When a person runs their first marathon (26.2 miles), they are counseled and prepared that they will need time to rest and recover after their race is over. A rule of thumb is that if a first-time marathoner trains for six months, they should expect it to be about six months before their body is fully recovered and back to normal. The same holds true for having surgery or a prolonged illness. No one would ever expect someone to “bounce back” right away after having an operation or being sick. An expected recovery period may last weeks to months in each of these situations.

Recovery after giving birth is no different. Women’s bodies go through immense physiologic and hormonal changes after having babies. It takes time to recover. Despite this, many new moms are unprepared for what to expect in the weeks to months postpartum. Here are some common bodily changes that all postpartum moms should be aware of, as well as worrisome symptoms that should prompt you to contact your doctor.

Postpartum Symptoms: When Should You Worry?

Vaginal Bleeding

This starts as bright red blood, like a heavy period, for the first few days to a week post-birth. It then lightens and changes to a brown to yellow color. Intermittent spotting can last up to six weeks or so.

Worrisome signs: If bleeding is very heavy (i.e., soaking through more than one pad per hour), contains clots larger than egg-sized, and/or does not start to improve after several days, contact your care provider. These symptoms can be due to a postpartum hemorrhage (PPH), which can be life-threatening.¹

Cramping

Uterine cramping is the most painful in the first days to a week after giving birth. The uterus contracts and decreases in size, also known as uterine involution, causing pain. Oxytocin, one of the main hormones released during breastfeeding, can worsen cramps in these early postpartum days. Ibuprofen and using a heating pad can help to ease pain from cramping.

Worrisome signs: Very severe cramping can signify a problem with the uterus. This may include endometritis (an infection of the lining of the uterus), retained placental fragments, PPH, or a complication after having a C-section.²

Perineal Pain

The perineum is the area between the vagina and the rectum. Pain in this area occurs due to stretching and/or tearing during labor and delivery. Episiotomies and having stitches in this area can also contribute to pain and discomfort. The best treatments for perineal pain include ibuprofen, sitz baths, and applying witch hazel wipes.

Worrisome signs: Persistent perineal pain, redness, and/or drainage can be signs of an infection.

Engorgement

Engorged breasts are a common occurrence when one’s breastmilk is coming in. The most common symptoms of engorgement are bilateral breast tenderness and swelling. Treatments include frequent breastfeeding, cold packs, and placing cabbage leaves on one’s breasts. In most cases, engorgement improves within a week or two. You should continue breastfeeding your baby on demand and not skip nighttime feedings.

Worrisome signs: Unilateral breast tenderness, redness, and swelling. These symptoms can signify mastitis, a relatively common breastfeeding problem that might require antibiotic treatment.

Hot Flashes and Night Sweats

These occur in the first few postpartum weeks as a mother’s hormones readjust to pre-pregnancy levels.

Worrisome signs: Development of a fever (temperature greater than or equal to 100.4 F). A postpartum fever is never normal and can be a symptom of mastitis or a serious bacterial infection of one’s uterus, blood, and/or urine.

Swelling

It’s common to experience some degree of water retention after giving birth. It is usually most pronounced in the legs, ankles, and feet. Postpartum swelling should gradually decrease over a week or two.

Worrisome signs: Swelling and pain localized to one leg can be from a deep venous thrombosis (DVT) or a blood clot. Postpartum women with symptoms of a DVT need emergent assessment to prevent a blood clot’s movement to the lungs (pulmonary embolism) or brain (stroke).

“Baby Blues”

These are feelings of sadness and crying occurring in the first few days after giving birth. “Baby blues” are usually a result of hormonal shifts during the postpartum period. These feelings are normal and should resolve by the end of the second postpartum week.

Worrisome signs: Persistence of feelings of sadness and hopelessness beyond the first few weeks, difficulty sleeping, and/or excessive worrying. These are signs of postpartum depression (PPD), which require urgent evaluation and treatment as PPD will not just “go away” like the “baby blues” do. Any mother who has feelings of wanting to harm herself, or others, needs emergent psychological evaluation as she might be developing postpartum psychosis.

Other Worrisome Postpartum Symptoms

Postpartum mothers with any of these “worrisome signs” should call their obstetrician or midwife for guidance on how to proceed ASAP. Additional postpartum symptoms that require immediate evaluation include the following:

• Shortness of breath or chest pain – symptoms of a possible pulmonary embolism (blood clot in the lung) or pneumonia (lung infection).
• Dizziness, confusion, slurred speech, and/or numbness can all be signs of a postpartum stroke.
• Severe headaches and/or seizures– can be from elevated blood pressure (i.e., postpartum preeclampsia) and/or a postpartum stroke.

I advise all new moms to listen to their bodies and trust that if something seems “wrong” or “off” after giving birth, there is probably a serious issue that needs to be addressed. If a mother seeks medical treatment and her concerns are minimized or ignored, it’s essential to seek a second (or third) opinion. New moms must remember to take good care of themselves postpartum. This will help you take the best possible care of your newborn babies. The first step in postpartum self-care is to be educated on what to expect and how to proceed if any problems arise.