During pregnancy, childbirth is seen as the finish line. Your due date is written in all caps on your calendar (though not even pregnancy brain could make you forget it!), and you’re doing everything you can to get you and your baby there safely. You’ve likely thought a lot about childbirth itself, perhaps putting together a birthing plan and asking friends what giving birth is actually like—and not how it’s portrayed in movies.

But once the baby’s here, you’re ushered into the postpartum period. Some people refer to the postpartum period as the “fourth trimester,” or the 12 weeks following birth. 

And because pregnancy and childbirth can be so overwhelming, it’s possible you haven’t given much deep thought to what it will be like after delivery. Sure, you may have the nursery set up, but postpartum brings a whole new set of never-ending questions. Like, when are you going to stop bleeding? Or why do you feel like bursting into tears at least three times a day?

There’s a lot of focus on the baby during the postpartum period, but we’re here to focus on you. This guide will answer a lot of questions, and help smooth your transition from pregnancy to parenthood.

What Is the Postpartum Period?

The postpartum period begins after giving birth. It describes the time it takes for the mother’s uterus to return to its pre-pregnancy state, which is typically between six and eight weeks. Once this has happened, the woman is technically considered to be out of the postpartum period. 

You’ll want to be aware of the physical changes that happen during the postpartum period, such as vaginal pain and bleeding. But also the emotional changes: Hormones drastically change after childbirth, which play a direct role in how a new mother can feel. 

There are such major emotional changes during this post-childbirth time, that some people refer to it as the “fourth trimester.” This suggests a period of 12 weeks, versus the six to eight weeks it can take for physical normalcy.

What's Happening During Postpartum?

Just as it can be helpful to break pregnancy down into trimesters, it’s easier to understand what’s happening during the postpartum period when you look at smaller chunks of time.

The First Two Weeks After Giving Birth

There’s a lot happening to your body and mind during the postpartum period. Some changes happen to every woman who gives birth. But giving birth vaginally or having had a c-section can tack specific issues on, too. Here’s what to watch for and how to treat yourself. 

Bleeding

Whether you have a vaginal birth or cesarean, you can expect to experience some vaginal bleeding afterward, says Luisa Vera, M.D., an obstetrician/gynecologist at UNC Rex Hospital in Raleigh, North Carolina. Curious as to why a c-section could cause this? 

During pregnancy, the lining of the uterus becomes super thick, but it thins back down after delivery and removal of the placenta. This can cause a discharge called “lochia,” which is a fancy term for blood, mucus, and uterine tissue.

“Immediately postpartum, women will usually have some bleeding, usually a little bit heavier than a period,” Dr. Vera says. This bleeding can continue for about six weeks. 

While you’re bleeding, be sure to use pads, and not tampons. This will allow the body to heal faster. 

Abdominal Pain

Regardless of how a woman gave birth, everyone’s uterus will shrink back down to its pre-pregnancy size and shape. This can cause some abdominal pain, which can either be dull or sharp. 

You might hear this type of pain referred to as “afterpains.” Typically, they last two to four days after giving birth.  

You don’t have to white-knuckle through the aches. A heating pad can ease some of the pain. Ibuprofen can help, too. 

If you’ve had a c-section, your doctor will ensure that you don’t leave the hospital without medication to manage your pain. The opioid crisis is all over the news, but opioids are still commonly prescribed after a c-section and can be used safely while breastfeeding. Your pain should never be unbearable, talk to your ob/gyn to find the best solution for your recovery.

Pain During Urination

It’s normal to feel stinging or burning when you pee for the first couple of weeks (and particularly the first few days) after childbirth, Dr. Vera confirms. 

Because of this, you may want to use a peri bottle when you go to the bathroom. A peri bottle has an angled neck that makes cleaning yourself easier, which helps reduce infection. To use it, fill it up with water, then squeeze the bottle to squirt water on your vagina while you urinate. This helps dilute the urine and makes it sting less.  

Poop Problems

As you’ve likely heard from a friend or two, it can really hurt to poop in the first couple weeks after childbirth. This is because your pelvic floor muscles and anal sphincter muscles may be sore or damaged. Constipation after childbirth is another common issue (oh joy). 

In both cases, Dr. Vera says that using a stool softener can be helpful. Eating a high-fiber diet can also help move things along.

Hemorrhoids

Speaking of your butt… Many women develop hemorrhoids after giving birth. This can last up to one month after delivery. If you’ve been spared hemorrhoids until now, they are a painful swelling of a vein in the rectum. 

Hemorrhoids can develop from the strain of pushing during labor, which makes them more likely for women who give birth vaginally. But women who had a c-section can still get hemorrhoids, too. Applying witch hazel directly on the hemorrhoids or adding it to a bath can reduce the ouch.

