Postpartum Recovery: What To Expect In The Weeks After Birth

The postpartum period, often called the fourth trimester, is a time of significant physical and emotional changes for new mothers. Understanding what the postpartum period entails can help reduce concerns and prepare moms for the road ahead. Learning about the postpartum healing timeline can also provide a better understanding of what to expect.

Key Takeaways: Healing After Childbirth

• Postpartum recovery includes physical healing as well as emotional adjustment; structured rest and gradual return to activity are important.
• Pelvic health physical therapy can play a valuable role in strengthening core and pelvic muscles and supporting overall postpartum wellness – whether a patient has had a vaginal or Cesarean delivery
• Access to resources such as postpartum support groups, physical therapy, and mother-centered education helps normalize recovery experiences and address common concerns.
• Awareness of warning signs for complications (such as excessive pain, bleeding, or mood changes) and timely communication with healthcare providers is critical for safe recovery.

Common Physical Changes After Labor And Delivery

“Every postpartum experience is a little different, but some physical changes are almost universal,”said Reece Clark, MD, an obstetrician with Franciscan Physician Network who delivers babies at Franciscan Health Mooresville.

Postpartum bleeding and hemorrhage, or lochia, usually lasts a few to several weeks. About 85% of women will have stopped bleeding by the 6-week postpartum visit. However, it is usually relatively heavier in the first few days to a week after delivery. Then, it tends to be light, and it may come and go a little unpredictably as it gradually resolves over a few weeks.  (Get a list of supplies for your postpartum recovery here.)

In addition, cramping is common, particularly during breastfeeding.

“The cramping can be quite intense, particularly in the first few days. Feeding or pumping releases oxytocin, which is the same hormone that makes the uterus contract during labor and after delivery. NSAIDs like ibuprofen or naproxen combined with Tylenol can be helpful.”

Other changes to a woman’s body after delivery include swelling and the speed at which the uterus shrinks back to its normal size.

“Most women have some swelling by the end of pregnancy, and it will usually improve within a few days to a few weeks after delivery. Walking, wearing compression stockings, and elevating the legs can be helpful, and for patients with painful feet/legs or carpal tunnel symptoms, a short course of diuretic tablets (water pills) may even be prescribed by your doctor. Also, the uterus will gradually shrink back to its normal size. Immediately after delivery, it reaches roughly the umbilicus (belly button). After about 2 weeks, it will be fully back inside the pelvis, and by about 6 weeks it will be back to its normal size, which is usually about 6-10cm (about 3-4").”

Breast changes are another common experience during the postpartum period, especially for those who initiate breastfeeding.

“Most women’s breast milk will come in by around three days postpartum. The more you put the baby to the breast right after delivery, the faster and smoother that process will go,” said Dr. Clark. “One thing that I like to share with patients is that the milk letdown tends to happen on average 1-2 days later for patients who had a C-section compared to those who had a vaginal delivery.”

Swollen and tender breasts are common in the first two weeks after delivery.

“The biggest thing women can do to help is to frequently put the baby to the breast to feed – we recommend feeding roughly every 3 hours around-the-clock. Another useful trick is to apply chilled cabbage leaves to the breasts – it sounds funny, but it is quite helpful. After about two weeks, this tenderness should subside. If you have serious pain with feeding or pumping, bleeding, or skin breakdown, you should see your doctor or a lactation consultant. If you have a painful red patch over the breast and fever, call your doctor or head to the ER immediately.”

Episiotomy And Postpartum Healing

Whether you’ve experienced a natural tear or an episiotomy (a surgical cut in the perineum to prevent severe tearing), postpartum stitches and episiotomy healing typically take about six weeks. It’s important to follow your doctor’s advice and avoid activities that might delay the healing process.

“If you experience sharp pain or a tugging sensation at the site of the stitches, it’s important to let your provider know,” Dr. Clark said. “Some discomfort and/or itching in the area is likely normal. As an aside, in modern obstetrics episiotomies are uncommon (about 1 in 50 to 100 deliveries in my practice).”

