Recovery after birth, physically

Postnatal care is the most neglected part of maternity services in most systems, with the majority of attention going to the pregnancy and the baby and comparatively little to the person who gave birth.

What is normal

Bleeding — lochia — for several weeks, heaviest in the first days, changing from red to pink to brown to yellowish.

Afterpains, cramping as the uterus contracts, frequently stronger during breastfeeding and with subsequent babies.

Perineal soreness, with any stitches dissolving over a couple of weeks.

Sweating, particularly at night, as fluid shifts.

Breast changes as milk comes in.

Constipation and haemorrhoids, both very common.

Hair shedding from around three months, which is dramatic and temporary.

And a mood dip around day three to five — the baby blues — affecting a majority of women and resolving within a fortnight.

The symptoms that need urgent attention

Worth learning before discharge, because postnatal deterioration can be rapid.

Heavy bleeding — soaking a pad in an hour, or passing clots larger than a golf ball.

Foul-smelling discharge, fever or feeling generally unwell, which may indicate infection.

Severe headache, visual disturbance, upper abdominal pain, sudden swelling or vomiting — which can indicate pre-eclampsia, which can occur or worsen after birth and is a leading cause of serious postnatal illness.

Calf pain, swelling or redness, or chest pain and breathlessness, which may indicate a clot — the risk of venous thromboembolism is elevated for weeks after birth.

A wound that is increasingly painful, red, hot or discharging.

Inability to pass urine, or complete loss of control of urine or stool.

And thoughts of harming yourself or the baby, which require help immediately.

Caesarean recovery

Major abdominal surgery, which the discharge process rarely emphasises.

Full recovery generally takes six weeks or longer, with internal healing continuing beyond that.

Practical points: take analgesia regularly rather than waiting for pain; support the wound when coughing, laughing or getting up; roll onto your side to get out of bed rather than sitting straight up; keep the wound clean and dry; and avoid heavy lifting, with the baby generally being the limit.

Driving restrictions are usually about being able to perform an emergency stop and about insurance, and checking with your insurer matters.

Numbness around the scar is normal and long-lasting; increasing pain, redness or discharge is not.

Perineal tears

Which vary considerably in significance.

First and second degree tears heal within weeks with basic care.

Third and fourth degree tears involve the anal sphincter, require specific repair and follow-up, and are associated with a risk of incontinence — anyone who has had one should be under specialist follow-up and should mention any bowel symptoms.

Pain that persists beyond a few weeks, or pain on sex months later, is not something to accept and warrants examination.

Pelvic floor

The part that determines a great deal of long-term quality of life.

Pelvic floor exercises can begin very soon after birth and are recommended for everyone, regardless of delivery mode, since pregnancy itself loads the pelvic floor.

Urinary leakage in the early weeks is common and is not something to accept permanently — persistent leakage at three months warrants referral to pelvic health physiotherapy, which is effective.

Any bowel incontinence, or a sensation of heaviness or bulging suggesting prolapse, should be raised promptly rather than at the six-week check.

Returning to activity

Gradual and individual.

Walking early and often, building gradually.

Avoiding high-impact activity and heavy lifting for the first months, with guidance commonly suggesting around twelve weeks before running, and longer after caesarean or significant tear.

Abdominal separation is normal in pregnancy and narrows over months; specific exercises help and aggressive abdominal work early can worsen it.

A pelvic health physiotherapy assessment before returning to running is recommended by specialist guidance and is routinely available in some countries and not others.

The six-week check

Frequently focused on the baby.

It is worth arriving with your own list: bleeding, pain, continence, mood, contraception, sex, wound healing, and anything about the birth you want to discuss.

Asking for a debrief about the birth is a reasonable request in many services, particularly where it was frightening or did not go as expected.

And symptoms should not be deferred to that appointment if they are urgent — the list above applies at any point.

General information only, not medical advice. Seek urgent care for heavy bleeding, signs of infection, severe headache, chest pain or calf pain after birth.