Body Pains

Hip pain and lower back pain may crop up, due to the toll pregnancy and childbirth can put on those areas of the body, says Annelise Swigert, M.D., an obstetrician/gynecologist at Southdale Obgyn in Minnesota. 

Sore Breasts

Immediately after childbirth, your body is in hormonal free fall. As soon as a woman gives birth, her estrogen and progesterone levels drastically fall, Dr. Swigert explains. While this is happening, her levels of prolactin—a hormone responsible for breast tissue development and milk production—rise. This can cause breasts to become sore. Nipples, too.

Breasts are particularly sensitive in the first few days after childbirth, when they’re very full of breastmilk. Typically, this goes away after five days. To get some relief, you can take ibuprofen. It’s safe even when breastfeeding.

When women are breastfeeding, their prolactin levels remain high, and estrogen levels go back up, too. “This is why women typically do not get a period when they are breastfeeding,” Dr. Swigert says. If a woman is not breastfeeding, her prolactin levels will fall to non-pregnancy levels after one or two weeks. 

Soreness From Tears or Stitches

Between 53% and 89% of women who give birth vaginally experience tearing of their perineum (the skin between your vagina and your butt) and don’t generally require stitches. The vast majority of tears heal within a few weeks on their own.

If you experienced a perineum tear during labor, using an ice pack can help relieve some of the soreness. Taking a sitz bath (a warm, shallow bath) can also soothe the area.   

Women who have a c-section will receive multiple layers of stitches (some that you cannot see, as well as those you can) that take longer to heal from, typically eight weeks. Avoid lifting anything heavier than your baby during this time. Taking ibuprofen can help with the soreness. 

While your incision is healing, keep watch to see if it becomes red or swollen or leaks discharge. These symptoms are signs of an infection. If you notice something, see your care team to treat it and prevent it from getting worse.

Mood Changes

You better believe these drastic hormonal swings can impact your mood—and that’s on top of the sleep deprivation and stress that comes with motherhood. “Mood swings are very common in the first two weeks postpartum,” says Winifred Soufi, M.D., Ph.D., an obstetrician/gynecologist in Atlanta, Georgia. “Eighty percent of women have postpartum blues at the two-week mark.”

All of these things—the hormones, lack of sleep, gigantic life change that just occurred—make women especially prone to postpartum depression and anxiety, says Dr. Swigert. Usually, women are screened for these two conditions by their doctor two weeks after giving birth, she says.

General baby blues typically don’t go beyond two weeks. If they last longer than that—or your feelings are getting significantly worse—this is a sign of postpartum depression, notes Dr. Vera. We’ll get into this more below.

Three to Six weeks After Childbirth, and Beyond 

Three weeks after giving birth, your body is still recovering, but the pain should be less intense and you should be improving each day. And while you’re still very likely sleep-deprived, you’ll start settling into your new normal. 

Emotionally

For many people, the baby blues are letting up now. That means you should feel at least a little better emotionally moving into week three. 

We’ll repeat because it’s important: If you’re still feeling sad or hopeless, it could be a sign of postpartum depression and is absolutely worth talking to your ob/gyn about. 

Physically

Generally, you should feel mostly physically healed six to eight weeks after giving birth. Six weeks after childbirth, you should not experience any more bleeding or discharge. 

If you had a tear during childbirth and received stitches, those stitches should resolve about six weeks after childbirth. Even after the stitches dissolve, it’s normal to feel some pain for about six months. 

If you are breastfeeding, you’ll probably leak milk from time to time. Your body is still trying to figure out how much milk to produce. It takes about six weeks for the body to adjust and create just the right amount of milk. 

Most doctors recommend waiting six weeks after giving birth to have sex. Now that you’re there, you should be okay to do so. But only if you feel ready. Listen to your body—and your mind!

Factors That Affect the Postpartum Period

Not everyone experiences postpartum the same way. This is especially true if you’ve had a traumatic birth—in which case, we encourage you to speak with your ob/gyn or a therapist to help you heal emotionally.

No matter what happened during childbirth, there are several lifestyle factors that can impact how easy or difficult it can be to navigate the postpartum period. Three things at play:

Level of Support

You know the phrase “it takes a village”? Well, it really does. Women who have a support system in place will have a smoother postpartum period, both physically and emotionally. “Sleep deprivation really accentuates depression and anxiety. This is a big issue for women,” says Dr. Swigert. 

This is why having a partner or others who can help with the baby is so important, she says. Getting adequate sleep can make a major difference in how you feel. A lack of sleep just makes everything worse.

A History of Anxiety or Depression

Women who have experienced anxiety or depression before pregnancy are at a higher risk for the postpartum varieties, says Dr. Vera. A strong support system matters here, too.

Dr. Vera again emphasizes the importance of reaching out to your ob/gyn if symptoms of depression or anxiety persist. Your doctor can share possible solutions. 

