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Postpartum recovery: what's normal, and when to call

The short answer

This one’s for whoever gave birth. Partners, read it too: you may spot a warning sign first.

  • Bleeding for up to 6 weeks is normal. It starts red and fades to pink, then yellow or white [1][2].
  • Some pain is normal for a few weeks, from the perineum, a cesarean incision or cramping. It shouldn’t stop you caring for yourself and your baby [3].
  • Some signs mean get care now. The full list is below. If you can’t reach your provider, go to the nearest emergency room [4][5].
  • The baby blues usually ease within 1 to 2 weeks. Postpartum depression is different, can start any time in the first year, and is treatable [6].
  • Your own care has a schedule. ACOG recommends contact with your provider within 3 weeks, and a full postpartum visit no later than 12 weeks [7].

Everyone’s baby gets checkups. Yours count too.

Get care right away for any of these

These are the CDC’s urgent maternal warning signs for after birth. Call your provider, and say you were pregnant in the last year [4]. If you can’t reach your provider, go to the nearest emergency room [5]. If it’s an emergency, call 911.

  • a headache that won’t go away or gets worse over time
  • dizziness or fainting
  • changes in your vision, such as flashes of light, blind spots or blurriness
  • a fever of 100.4°F (38°C) or higher
  • extreme swelling of your hands or face
  • trouble breathing
  • chest pain or a fast-beating heart
  • severe nausea and throwing up, or not being able to keep fluids down
  • severe belly pain that doesn’t go away
  • heavy bleeding (soaking through one or more pads in an hour), passing clots bigger than an egg or passing tissue, or discharge that smells bad
  • severe swelling, redness or pain in a leg or arm
  • overwhelming tiredness
  • thoughts of harming yourself or your baby

ACOG is more direct about two of these. If you have thoughts of hurting yourself or your baby, or pain, swelling and tenderness in a leg, call 911 or get emergency help right away [3].

For thoughts of harming yourself or your baby, you can also call or text 988, or the National Maternal Mental Health Hotline at 1-833-TLC-MAMA (1-833-852-6262). It’s free, confidential and open 24/7 [8].

Postpartum preeclampsia is rare, but it can happen after birth even if you didn’t have preeclampsia in pregnancy [1]. Several signs above, like a headache that won’t quit, vision changes and swelling in your hands or face, can point to it [1].

What’s typical in the first 6 weeks

Bleeding

Bleeding and discharge after birth is called lochia. It can last up to 6 weeks [1][2].

  • It changes color: less red, then pink, then yellow or white [1][2].
  • It eases most in the first week, but may not stop completely for several weeks [1].
  • Small clots can come out when you first get up in the early days [1].
  • A short burst of red bleeding around 7 to 14 days isn’t uncommon after a vaginal birth. It happens as the spot where the placenta was attached heals over [1].

Call your provider if bleeding is still as heavy as a period after more than 4 days (apart from that brief 7-to-14-day bump), is light but lasts beyond 4 weeks, or comes back after stopping for more than a few days [1][2].

Pain after a vaginal birth

Expect a few weeks of swelling and pain in the perineum, the area between the vagina and anus. A tear or episiotomy can hurt more and take longer to heal [3]. Stitches dissolve on their own [1]. What helps [3]:

  • an ice pack for 10 to 20 minutes at a time, most useful in the first 24 to 72 hours;
  • a pillow or cushion to sit on, or a sitz bath (sitting in warm, shallow water);
  • warm water from a squeeze bottle when you pee, then pat dry;
  • a stool softener, if your provider agrees.

Wait 6 weeks before tampons, sex, or impact exercise like jogging [1]. Light activity and walking are fine when you feel ready [1].

Cramps (“afterpains”)

Your uterus contracts as it shrinks back. It can feel like period cramps or even contractions. Afterpains are more common if you’ve given birth before, and in the first few days of breastfeeding or chestfeeding. A heating pad helps [3].

Pain medicine

Ibuprofen is usually the preferred first choice if you’re breastfeeding or chestfeeding, because little of it passes into milk. Acetaminophen is also considered safe. Talk with your ob-gyn before combining pain medicines [3].

Cesarean recovery

It can take weeks to get your strength back after any birth, and longer after a cesarean [6]. MedlinePlus’s guide to going home [2]:

  • Pain should ease after 2 or 3 days, but the incision can stay tender for 3 weeks or more. Most people need pain medicine for a few days to 2 weeks.
  • Walk around. It helps you heal and helps prevent blood clots.
  • Lift nothing heavier than your baby for 6 to 8 weeks.
  • Don’t drive for at least 2 weeks, or while taking opioid pain medicine.
  • No baths, hot tubs or swimming until your provider says so, usually not before 3 weeks.
  • Most regular activities come back in 4 to 8 weeks.

