5 Things I Wish I'd Known About Postpartum Cramping

I thought I was prepared for childbirth. But no one warned me about postpartum cramping.

Young adult woman with stomach pain laying down
Photo: Burak Karademir/Getty Images

A planner by nature, I wanted to be as prepared as I could be for pregnancy, labor, birth, and postpartum recovery. I thought I'd researched it all but after my first baby was born, I was still in a lot of pain.

Turns out, what I was experiencing was actually postpartum cramping (sometimes referred to as after-birth pain). I was completely unprepared not just for them to happen (why didn't anyone warn me??) but also for how much they could hurt.

After going on to experience postpartum cramping with each of my next three pregnancies, I finally realized that not only is postpartum cramping very real, but it can be extremely intense for some people. Postpartum cramps are a real thing, so why aren't more people talking about them?

Here's what I wish someone had told me about postpartum cramping.

What Is Postpartum Cramping?

Postpartum cramping are uterine contractions, similar to what you might experience during labor, but on a smaller scale. These less-intense contractions are triggered by oxytocin and help return your uterus to pre-pregnancy size.

1. Postpartum Cramping Can Feel Like Labor

For me, postpartum cramping pain was very similar to contractions or really bad menstrual cramps. It felt like a fire in my pelvis and lower back that came and went with timed surges. It was intense, and at times, almost as intense as labor. I just assumed the 12-plus hours of labor that ended in a dramatic episiotomy and quick delivery was to blame.

But I experienced the same pain after my second child, and again after I had my third. By the time I had my fourth child, the pain had intensified, and I knew this was no fluke.

I had not learned about postpartum cramping in my pre-childbirth research, but when I talked to my mom, who had four children of her own, I learned that she also experienced them, and she knew right away the name of the pain I was feeling.

2020 research has found that there may be a genetic link for how some pregnant people experience pain during labor, so perhaps there is a genetic link to after-birth pain and postpartum cramping as well.

2. Postpartum Cramping Is Normal

While postpartum cramping can be very painful, the experience is also very normal, says Rachel Borton, Ph.D., F.N.P., director of the Family Nurse Practitioner (FNP) online program and assistant professor of nursing at Bradley University.

The cramping is caused by the uterus shrinking back to its normal, smaller size explains Dr. Borton. Typically, the process of your uterus shrinking back down to its pre-pregnancy size can take around six weeks, but for some people, it can take even longer than that.

3. Postpartum Cramping = Contractions

What causes postpartum cramping? You guessed it: Oxytocin, the hormone that causes contractions during labor, is also responsible for after-birth contractions as well.

Oxytocin is also released during breastfeeding and chestfeeding, so if you're pumping or nursing, you may experience an increase in postpartum cramping when your baby is eating. Parents who have given birth via C-section can also experience postpartum cramping.

These contractions can happen in every uterus, but the pain is individual.

"Not all people experience postpartum cramps," says Sharyn N. Lewin, M.D., FACS, FACOG, a board-certified gynecologic oncologist, women's health and wellness specialist, and medical director at Holy Name Medical Center's gynecologic oncology division in Teaneck, New Jersey. "For the majority, discomfort is mild and relieved with Motrin or Tylenol," she adds.

4. Postpartum Cramping Happens More in Later Pregnancies

It turns out my experience of my postpartum cramps being more painful after subsequent births is relatively common, too. "Sometimes with first-time deliveries, they aren't as noticeable, but typically with the second delivery the body is quick to remember, and [people] will report that pain quickly and a little more severe," says Dr. Borton.

They are also more likely for people who are carrying multiple babies. "Afterpains are more common when the uterus was over-distended," explains Dr. Lewin.

5. Postpartum Cramping Pain Can Be Treated

Thankfully, afterbirth pain doesn't usually last as long as it takes for the uterus to go back to its normal size. The cramping "typically only lasts two to three days following delivery," says Dr. Borton. Dr. Lewin confirms that postpartum cramps are typically "mild," and they should "resolve within one week of delivery."

There are also ways to ease the pain, and people experiencing afterbirth pain can opt for over-the-counter medicine. Dr. Borton says non-steroidal anti-inflammatory drugs (NSAIDs), such as Advil or Motrin (ibuprofen), as well as painkillers like Tylenol (acetaminophen) are usually enough to ease the pain, and they're safe to take while nursing.

The same tricks that work during a painful period or early labor can help bring comfort, too. Think of things like applying a heating pad or a hot water bottle on your lower abdomen.

After my fourth pregnancy, I opted for both a compression garment, which Dr. Lewin agrees is safe to use after delivery, as well as NSAIDs, and that made the postpartum cramping pain level far more tolerable.

When to Call a Doctor About Postpartum Cramping

Most times, postpartum cramping is mild and can be relieved with an over-the-counter pain reliever. But there are times when afterbirth cramps may be a cause for concern.

When to Call a Doctor

Dr. Borton says you should call a doctor for your postpartum cramping if you notice:


  • The cramps are not relieved by Motrin (ibuprofen) or Tylenol (acetaminophen).
  • The cramping feels like a sharp, stabbing pain.
  • You notice any unusual vagina discharge or smell.
  • You have a fever.


Dr. Lewin adds that any temperature at or above 100.4 degrees Fahrenheit for at least two days within the first 10 days of giving birth (but not including the first 24 hours after birth) is a cause for concern, whether you're experiencing postpartum cramps or not.

"This [symptom] requires workup by your physician," says Dr. Lewin.

Key Takeaways

The bottom line is that if you were also caught off guard by the postpartum cramping when you thought you read and researched it all, you're not alone.


Postpartum cramping is one part of labor and birth that we don't talk about enough, and since it seems to impact parents during subsequent pregnancies, we have to remember that even if we've gone through this before, every labor, birth, and recovery is different.


Don't be afraid to speak up to your delivery nurse if you experience postpartum cramping because there are ways you can relieve your pain.

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Sources
Parents uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Relief of Pain Due to Uterine Cramping/involution After Birth. Cochrane Database of Systematic Reviews. 2020

  2. Genetic Variant May Explain Why Some Women Don’t Need Pain Relief During Childbirth. Cell Reports. 2020. 

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