If you’ve ever searched online for “postpartum” chances are you were given a list of sites explaining postpartum depression. The postpartum period is about waaaaaay more than just depression. You are becoming a new version of yourself as well as someone’s parent. You are dealing with lack of sleep, figuring out how to take care of a new baby who didn’t come with instructions...all the while, your body is undergoing some major changes as well, which can leave you feeling like you have been left on an amusement park ride a little too long. 

What are some normal changes you can expect during the immediate postpartum period? Let’s work our way through the body. 

Hormones

After the birth of your baby and placenta, your body has a major shift in hormones.

• Oxytocin, or “love hormone,” is important during parent-infant bonding, stimulates cramping or “after-birth contractions” and aids in milk-let down while nursing. 

• Prolactin, or “milk hormone,” is responsible for milk production and is regulated by other hormones, including estrogen. When estrogen is present, milk production is decreased. When prolactin is present, estrogen levels are low. 

• Estrogen is a key hormone that helps regulate the menstrual cycle and are low while nursing.  

Uterus

After your baby is born, your uterus starts to shrink, from being the size of a watermelon during pregnancy to the size of your fist in about 6 weeks.  This shrinking is done with the help of the cramping/contractions caused by oxytocin. Cramping is normal during the first few days postpartum. You may also look like you are still pregnant for a few weeks.  

Bleeding

Lochia or vaginal bleeding is a normal part of recovering. It is important to note that this is not a period. It is the normal shedding from the place that the placenta was attached to. You can expect the bleeding to last for about 4-6 weeks, with an average of 2-3 weeks. Your bleeding will change in amount and color from a dark red, heavier bleeding the first 3-5 days before becoming brownish, then a whitish/yellow discharge before stopping altogether.  

Respiratory

When you are pregnant, the growing baby and uterus put pressure on your diaphragm, which can cause you to feel short of breath. This resolves rapidly after your baby is born!  

Breasts

Your breasts may look completely foreign to you. They have been undergoing many changes during pregnancy in preparation to produce milk for the baby (thanks prolactin). The first milk or colostrum is a thick, sticky yellow substance. With the help of hormonal changes, your transitional milk will “come in” within 3-4 days postpartum. Your breasts will become engorged or feel firm to the touch. You may have a slight elevation in your temperature or “milk fever,” though this is not a true fever. Producing milk is HARD WORK and you might find yourself feeling like the hungry caterpillar trying to eat everything! Don’t panic: this will pass! 

Blood Volume, Kidneys, and Bladder

During pregnancy, your blood volume increases to help support blood flow to the placenta. After birth, there is a rapid shift in blood flow back into circulation. This helps to compensate for normal blood loss that occurs during childbirth, but may lead to anemia. Symptoms include fatigue, shortness of breath, dizziness, or restless legs. Your provider may start you on iron supplements and it may take a few months to return to normal levels. 

It usually takes about two weeks for your blood volume to return to its normal state. During this time, it is common to have a natural diuresis and diaphoresis effect-you may experience sweating while sleeping.

Some people have a hard time feeling the sensation to pee initially. If you had an epidural, it may be harder to recognize the urge to go in the first few days. 

Gastrointestinal 

It can take a few days for the tone of the GI tract to return. You may experience bloating, constipation, and pain. The first poop after having a baby can seem daunting, but it doesn’t have to be! 

• Everybody poops...unless they are suffering from constipation. Holding in bowel movements can lead to unhealthy elimination patterns and constipation. Certain pain medications or iron tablets increases this risk. Try to eat a high fiber diet, stay hydrated, and active. Stool softeners also help!

• Hemorrhoids can be a literal pain in the butt. Many people develop them during pregnancy and some afterward due to pushing. They are usually short-lived and it’s important to avoid constipation and straining during bowel movements. 

Abdominal Muscles

After months of stretching and making room for the growing baby, you may have something called diastasis recti, which is a measurable gap between your abdominal muscles. This can lead to back pain in future pregnancies. Sometimes this resolves on its own, but physical therapy may help. 

Vagina 

During the pushing part of labor, the vagina stretches to make room for baby. After birth, the muscle tone in the vagina is lax, and over time increases its tonicity. Decreased tone can lead to prolapse of the uterus, bladder, and even rectum. This does not mean that your partner will be able to tell a difference during sex or that you are “loose” and asking your provider for “an extra stitch” will not help tighten things up! 

• Vaginal Lacerations

It can be normal to experience a laceration or a tear to your vagina or perineum (the space between your vaginal opening and rectum). Depending on the severity of the tear, your provider might have to use stitches (sutures) to bring the tissue back together.⁠⁠ The vagina is amazing and heals quickly. 

Muscles

You might feel like you just completed a marathon and you may be sore in places you weren’t expecting. If you had an epidural, you might have some tenderness or even some bruising to the site where they placed it. 

Endocrine System

Ovulation and menstruation are inhibited by prolactin levels, which results in estrogen suppression. Low estrogen can contribute to feelings of mental health instability, brain fog, sleep disturbances, and vaginal dryness. You can expect your first period within 6-8 weeks postpartum if you aren’t breastfeeding. If you are, it might be a while before it returns. 

Our bodies are truly amazing, and it’s important to remember that everyone is different and therefore everyone’s postpartum journey will be different--even with subsequent pregnancies. It can seem like a daunting time period, but it doesn’t have to be! The more we can prepare ourselves for our experiences, from the hormonal changes to the physical changes, the more understanding we will have.