand is highly recommended to soften tight scar tissue and any raised bumps around the perineal scar, as well as release any pelvic trigger points.
Strengthening Pelvic Floor Muscles After Childbirth
To improve support for pelvic organs like the bladder and alleviate incontinence, strengthening and improving flexibility of the pelvic floor muscles is also helpful. To strengthen weak pelvic floor muscles after childbirth, increase the amount of Kegel reps you perform every few weeks, or consider using Kegel Weights for more efficacy in targeting the pelvic floor muscles.
Designed to stay in place as you carry out other household activities, Kegel Weights re-train the pelvic floor muscles to contract and release on demand.
Relieving Pain During Sex After Childbirth
In addition to feeling pain during sex after giving birth, some women can also develop a fear of vaginal penetration depending on the extent of pelvic trauma experienced during delivery. In both cases, it’s helpful to speak with a pelvic physical therapist or OB/GYN about using vaginal dilators.
Recommended for at-home use, a set of vaginal dilators is designed to gently and slowly rejuvenate the vaginal muscles, while also restoring strength and flexibility to the pelvic floor muscles. Dilators can also help to rebuild confidence in vaginal penetration before slowly easing back into pleasurable sex with a partner.
Postpartum Hair Loss
When hormones increase during pregnancy, your hair typically grows thicker. As the hormones gradually return to pre-pregnancy levels in week six, new mothers might notice some extensive hair loss on their hairbrush or while washing their hair. This is nothing to worry about and once hormones are back to normal levels, your hair will stop falling out.
Return of Menstruation
Women who are not breastfeeding will usually return to regular menstruation anywhere from four to twelve weeks after giving birth. For those who breastfeed exclusively, menstruation may not return for a few months.
Conclusion
Although postpartum recovery is known to take at least six weeks, it can vary from woman to woman. Healing after giving birth will depend on whether you had a vaginal birth or a C-section, if perineal tears occurred, how well the scars heal in the aftermath, your overall mental & physical health, and the support of those around you as you heal.
Although urinary incontinence, pain during sex, and a fear of vaginal penetration are common after vaginal births, they do not have to last forever. Postpartum symptoms like these can be relieved by restoring the pelvic floor muscles, relieving tight scar tissue, and releasing pelvic trigger points with the help of pelvic massage wands and vaginal dilators.
References
Women’s Health – Recovering from Birth - https://www.womenshealth.gov/pregnancy/childbirth-and-beyond/recovering-birth
National Library of Medicine - Physical health and recovery in the first 18 months postpartum - https://pubmed.ncbi.nlm.nih.gov/23281904/
Mayo Clinic – Vaginal Tears in Childbirth - https://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/in-depth/vaginal-tears/art-20546855
The Pelvic Hub – Dilators For Dispareunia - https://www.thepelvichub.com/ask-the-experts/dilators-for-dyspareunia
Women’s Health – Postpartum Depression - https://www.womenshealth.gov/mental-health/mental-health-conditions/postpartum-depression
Pregnancy, Birth, Baby – Periods After Pregnancy - https://www.pregnancybirthbaby.org.au/periods-after-pregnancy