Postpartum Care

Postpartum care is the medical care you receive in the weeks and months after giving birth. It covers physical recovery, bleeding, pain, infection, blood pressure, mood, feeding, contraception and the return to ordinary life.

The single six-week check is out of date. ACOG's position is that postpartum care should be an ongoing process rather than one appointment: contact with your clinician within the first three weeks after birth, further care as needed, and a comprehensive visit no later than 12 weeks. Most serious postpartum complications occur before the old six-week mark — which is exactly why waiting for it was never a good plan.

Go to an emergency department now for any of these

Learn these before you deliver, and make sure whoever is at home with you knows them too.

Bleeding that soaks through a pad in an hour, or passing clots larger than a golf ball
Fever over 100.4°F
A severe headache that does not respond to medication, blurred vision, or flashing lights
Chest pain or difficulty breathing
Pain, swelling or redness in one calf
A red, painful area on the breast with fever and body aches
Thoughts of harming yourself or your baby

Blood pressure can rise for the first time after delivery, and preeclampsia can appear postpartum in a woman who had a completely normal pregnancy. Headache with vision change after a birth is an emergency, not a tension headache.

What recovery actually involves

Bleeding. Lochia is heaviest in the first few days, then fades over several weeks. It should get lighter, not heavier. A sudden increase after it had settled is worth a call.

Pain. Perineal soreness or a cesarean incision that aches for a couple of weeks is expected. Pain that worsens rather than improves is not.

The cesarean incision. Keep it clean and dry, no heavy lifting for about six weeks, and call for spreading redness, drainage or opening.

Bladder and bowel. Leaking urine when you cough, sneeze or laugh is very common in the first weeks. It is common — it is not something you have to keep. See urinary incontinence and pelvic organ conditions.

Sleep and energy. Exhaustion is universal. Exhaustion that comes with a racing heart, breathlessness or dizziness may be anemia and is worth testing for.

Mood

Baby blues — tearfulness, irritability and mood swings in the first two weeks — affect most new mothers and resolve on their own.

Postpartum depression is different. It lasts longer than two weeks, it interferes with functioning, and it can begin at any point in the first year, not just the first month. Anxiety, intrusive frightening thoughts, and rage are as common a presentation as sadness. It is a medical condition with effective treatment, and it is not a verdict on you as a mother.

We screen for it with a validated questionnaire, and we ask again at later visits rather than once. If you are struggling, say so at any visit, or call between visits. You do not need to wait until you are asked.

Feeding

We support whatever feeding decision you make. Breastfeeding, formula, or both are all acceptable, and a baby who is fed and gaining weight is a fed baby. What we will help with is the mechanics: latch, supply, engorgement, cracked nipples, blocked ducts, and mastitis — which needs prompt treatment when it comes with fever.

If breastfeeding is not working and you want it to, ask early. Most problems are fixable in the first two weeks and harder later.

Contraception and the next pregnancy

Ovulation can return before your first period, and before you feel remotely ready. Fertility can return as early as three weeks after birth if you are not exclusively breastfeeding.

Options are discussed before you leave the hospital and again at your postpartum visit. An IUD or implant can be placed immediately after delivery or at the postpartum visit; progestin-only methods are compatible with breastfeeding; combined estrogen methods are usually delayed for several weeks because of clot risk. If you are certain you are done, permanent options are on the table too. See birth control, the IUD and tubal ligation.

Spacing pregnancies by at least 18 months lowers the risk of preterm birth in the next pregnancy — worth knowing before you decide.

Sex, exercise and returning to normal

The standard advice is nothing in the vagina for about six weeks, so tissue can heal. After that, timing is yours. Vaginal dryness is common and often hormonal, especially while breastfeeding, and it is treatable rather than something to endure.

Return to exercise gradually. Walking early is good. High-impact activity and heavy lifting wait until you have been cleared, and longer after a cesarean.

Talk to us

Medical disclaimer

This page is general health information, not medical advice for any individual. Postpartum recovery varies, and your own follow-up schedule depends on your delivery and your medical history. For heavy bleeding, fever, severe headache with vision changes, chest pain, breathlessness, calf pain and swelling, or thoughts of harming yourself or your baby, seek emergency care immediately.