Postpartum Recovery
Having a baby brings many physical and emotional changes. Postpartum recovery refers to the period after childbirth during which the body heals from pregnancy and delivery.
The Postpartum Recovery period—sometimes called the “fourth trimester”—is a time of adjustment, healing, and restoration of strength. It involves everything from uterine involution (the uterus shrinking back to normal size) to the healing of the perineum (if a tear or episiotomy occurred), hormonal fluctuations, and the re-training of muscles that were stretched or weakened during pregnancy.
Below, we will cover aspects of pelvic health in postpartum recovery, including pelvic floor healing, incontinence, pelvic pain, and practical tips for a smoother recovery.
Physical Changes Right After Birth
Immediately after delivery, whether vaginal or cesarean, several things happen in the body:
Uterine Contractions: The uterus contracts strongly to help detach and expel the placenta and compress blood vessels to prevent hemorrhage. These contractions, called “afterpains”, can cause crampy abdominal pain in the first few days postpartum, especially during breastfeeding, which triggers oxytocin release. Afterpains are typically more noticeable in women who have had multiple children. They usually subside within a week. A heating pad on the belly and NSAIDs like ibuprofen can help manage this normal postpartum cramping.
Lochia (Postpartum Bleeding): For the first 6 weeks or so, the body expels lochia, a vaginal discharge made up of blood, mucus, and uterine tissue. It resembles a prolonged menstrual period—starting as bright red bleeding, transitioning to pink or brown, and finally becoming yellowish-white before stopping. It is important to use pads, not tampons, during this period to reduce infection risk.
Perineal Healing: The perineum (the area between the vagina and anus) may be very tender, especially if a tear or episiotomy was repaired with stitches. Swelling and bruising are common. Hospitals often provide ice packs or witch hazel pads to apply to the perineum in the first 24 hours to reduce swelling. Keeping the area clean using a peri-bottle with warm water after urination and patting dry gently can aid healing. Pain from perineal tears or episiotomy is usually significant for a few days but improves within the first 1–2 weeks.
Pelvic Floor Weakness: The pelvic floor muscles are often weakened or overstretched after vaginal delivery. Many women experience difficulty contracting these muscles in the first few days postpartum. This usually improves as swelling decreases and muscle tone gradually returns.
C-Section Recovery: Those who had a cesarean birth will have an abdominal incision that causes its own pain and mobility limitations. The uterus still contracts, and lochia will still occur, but the primary focus of recovery is managing incision pain and gradually increasing movement. Walking is encouraged to prevent blood clots, but heavy lifting is off-limits for several weeks. The incision heals externally in about 6 weeks, but internal healing takes longer.
Hormonal Shifts & Emotional Changes: Postpartum hormonal fluctuations (a drop in progesterone and estrogen, an increase in prolactin if breastfeeding) can cause mood swings, fatigue, and the “baby blues.” These emotional shifts are normal and usually improve within two weeks, but if feelings of depression or anxiety persist beyond that, it is important to speak with a healthcare provider.
Pelvic Floor and Incontinence Postpartum
Pregnancy and childbirth put a significant strain on the pelvic floor, leading to weakness, nerve stretching, and temporary loss of muscle control. Many women experience urinary incontinence (often stress incontinence, leaking urine when coughing, laughing, or sneezing) in the days and weeks after delivery. This is very common but often improves significantly within 3–6 months as tissues heal.
What to Do:
Start Kegel Exercises Early: Begin gentle pelvic floor contractions as soon as swelling subsides and pain allows. Even subtle squeezes help increase blood flow and promote muscle recovery. Over time, increase repetitions and duration to regain strength.
Practice Proper Breathing & Core Engagement: When moving, especially getting out of bed or lifting your baby, use exhalation and core activation to support the pelvic floor and prevent excessive pressure.
Use Protection if Needed: If urinary leakage persists, wearing light pads can help until symptoms improve. If incontinence continues beyond 3–6 months, speak with a healthcare provider about pelvic floor physical therapy.
Prevent Constipation & Straining: The first bowel movement after birth can be intimidating, especially with perineal stitches or a C-section incision. To avoid straining, drink plenty of water, eat fiber-rich foods, and take stool softeners as needed.
Fecal Incontinence
While less common than urinary leakage, some women experience fecal incontinence, particularly after a severe perineal tear (3rd or 4th degree). In such cases, pelvic floor physical therapy can strengthen the anal sphincter and improve bowel control.
Postpartum Pelvic Pain and Healing
Mild pelvic pain in the postpartum period is normal as the body heals. Here are some common sources of postpartum pain and how to manage them:
Perineal Pain: If you had a tear or episiotomy, expect significant soreness in the first 2 weeks. Using a warm peri-bottle after urination, sitz baths, and witch hazel pads can reduce discomfort. Most sharp pain transitions into an ache within 2 weeks. If pain worsens or signs of infection appear (redness, swelling, pus discharge), see a provider.
Pelvic Pressure or Prolapse Sensations: A heaviness or bulging sensation in the vagina is common immediately postpartum due to temporary pelvic organ laxity. Avoid heavy lifting and long periods of standing. If the sensation persists beyond 6 months, consult a specialist to evaluate for pelvic organ prolapse.
Pelvic Girdle Pain (Hip or SI Joint Pain): If you had pelvic instability during pregnancy, it may continue postpartum. Using a pelvic support belt and avoiding asymmetrical movements (like carrying weight on one hip) can help reduce pain.
C-Section Incision Pain: Support the incision with a pillow when coughing or laughing and follow lifting restrictions. Numbness around the incision is common and may take months to improve.
Uterine Cramping ("Afterpains"): These contractions help shrink the uterus and are more intense in women who breastfeed. Taking ibuprofen and using a heating pad can ease discomfort.
Postpartum Pelvic Health Timeline & Tips
Weeks 0–2:
Prioritize Rest while incorporating gentle movement (short walks at home).
Begin light pelvic floor exercises (only if comfortable).
Monitor bleeding and pain levels—seek medical help if bleeding soaks a pad in an hour or if severe pain persists.
Prevent constipation with fiber, fluids, and stool softeners.
Weeks 2–6:
Lochia should be decreasing (from red to pink to light yellow).
Gradually increase activity, but avoid high-impact exercise.
Discuss pelvic floor concerns at your 6-week postpartum checkup.
Months 3–6:
Most women feel significantly better by this time.
Focus on core rehabilitation and postpartum-specific exercise programs (yoga, Pilates).
If incontinence or prolapse persists, consider pelvic floor therapy.
Months 6–12 & Beyond:
Pelvic health should continue improving, but some symptoms (such as prolapse or severe incontinence) may require further evaluation.
Patience is key—the body takes months to fully recover.
Final Thoughts on Postpartum Recovery
Every woman’s postpartum experience is unique. Healing takes time, and it is essential to listen to your body, ask for help, and prioritize self-care. While many symptoms resolve within 6 months to a year, pelvic floor therapy, exercise, and medical guidance can enhance recovery and prevent long-term complications.