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The Fourth Trimester: What to Expect of Your Body After Giving Birth
If you’ve recently given birth, your body has just accomplished a miraculous feat … growing another life! Immediately after delivery, your body begins a cascade of changes designed to help you recover. Although your pregnancy has technically ended, your body will need at least several weeks to heal.

You probably discovered that labor is hard work! It is normal to feel tired after a long labor and delivery, and you may discover soreness in muscles you never knew existed. If you had an epidural during labor, you may have residual discomfort in the center of your back, as well as aching leg muscles from labor itself. Your fatigue may be related to anemia as well, as all deliveries result in a substantial amount of blood loss. Most health care providers order a blood test after delivery to check for anemia; you can ask for your results and advice on whether to take supplemental iron. In addition to iron, eating a healthy diet, drinking plenty of fluids and sleeping when you can will be helpful.

Your body is programmed to nourish a growing baby, and your breasts have already been preparing for this event. Initially, you will produce colostrum, a special liquid designed to provide your baby with concentrated nutrients and disease-fighting antibodies. It will be three or four days before you begin to produce actual milk, which may appear more yellow than cow’s milk. Your breasts are likely to engorge as you overfill with milk, and this can be painful and may initially cause a brief fever. Your body is responsive to your baby’s needs. As your baby nurses, your body will produce the right quantity of milk for your baby. Nursing your baby at least every three hours may help to relieve engorgement.

If you had an episiotomy for a vaginal birth or a laceration requiring stitches, you may feel sore for several days. Lying or standing may be more comfortable than sitting. Ice packs can reduce pain and swelling initially; soaking in a shallow bath of warm water may feel soothing after the first 24 hours. You can request medication to ease the pain; your practitioner can prescribe medicine that won’t interfere with breastfeeding. Keep your skin clean using a spray bottle or cup of warm water to rinse yourself off after each visit to the bathroom. Bowel movements may be painful; eating fiber, drinking plenty of liquids and using a laxative can help.

If you had a cesarean section, you’ll be more aware of your abdominal discomfort than your bottom discomfort. Your abdominal incision could be quite painful, but this will taper off over the next few weeks. Avoid using your abdominal muscles when you get into or out of bed; have your nurse show you how to support yourself with your arms as you try to sit or stand up. The area of abdominal pain may seem wider than your skin incision. This is because the visible incision doesn’t reveal the full extent of the surgery below the skin. A tugging or burning feeling on either size of a horizontal c-section scar is common.

Regardless of your type of delivery, you will be bleeding after your delivery as the uterus sheds its lining and heals. This bleeding is called lochia. It is initially red, then fades to pink or brown before becoming more clear over the next few weeks. Your uterus remains enlarged following delivery; it will take several weeks to recede to its pre-pregancy size. This process is called “involution”, and is accompanied by a series of contractions, known as “afterbirth pains”. These contractions usually increase with nursing, and help reduce the size of the uterus and the amount of postpartum bleeding.

Your abdominal muscles remain stretched for several weeks following the delivery, and early attempts to tighten them may be futile. The combination of loose abdominal muscles and a still-enlarged uterus will allow your belly to appear pregnant a while longer. Don’t be surprised if a well-intentioned stranger asks how far along you are two weeks after you have delivered! Eventually you will find that doing abdominal exercises will strengthen your muscles and allow you to pull in your belly again. Be careful with lifting and cautious as you exercise : your ligaments have loosened during pregnancy and you are somewhat more vulnerable to injury. If an activity hurts or seems to be causing strain, back away from it.

Leg swelling is common following a delivery, especially if you received intravenous fluid during your labor. Swelling is especially common after cesarean sections, and may become more evident a few days AFTER the delivery, as you become more mobile. The swelling should not be painful or asymmetric (one leg swollen more than the other); notify your doctor if either of these situations occur. Swelling will slowly resolve on its own; propping your legs up on pillows while you recline will reduce the swelling only temporarily.

WARNING SIGNS: When should I call my doctor?
Your health care provider may provide a list of post-partum instructions and guideline for when to call. In general, any of the following should prompt a call to your doctor:
  • If your bleeding saturates a maxi-pad in an hour or you pass a blood clot larger than a lemon;
  • If you have a fever higher than 100.4 degrees after the first 24 hours;
  • If you have increasing pain or swelling in your episiotomy site, or if you notice a foul odor from your vaginal secretions;
  • If your breasts have specific areas of pain, redness, or tenderness to touch;
  • If you have pain with urination, or an inability to urinate, or constipation; or
  • If you have calf pain, or redness, swelling and tenderness on your leg.
Laura E. Stachel M.D. Obstetrician & Gynecologist