Diet and Nutrition

Eating healthy makes the postpartum period easier, says Dr. Swigert. Nursing women need 500 extra calories a day and should be sure to get adequate protein and calcium, which helps with breastmilk production.

Postpartum Mental Health Issues 

As Dr. Soufi explained earlier, 80% of women have postpartum blues at the two-week mark. Beyond that, or if your feelings get significantly worse, there may be something more serious going on.

Postpartum depression is not the only emotional issue women may face after giving birth. Postpartum anxiety, postpartum post-traumatic stress disorder, and postpartum obsessive-compulsive disorder can also occur. Here are some signs to watch for.

Postpartum Depression

Many of the symptoms of postpartum depression are the same with typical depression:

• Loss of interest or pleasure in things you normally enjoy
• Sleeping too much or too little
• Feelings of worthlessness or guilt
• Fatigue
• An inability to concentrate
• Suicidal ideation or reoccuring thoughts of death

What about not bonding with your baby? This isn’t always a sign of postpartum depression: It can take time to connect with your baby, so don’t think there’s something “wrong” with you if it doesn’t happen right away. 

That said, feelings of depression can get in the way. If you don’t even want to try to bond with your baby, that’s a good indicator that it’s time to talk to your ob/gyn or mental health pro.

Postpartum Anxiety

It’s completely normal to worry about keeping your baby safe after giving birth. But if those feelings become so intense that you’re worrying literally all the time, you may have postpartum anxiety. Postpartum anxiety is the feeling of overwhelming worry about your baby. For example, you may constantly worry whether they are eating enough or are safe.   

Postpartum Post-Traumatic Stress Disorder

If childbirth was especially stressful or traumatic, it could lead to postpartum post-traumatic stress disorder. For example, unexpected emergent needs in delivery, like the need for a blood transfusion, or an emergency c-section. While these may be routine for your care team it is really important that you talk through the emotional impact—this could lead to postpartum post-traumatic stress disorder. 

Women with this disorder experience intrusive flashbacks or dreams of the experience. They may have trouble falling or staying asleep. They may also feel extremely on edge, always on the lookout for potential danger.

Postpartum Obsessive-Compulsive Disorder

Developing a constant fear of harming your baby—such as dropping them or contaminating them with germs—are signs of postpartum obsessive-compulsive disorder. It’s important to understand that postpartum OCD thoughts are completely uncontrollable and in no way a reflection of your ability to care for your baby. 

Having these thoughts does not mean that you actually want anything bad to happen to your baby. That’s exactly why they’re so disturbing! 

How to Feel Better During the Postpartum Period

If at any point you feel the urge to harm yourself or your baby, call or text the national suicide and crisis lifeline at 988. Beyond that, we really encourage you to talk to your ob/gyn about any difficulties. There is no shame in what you’re going through. It can happen to anyone, and you shouldn’t have to face these feelings alone.

Also know this: Your doctor wants to hear about any physical or mental hurdles you’re facing postpartum, no matter how big or small. Whatever it is, they have ideas and solutions that can help. Rest assured, you are not the only woman who has faced these things—and your doctor has heard it all. You can ask them about medication and support groups.

Mental Health Medication for Postpartum Depression and Other Issues

Most antidepressant and antianxiety prescription medications are safe to take while breastfeeding, says Dr. Vera. If you are struggling emotionally, speak with your doctor about your medication options. 

Also, in very exciting news, the first pill for postpartum depression was recently approved by the Food & Drug Administration. Prior to its approval, there was a similar treatment, but you had to get it through an IV and it required a hospital stay. This made it too cumbersome for many women to actually take advantage of, Dr. Vera explains.

The new medication, zuranolone, is taken orally for 14 days after labor. It works by rebalancing pregnane, which is essentially a “mother hormone” to the hormone progesterone, and is associated with GABA. Low GABA levels can lead to anxiety and depression. Zuranolone keeps GABA levels from dropping, helping to prevent these issues. 

Currently, zuranolone is not FDA-approved to treat postpartum anxiety, OCD, or PTSD. However, many prescription medications for anxiety and other mental health conditions are safe to take while breastfeeding, notes Dr. Vera. If you think you might benefit from prescription mental health meds, talk to your care team.

Support Groups for Postpartum Women

Sometimes, no one understands how you feel quite like other people going through the exact same thing. If you want to connect with other new moms, Postpartum Support International has a great local support group finder. Or, use Meetup.com and search for new parent groups in your area.

After you give birth, there’s a lot of exciting attention on the baby. It makes total sense: Babies are adorable! But you are going through a heck of a lot, too, and having a support system (and a good ob/gyn) is key to getting through it. 

No matter what you’re going through—all the aches, pains, exhaustion, mood swings—you don’t have to do it alone. Just look at your baby and think about how incredible you are for what you’ve already done. You’ve got this! And when you don’t, we’re here for you.