Postpartum Recovery After Birth

Published NHS and NICE guidance indicates that the 6-week postnatal check is a key milestone, but recovery continues well beyond this point. Pelvic floor and core strength may take 3–6 months to return. Every body is different.

The first few days after birth are intense. Published guidance indicates the following are common and expected:

• Lochia (postpartum bleeding) — Heavy, bright red bleeding is normal in the first 2–3 days. Use maternity pads, not tampons. Published NHS guidance advises against tampon use during this period.
• Uterine cramping (afterpains): The uterus contracts to return to its pre-pregnancy size. Published guidance indicates these may be stronger with second or subsequent births, and may intensify during breastfeeding. Paracetamol or ibuprofen may help: ask your midwife.
• Perineal pain, Soreness, swelling and bruising of the perineum are common after vaginal birth, whether or not there was a tear. Sitting may be uncomfortable.
• Fatigue, Extreme tiredness is universal. Labour is physically exhausting, and sleep deprivation begins immediately. Published guidance emphasises resting whenever possible.
• Hormonal shifts: Oestrogen and progesterone levels drop sharply after delivery of the placenta. This can cause sweating, mood changes, and emotional sensitivity. Published guidance indicates this is physiologically normal.
• First bowel movement, This may take 2–3 days and can feel daunting. Staying hydrated, eating fibre-rich foods, and gentle movement can help. Ask your midwife about stool softeners if needed.

Published RCOG and NHS guidance classifies perineal tears into four degrees:

Source: RCOG, Third- and Fourth-degree Perineal Tears, Management (Green-top Guideline No (last checked Oct 2026). 29)

Published guidance for perineal care includes:

• Peri bottle — Squirt warm water over the perineum while urinating and after using the toilet. This reduces stinging and keeps the area clean.
• Sitz baths: Sitting in a shallow bath of warm water for 10–20 minutes, 2–3 times daily, may help with discomfort and promote healing.
• Ice packs: A wrapped ice pack applied for 10–20 minutes can help reduce swelling in the first 24–72 hours.
• Stitches care, Dissolvable stitches typically dissolve within 2–4 weeks. Keep the area clean and dry. Pat (do not rub) dry after washing.
• Pain relief: Published NICE guidance indicates paracetamol and ibuprofen are commonly used. Speak with your midwife about what is appropriate for you.
• Positioning, Lying on your side may be more comfortable than sitting. When sitting, a cushion or ring cushion may help relieve pressure.

Published NHS and NICE guidance describes three stages of postpartum bleeding:

• Lochia rubra (days 1–3): Heavy, bright red blood, similar to a heavy period. May contain small clots. This is the heaviest phase.
• Lochia serosa (days 4–10) — Pinkish-brown, watery discharge. Flow reduces noticeably. Still heavier than a normal period.
• Lochia alba (days 10 onwards): Yellowish-white or creamy discharge. Gradually tapers over the following weeks.

Total duration: Published guidance indicates lochia typically lasts 4–6 weeks, though it can vary.

The pelvic floor muscles support the bladder, uterus and bowel. Published NICE and RCOG guidance indicates that pregnancy and vaginal birth stretch and sometimes weaken these muscles significantly.

• Why it matters: Weakened pelvic floor muscles can lead to urinary incontinence (leaking when coughing, sneezing or exercising), reduced sensation, and in some cases pelvic organ prolapse.
• Pelvic floor exercises (Kegels): Published NICE guidance recommends starting pelvic floor exercises as soon as comfortable after birth, ideally within the first few days. Aim for 8–12 squeezes, 3 times per day.
• How to do them, Squeeze as if stopping the flow of urine. Hold for up to 10 seconds, then relax. Build up gradually. Do not actually stop urine flow mid-stream as a regular practice.
• When to seek help — If you have persistent urinary leaking beyond 3 months, difficulty controlling wind or bowel movements, or a feeling of heaviness or dragging in the pelvis, ask your GP for a referral to a women's health physiotherapist.

During pregnancy, the abdominal muscles stretch to accommodate the growing baby. Published guidance indicates this is universal and expected.

• Diastasis recti: A gap between the left and right rectus abdominis muscles. Published guidance indicates this is present in most women immediately after birth. The gap often closes naturally within the first 8 weeks but may persist in some cases.
• When to check — You can check by lying on your back with knees bent, placing fingers above the belly button, and lifting your head slightly. A gap wider than 2 finger-widths after 8 weeks may benefit from guided exercises.
• Gentle exercises: Pelvic tilts, gentle core engagement (drawing the belly button towards the spine while breathing normally), and side-lying exercises can help. Avoid sit-ups and planks until the gap has closed or you have been assessed by a physiotherapist.
• When to seek help, If the gap persists beyond 8 weeks, or if you have a visible doming or bulging of the abdomen when engaging core muscles, ask your GP for a referral to a women's health physiotherapist.

Whether breastfeeding or not, breast changes are a normal part of the postpartum period.

• Engorgement, Published NHS guidance indicates that breasts commonly become swollen, hard and painful around days 3–5 when milk "comes in". Frequent feeding or expressing, cold compresses between feeds, and supportive bras may help.
• Blocked ducts: A tender, firm lump in the breast that may be red or warm. Published guidance suggests continued feeding from the affected side, gentle massage towards the nipple, and warmth before feeds. If accompanied by flu-like symptoms or fever, this may indicate mastitis; contact your GP or midwife.
• If not breastfeeding. Published guidance indicates wearing a supportive (not tight) bra, avoiding nipple stimulation, and using cold compresses can help manage engorgement. Milk production typically reduces within a few days to a week.

For detailed breastfeeding support, published guidance from the Australian Breastfeeding Association (ABA) and the NHS breastfeeding support pages are recommended resources.

Emotional changes after birth are extremely common. Published NICE and NHS guidance distinguishes between:

• Baby blues (days 3–10), Tearfulness, mood swings, irritability and anxiety that typically peak around days 3–5. Published guidance indicates this affects up to 80% of new parents and usually resolves within 2 weeks without treatment.
• Postnatal depression, Persistent low mood, loss of interest or pleasure, difficulty bonding with the baby, feelings of guilt or worthlessness, changes in appetite or sleep beyond what is expected with a newborn, lasting more than 2 weeks. Published NICE guidance (CG192) indicates this affects approximately 10–15% of new mothers.
• Postnatal anxiety, Persistent worry, racing thoughts, difficulty relaxing, physical symptoms such as a racing heart. This can occur alongside or separately from depression.
• Birth trauma / PTSD, Some people experience flashbacks, nightmares or avoidance related to their birth experience. Published guidance indicates this is real and treatable.