SymptomWomen's & pregnancy health
Recent Pregnancy: Postpartum Symptoms and When to Get Help
A recent pregnancy brings big physical and emotional changes in the weeks after birth, a time called the postpartum period. Bleeding (lochia), cramping, sore breasts, tiredness and mood swings are normal. But most pregnancy-related deaths happen after delivery, so certain symptoms in the first 6 weeks, and up to a year, need urgent care: heavy bleeding, a severe headache, chest pain or breathlessness, a painful swollen leg, fever, or thoughts of self-harm.
Also called: Postpartum, after childbirth, post-delivery, puerperium, fourth trimester
At a glance
- What it means
- The weeks and months after giving birth, as the body recovers from pregnancy.
- Normal
- Bleeding for 4 to 6 weeks, cramping, sore perineum or scar, breast fullness, fatigue, baby blues.
- Warning signs
- Heavy bleeding, severe headache or vision changes, chest pain, breathlessness, leg swelling, fever, self-harm thoughts.
- Highest-risk time
- The first 1 to 2 weeks, though problems can arise up to a year after birth.
- Checkups
- Contact with your care team within 3 weeks, and a full visit by 12 weeks.
When to get help
Call 911 or go to the ER
- Soaking a large pad in an hour or less, or passing clots bigger than an egg
- Chest pain, trouble breathing or coughing up blood
- A seizure, or a severe headache that does not go away, with vision changes
- Thoughts of harming yourself or your baby: call or text 988 (US), or call 911 or your local emergency number
- Fainting or feeling your heart racing with dizziness
See a doctor within a day or two
- Fever of 38 °C (100.4 °F) or higher
- A red, swollen, painful calf or leg on one side
- Blood pressure of 160/110 or higher, or 140/90 with headache, swelling of the face or hands, or upper belly pain
- A red, painful, hot area of the breast with fever and chills
- Foul-smelling discharge, or a C-section wound that is red, opening or leaking pus
- Severe belly pain that is getting worse
Book a routine appointment
- Low mood, anxiety or tearfulness lasting more than 2 weeks
- Leaking urine or stool, or a bulge or heaviness in the vagina
- Pain during sex after you have healed
- Ongoing difficulty with breastfeeding
Usually safe to manage at home
- Bleeding that is slowly getting lighter and changing from red to pink to cream
- Mild cramping during breastfeeding in the first few days
- Tearfulness and mood swings in the first 2 weeks (baby blues)
What is normal after childbirth
Bleeding (lochia)
Vaginal discharge after birth is called lochia. It contains blood and tissue from the lining of the uterus.
| Time after birth | What to expect |
|---|---|
| Days 1 to 4 | Bright red, heavy like a period, small clots |
| Days 4 to 10 | Pinkish-brown and lighter |
| Up to 4 to 6 weeks | Yellowish-white or cream, gradually stopping |
Bleeding may briefly increase with activity or breastfeeding. A sudden return to heavy, bright red bleeding after it had lightened should be checked.
Other normal changes
- Afterpains: cramps as the uterus shrinks, stronger during breastfeeding and in later births.
- Perineal soreness after a vaginal birth, especially with stitches. Usually much better in 2 to 3 weeks.
- C-section wound pain: expect several weeks of recovery. Avoid lifting anything heavier than your baby for about 6 weeks.
- Breast engorgement: breasts become full, firm and tender around days 3 to 5 as milk comes in.
- Night sweats and frequent urination for the first couple of weeks as the body sheds extra fluid.
- Constipation and hemorrhoids.
- Hair shedding around 3 to 4 months after birth, which recovers by about a year.
- Fatigue: expected with broken sleep and recovery.
Emotional changes
Up to 80% of new parents get the baby blues: tearfulness, mood swings and anxiety starting 2 to 3 days after birth and settling within 2 weeks. Symptoms that are more intense or last longer may be postpartum depression or postpartum anxiety, which affect around 1 in 7 and respond well to treatment.