Women should avoid sexual activity for at least six weeks postpartum to heal properly and reduce the risk of infection.

Postpartum Rest, Recovery, & Return to Activity

"Any type of delivery is a major physical event to go through, so rest is very important. However, a safe return to normal activity also helps expedite recovery. Plenty of walking is good for everyone. After a vaginal delivery, more strenuous exercise can be restarted when the patient feels ready. After a C-section, one needs to wait at least 6 weeks to restart their usual exercise regimen. In terms of rest, use your support system. A partner can help handle a nighttime feeding to allow you to sleep for ~6 hours straight instead of 3. Family members can watch the baby for an hour or two during the day to let you regroup and nap etc. Better rest promotes physical recovery and helps patients protect their mental health.”

Franciscan Health is proud to be recognized for excellence in infant and maternal health. We are designated as a baby-friendly hospital, offering comprehensive postpartum support. Franciscan also has a dedicated team of pelvic floor physical therapists & occupational therapists that we can connect our obstetric patients to when needed or desired.

 Pelvic health physical therapy guides women through safe strengthening exercises beginning at around four to six weeks postpartum. This can help improve overall pelvic floor function and has various health & quality of life implications.

Recognizing And Managing Postpartum Depression

“Postpartum depression and anxiety are common but often unexpected,” said Dr. Clark

“The postpartum phase is the highest-risk phase for women’s mental health. In addition to dramatic hormonal shifts following delivery, there is physical discomfort and healing involved as well as the significant challenge of adapting to life with a new baby.”

There is a difference between postpartum blues and depression. Open communication with loved ones and getting professional support are critical steps to address these feelings.

For women who have postpartum depression symptoms or anxiety before delivery, they must put a plan in place for how they’re going to manage things if they do start to struggle. If symptoms continue beyond two weeks or you feel overwhelmed, contact your healthcare provider. In addition, it’s important to note that men can get postpartum depression and may benefit from professional support.

“For patients with a known anxiety, mood, or other significant mental health condition, I will usually recommend a clinic visit 1 week after delivery to check in on their mental health. Additionally, I see all patients 2 weeks after delivery, and a big part of that is to check in on mental health.”

Support For Breastfeeding Challenges

Breastfeeding can come with challenges, from difficulty latching to managing engorgement. Breast engorgement can take new moms by surprise during the first weeks postpartum. Dr. Clark recommended, “It’s helpful to discuss strategies for managing engorgement with your OB provider during the third trimester, especially if you plan to breastfeed.”

New moms should use resources like lactation consultants, who are available at Franciscan Health, to provide one-on-one support.

“New moms can also attend drop-in lactation groups to get advice and connect with other mothers,” he said.

Franciscan Health offers resources like the Village Postpartum Support Group, where moms can connect and share experiences.

Partners and Family Members Play a Vital Role

Support from loved ones is very important, especially in those first couple weeks after delivery. Partners and family can take the lead in caring for the older children, doing household chores, and grocery shopping.

“Being a good listener, looking for ways to be helpful, and understanding the mom’s physical and emotional journey are key ways to support her,” Dr. Clark said. “It is hard to overstate how helpful supportive partners, family members, and even friends can be for our patients in the postpartum phase.”

When To Call Your Doctor

Talk with your provider during recovery if you experience any of the following symptoms:

• Breast pain with redness or fever, which could indicate mastitis (an infection of the breast tissue)
• Heavy bleeding, such as passing clots larger than a quarter
• High blood pressure or headaches with vision changes
• High fever or severe abdominal pain

At Franciscan Health, we’re here to support you through every step of your postpartum journey. For more than a century, we have provided women with high-quality obstetrics and gynecology care through each phase of life. Whether you need guidance, treatment or reassurance, our expert physicians are ready to help.