A heating pad, a belly binder, or a feeding position that keeps pressure off the incision can help too [3].

Call your provider if the incision is red, warm, swollen or draining, or opens [2].

Also call your provider if

  • pain from a tear, episiotomy or incision doesn’t go away or gets worse [3];
  • peeing hurts or burns badly, or for more than a few days [3];
  • you have red streaks or painful new lumps in your breasts or chest [3];
  • part of your breast or chest is tender, red or warm, which can be a sign of infection [1];
  • discharge gets heavier or smells bad [1].

Baby blues, depression and anxiety

The baby blues often start about 2 to 3 days after birth. You might feel down, anxious or upset, on and off. They usually get better within a few days or 1 to 2 weeks, without treatment [6].

Postpartum depression is different. ACOG describes it as intense sadness, anxiety or despair that keeps you from doing daily tasks. It most often starts 1 to 3 weeks after birth, but can start any time in the first year [6].

Call your ob-gyn or another provider right away if you think you have it, or if your partner or family are worried about you. Don’t wait for your checkup [6]. It’s treatable, with medicines and talk therapy [6]. Many medicines for postpartum mood and anxiety disorders are safe while breastfeeding [9].

Blues that last past 2 weeks are worth a call. ACOG lists feelings of hopelessness that last more than 10 days after birth as a reason to call your provider [3].

Screening

You’ll probably be asked. The AAP recommends that pediatricians screen for postpartum depression at your baby’s 1-, 2-, 4- and 6-month checkups [10]. Many use a 10-question form called the Edinburgh scale (EPDS) [9]. Answer honestly. It’s there for you, and nobody is grading your parenting.

If you take a quiz online, bring the result to your provider either way.

Partners get depressed too

A 2010 review of 43 studies found depression in about 1 in 10 fathers during pregnancy and the first year after birth, and more often 3 to 6 months after birth [11]. The research studied fathers, but the advice is the same for any partner: if you’re struggling, tell your own doctor. The hotline and 988 are for you too [8].

Your postpartum care

ACOG recommends [7]:

  1. Contact with your provider within the first 3 weeks after birth.
  2. A full postpartum visit no later than 12 weeks after birth, covering your physical, social and emotional well-being.

In practice, many providers still book a checkup at around 4 to 6 weeks [1][2]. Either way, don’t wait for it if something on the lists above happens.

Bring your questions. Bring your list. Bring the baby if you have to.

Birth control and spacing

You can get pregnant before your first period comes back [12]. If and when you want to talk about birth control or pregnancy spacing, talk to your provider. Many methods can start right after birth, and all are safe with breastfeeding, though a few aren’t recommended in the first weeks [12].

Sources

  1. MedlinePlus (National Library of Medicine), “Vaginal delivery - discharge.” medlineplus.gov
  2. MedlinePlus (National Library of Medicine), “Going home after a C-section.” medlineplus.gov
  3. American College of Obstetricians and Gynecologists, “Postpartum Pain Management.” acog.org
  4. CDC, Hear Her campaign, “Urgent Maternal Warning Signs.” cdc.gov
  5. ACOG Foundation, “Urgent Maternal Warning Signs.” obgynsafety.org
  6. American College of Obstetricians and Gynecologists, “Postpartum Depression.” acog.org
  7. American College of Obstetricians and Gynecologists, Committee Opinion No. 736, “Optimizing Postpartum Care” (2018). acog.org
  8. Health Resources and Services Administration (HRSA), “National Maternal Mental Health Hotline.” mchb.hrsa.gov, and 988 Suicide & Crisis Lifeline. 988lifeline.org
  9. HealthyChildren.org (AAP), “Postpartum Depression & Breastfeeding.” healthychildren.org
  10. Earls MF, et al., “Incorporating Recognition and Management of Perinatal Depression Into Pediatric Practice,” Pediatrics 2019;143(1):e20183259 (AAP clinical report). doi.org
  11. Paulson JF, Bazemore SD, “Prenatal and Postpartum Depression in Fathers and Its Association With Maternal Depression: A Meta-analysis,” JAMA 2010;303(19):1961–1969. doi.org
  12. American College of Obstetricians and Gynecologists, “Postpartum Birth Control.” acog.org

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