Postpartum warning signs and what they can mean
| Symptom | Possible cause |
|---|---|
| Heavy bleeding, large clots, dizziness | Postpartum hemorrhage from retained tissue or a uterus that does not contract |
| Severe headache, vision changes, swelling, high blood pressure | Postpartum preeclampsia, which can appear up to 6 weeks after birth even if blood pressure was normal in pregnancy |
| Painful, swollen leg | Deep vein thrombosis; the risk of blood clots is highest in the weeks after birth |
| Chest pain, sudden breathlessness | Pulmonary embolism, heart problems |
| Breathlessness lying flat, swollen legs, palpitations | Peripartum cardiomyopathy, a weakened heart muscle in late pregnancy or the months after |
| Fever, foul discharge, lower belly pain | Infection of the uterus lining (endometritis) or wound |
| Red, painful breast with fever | Mastitis or breast abscess |
| Burning urination, fever, back pain | Urinary or kidney infection |
| Confusion, hallucinations, extreme mood swings in the first 2 weeks | Postpartum psychosis, a rare emergency |
Recovery timeline
- First 2 weeks: heaviest bleeding and soreness. Rest when you can, accept help, and focus on feeding and recovery.
- 2 to 6 weeks: bleeding fades, wounds heal, energy slowly returns. Gentle walking and pelvic floor exercises are encouraged.
- 6 to 12 weeks: many people resume exercise and sex when they feel ready and bleeding has stopped. Contraception is important, as you can ovulate before your first period.
- Up to a year: pelvic floor, abdominal muscles (including diastasis recti), hormones and mood can take months to settle.
Self-care after birth
- Perineal care: rinse with warm water after using the toilet, change pads often, and use cold packs in the first 24 to 48 hours.
- Pain relief: acetaminophen (paracetamol) and ibuprofen are generally compatible with breastfeeding at label doses. Ask before using other medicines.
- Bowels: fluids, fiber and a stool softener if advised.
- Pelvic floor exercises: start gently in the first days to reduce leaking.
- Sleep and nutrition: rest when the baby sleeps, and eat regular meals. Breastfeeding increases fluid and calorie needs.
- Movement: short walks help prevent blood clots and constipation.
- Ask for help with household tasks, and tell someone if you are struggling emotionally.
Postpartum checkups
ACOG recommends contact with your obstetric care provider within the first 3 weeks after birth and a full postpartum visit no later than 12 weeks. Those with high blood pressure in pregnancy should have a blood pressure check within 3 to 10 days. People with gestational diabetes need a glucose test 4 to 12 weeks after birth.
Frequently asked questions
What is normal after giving birth?
Normal symptoms include bleeding that lightens over 4 to 6 weeks, cramping, a sore perineum or C-section scar, breast fullness, night sweats, constipation, tiredness and mood swings in the first 2 weeks. Symptoms should gradually improve, not get worse.
What are the warning signs after a recent pregnancy?
Seek urgent care for heavy bleeding, a severe headache or vision changes, chest pain, trouble breathing, a painful swollen leg, fever, a seizure, or thoughts of harming yourself or your baby. These can be signs of hemorrhage, preeclampsia, blood clots, infection or postpartum mental illness.
How long does postpartum bleeding last?
Usually 4 to 6 weeks. It starts heavy and red, then becomes pink or brown, then cream-colored before stopping. Contact your provider if bleeding suddenly becomes heavy again, has a bad smell, or comes with fever.
Can you get preeclampsia after giving birth?
Yes. Postpartum preeclampsia most often appears within the first week but can occur up to 6 weeks after birth, even with normal blood pressure in pregnancy. Watch for severe headache, vision changes, swelling and upper belly pain.
When does the postpartum period end?
The traditional postpartum period is 6 weeks, when the uterus has returned to its usual size. But recovery of the body, hormones, sleep and mood often takes months, and some complications can arise up to a year after birth.
Sources
This guide was written from current patient and clinical guidance, including:
- American College of Obstetricians and Gynecologists: Optimizing Postpartum Care (Committee Opinion)
- CDC: Hear Her campaign: Urgent maternal warning signs
- AWHONN: POST-BIRTH warning signs
- NHS: Your body after the birth
- MedlinePlus: Postpartum care