Your Body After Birth: What Changes and What Settles

What is actually happening

The HSE says the honest version first: “after giving birth, it may take some time before your body looks and feels the way it did before you got pregnant. And it may never completely return to the way it was.” That is not defeatism. Some changes reverse within days, some over months, and a small number are permanent — and knowing which is which is what stops people worrying about the wrong things.

The engine of most of it is hormonal. The HSE explains that during pregnancy your body has very high levels of oestrogen and progesterone, and “these levels drop suddenly after the birth of your placenta.” Almost every change below is downstream of that drop, plus the mechanical fact of a womb that has to shrink back from the size of a watermelon.

Days: the womb, the bleeding, the breasts

Your uterus contracts back down, and you feel it. The NHS: “you may notice the bleeding is redder and heavier when you breastfeed. This happens because breastfeeding makes your womb contract. You may also feel cramps similar to period pains.” The HSE explains the mechanism — breastfeeding releases oxytocin, which makes the womb contract, and so “can help to reduce the size of your womb”.

Bleeding (lochia) is heavy at first and needs super-absorbent pads. The HSE describes the colour sequence: “bright red at first. This will change to brown and eventually to a yellow or whitish colour as your uterus heals”, lasting up to 6 weeks. A useful HSE observation: an increase in blood or a darkening in colour after something strenuous “may be a sign that you need to take it easy.”

Breasts follow their own three-day clock. The NHS: to begin with they produce colostrum; “on the third or fourth day, they may feel tight and tender as they start to produce milk.” A supportive nursing bra helps.

Weeks: the tummy, the pelvic floor, the perineum

Your abdomen will not be flat when you leave hospital. The NHS: “after delivery, your tummy will probably still be a lot bigger than before pregnancy. This is partly because your muscles have stretched.”

Those muscles are often separated. The NHS says it is common for the two muscles running down the middle of your stomach to separate during pregnancy, “usually about 2 finger widths”, and that the separation “will usually go back to normal by the time your baby is 8 weeks old”. If the gap is still obvious at 8 weeks, contact your GP.

The pelvic floor takes longer, and it is where most avoidable long-term problems live. The NHS notes that “after having a baby, it's quite common to leak a bit of pee if you laugh, cough or move suddenly”, and that pelvic floor exercises can help. NICE requires that women be given information about the importance of pelvic floor exercises before transfer to community care and at postnatal contacts.

If you had stitches, the NHS says they usually dissolve by the time the cut or tear has healed, and that “if you've had stitches, it's very unlikely you'll break them”. Piles are common after birth and “usually disappear within a few days or weeks”.

Months: dryness, joints, hair, feet

Vaginal dryness and hot flushes are hormonal, not permanent. The HSE says oestrogen levels “usually return to normal when you stop breastfeeding and your periods return”, and recommends lubricant in the meantime. You may notice these changes “even if you had a caesarean birth”.

Joints stay loose for a while. The NHS: “your ligaments and joints are also more supple and flexible for a few months after birth, so there's an increased risk of injury if you stretch or twist too much.” The HSE adds that body tissue is “more stretchy and less supportive” and joint stability is affected.

Two changes people are rarely warned about, both from the NHS: your back and cup size are likely to have changed, so a pre-pregnancy sports bra will not fit; and “your feet may also have slightly changed their size and shape during pregnancy”, so it may be worth being measured for new shoes.

When periods come back

This varies more than almost anything else. The NHS: if you bottle feed, or combine bottle and breastfeeding, “your first period could start as soon as 5 to 6 weeks after you give birth”; if you fully breastfeed including at night, “your periods may not start again until you start to reduce breastfeeding.” The HSE says that if you are breastfeeding your period may not return for at least 6 months, and that if you mix breast and bottle it usually returns within about 2 months.

Fertility returns before periods do. The NHS: you can get pregnant just 3 weeks after birth, even if you are breastfeeding and your periods have not restarted. And do not use tampons or menstrual cups until after your 6-to-8-week postnatal check, because there is still a wound where the placenta was attached.

What settles on its own, and what needs help

Settles by itself: lochia; engorgement; afterpains; piles, usually; abdominal separation, usually by 8 weeks; hormonal dryness and hot flushes, as oestrogen recovers.

Needs help: incontinence that persists; a heavy feeling or bulge in the vagina, which the HSE identifies as possible pelvic organ prolapse; an abdominal gap still obvious at 8 weeks; pain during sex; back or pelvic girdle pain. The NHS's position is worth quoting: “if a physical problem is bothering you, ask a GP or health visitor for help at any time. They can advise you and refer you to a specialist if necessary.”

NICE NG194 builds this into the system: at 6 to 8 weeks a GP should carry out an assessment and respond to concerns, “which may include referral to specialist services in either secondary care or other healthcare services such as physiotherapy.”

When to call

Tell your midwife, health visitor or GP straight away if you have any of these (NHS list):

• Pain, swelling or redness in the calf muscle of one leg — possible deep vein thrombosis. Redness can be harder to see on brown and black skin.
• Pain in your chest, or difficulty breathing — possible pulmonary embolism.
• Sudden or very heavy blood loss from your vagina, possibly with feeling faint or a rapid heartbeat — possible postpartum haemorrhage.
• A high temperature with a sore and tender tummy — possible infection.
• Headache, changes in your vision, or vomiting — possible pre-eclampsia.

Also contact your midwife or GP if you are losing blood in large clots, if bleeding or discharge smells unpleasant, if you are finding it really difficult to pee, or if poo is leaking. Call your local emergency number (999 in the UK and Ireland, 911 in the US and Canada, 000 in Australia, or 111 in New Zealand) if bleeding suddenly becomes heavy and you feel faint or dizzy.