Your body is still in for some major postpartum changes as it recovers from the pregnancy and labor and adjusts to its new demands, like breastfeeding. Here's a guide on what to expect.
When: Immediately after delivery
Why: Pushing during labor also pushes those extra fluids that you've been carrying to your face and extremities, says Kristina Sole, MD, an associate ob-gyn at the Cleveland Clinic. Indeed, shortly after I delivered my son, Campbell, I inflated like a float at the Macy's Thanksgiving Day parade, as much of the extra fluid that I'd been toting throughout my body for the past nine months spread to my legs.
Women who have c-sections are also likely to find themselves swollen, thanks to the IV fluids they received. Fortunately, within five days of delivery, your kidneys will kick into overdrive, and you'll start peeing and sweating out this water. If your legs, ankles, or feet resemble those of the Stay Puff Marshmallow Man, elevate them above your heart with a pillow while lying down. However, "if the swelling is worse on one side or if pain is involved, you may have a significant problem like deep vein thrombosis, a condition where there is a blood clot that usually occurs in the leg," says Nicole Karjane, MD, assistant professor of obstetrics and gynecology at Virginia Commonwealth University, in Richmond. Contact your doctor immediately if you feel you may have this rare but serious condition.
What: Soreness in your vaginal region
When: From delivery to 6 weeks
Why: Really, wouldn't it be more surprising if you weren't sore? When you give birth vaginally, your perineum (the area between your vagina and anus) will swell and may even tear, or you might have an episiotomy.
"Honestly, I wondered when I would ever be able to sit down again!" says Liz Delizia, of New York City, mother of Morgan, now 2. "You have to look at birth as a trauma to the body," says Joel Evans, MD, coauthor of The Whole Pregnancy Handbook (Gotham). "But the good news is that the body has the ability to repair itself." Recovery time varies, but nearly all new moms see the soreness dissipate within six weeks. Until then, you can sit on doughnut pillows, which provide cushioning but also don't apply direct contact to the vaginal region; sink into a sitz bath, a shallow basin that allows you to soak only your bottom; or relax for a spell in a regular bath. And use the ice packs and witch hazel pads offered in the hospital. They'll help ease the swelling and relieve pain temporarily.
When: From delivery to 6 weeks
Why: After labor, whether you've delivered vaginally or by c-section, your uterus will slough off tissue from its lining, which results in what might seem like a monthlong period. "In most women, it changes from bright or dark red blood to a pink blood, then to a clear or yellowish discharge over the first few weeks," Dr. Karjane says. "Some women will stop bleeding for a day or so, but the bleeding can start up again as you engage in more activity. As long as there is no fever or abdominal or uterine pain, discharge and mild bleeding in the first six weeks is normal."
What: Breast engorgement
When: 2 to 5 days after delivery
Why: Until your system determines how much milk you need to produce and when, your breasts might swell and feel rock-hard. "Most women can tell when their milk comes in," says Dr. Sole. "Your breasts might feel like foreign objects attached to your body." To prevent pain, Dr. Sole recommends wearing a supportive bra, both during the day and at night, nursing your child on demand, applying cold cabbage leaves (their shape can conform to your breasts), and when necessary, pumping out excess milk. For moms who opt not to breastfeed, she suggests avoiding any nipple or breast stimulation, applying cold compresses to help stunt milk production, and wearing a sports bra to help compress your breasts.
What: Bladder dysfunction and incontinence
When: From delivery to 8 weeks
Why: A few days after delivery, you may let out a sneeze or a cough...and yep, a trickle of pee. Slight incontinence is a very common side effect of giving birth, says Roger W. Harms, MD, editor-in-chief of the Mayo Clinic Guide to a Healthy Pregnancy (Collins). Before you got pregnant, your pelvic muscles and ligaments worked together to prevent urinary leakage, but now they've softened and stretched and lack their previous strength. Additionally, your bladder has shifted position, sinking close to the space where the baby came out. All of which means that with each ah-choo, you're involuntarily peeing. "Kegel exercises, in which you tense and release your vaginal muscles, can strengthen those internal muscles and push the bladder back up," Dr. Harms says. "In nearly all cases, this resolves itself within six to eight weeks."
When: The first few days after delivery
Why: In the days that follow delivery, you'll experience cramps that can range from mild to almost contraction-like, as your uterus shrinks back to pre-pregnancy size (a process that may take up to six months). These cramps can be exacerbated by breastfeeding, which stimulates the release of oxytocin, the hormone that causes contractions. Ibuprofen, massage, or a heating pad can help ease the pain, Dr. Sole says.
When: The first few days after delivery
Why: The narcotics used in some epidurals and those that are given during a c-section slow digestion, says Dr. Sole. And don't forget that your rectum is swollen from the pressure exerted on it during delivery; this swelling needs to subside before you can have a bowel movement. To help get things moving, stay hydrated, eat high-fiber foods such as fruits and vegetables, and take the stool softener they give you in the hospital. And even though you fear it may hurt, try to go to the bathroom or you'll get further backed up, Dr. Karjane says.
What: Hair loss
When: 1 to 5 months after delivery
Why: "Around the fourth month after Lily was born, I had an incredible amount of hair falling out," says Missy Jacobs, of New York City. Don't worry: There's no need to invest in Rogaine. "Due to hormonal changes in pregnancy, hair becomes thicker and fewer hairs fall out," Dr. Karjane says. "After delivery, these effects go away. Although the amount of hair loss can be shocking, rarely do women experience extensive hair thinning." Within several months to a year, you should be back to normal.
Loss of Skin Pigmentation
What: Skin lightening
When: Up to or longer than a year
Why: During pregnancy, most women experience some form of hyperpigmentation, such as a linea nigra (the line that runs down your belly) or melasma (darker pigmentation on your face), both of which are believed to be caused by an increase in estrogen. After you've given birth, these lines will fade, Dr. Harms says, but they do so very slowly and they may never disappear entirely. Your best bet: prevention. "These lines can be reawakened with sun exposure, so I always recommend an SPF 30 or higher," Dr. Harms says.
Many moms endure the baby blues, but how do you know if you're among the 10 to 20 percent of women who suffer from the more serious postpartum depression (PPD)? While the baby blues last anywhere from a few days to a few weeks and include symptoms such as crying spells, anxiety, inability to sleep, and quick fluctuations in mood, PPD lingers for much longer and rarely seems to lift. Joel Evans, MD, coauthor of The Whole Pregnancy Handbook (Gotham), explains the risk factors and signs of postpartum depression: