20 Things to Know About Your Postpartum Body

Body Aches

"With all the pushing and contortions of labor, it's natural to feel washed out, tired, and achy," says Julian Robinson, M.D., an assistant professor of obstetrics and gynecology at New York-Presbyterian Hospital, in New York City.

As your uterus contracts back to size, many postpartum people feel abdominal aches and flutters (somewhat akin to menstrual cramps) that grow more pronounced during breastfeeding. However, the discomfort should last only a few days and can be treated with a prescription or over-the-counter painkillers.

Vaginal Discharge

You may have heard about the postpartum vaginal discharge known as lochia, but you weren't expecting it to be so, well, bloody. Although it's not pretty, lochia is just benign leftover blood, mucus, and tissue from your uterus. No matter how you deliver, the flow can be as heavy as, if not heavier than, your period.

Tampons and other internal menstrual products can put you at risk for infection or cause pain or irritation, so use heavy-duty pads instead. "For the first few days after delivery, expect to change your pad every couple of hours," says Eileen Ehudin Beard, a nurse-midwife and family nurse-practitioner in Silver Spring, Maryland. The amount of discharge should decrease from there.

According to the March of Dimes, it is normal to experience lochia for up to a month or more as your uterus goes from 2.5 pounds to 2 ounces in size in the first few weeks of postpartum recovery.

Swollen Feet and Extremities

"During pregnancy, your body produces roughly 50% more blood and other fluids than normal to accommodate your growing baby," says Lyssie Lakatos, R.D., C.D.N., C.F.T., a personal trainer and nutritionist in New York. Hormone fluctuations can also contribute to edema, or swelling of the hands, face, ankles, neck, and other extremities. In fact, it's normal for your feet to increase by half a size.

It can take weeks for all the extra fluids to leave your system. To speed up the process, "choose foods rich in potassium, such as fruits and vegetables; it helps counteract the water-retaining effects of sodium," says Lakatos. She also suggests drinking more than the recommended eight glasses of water per day, especially if you are nursing.

A few other things you can try include:

• Avoiding sitting or standing for more than 30-60 minutes at a time
• Avoiding salty foods and opting for low sodium when possible
• Elevating your legs and feet throughout the day
• Wearing compression socks to reduce swelling

Enlarged Breasts

Your breasts will probably become flushed, swollen, sore, and engorged with milk for a day or two after birth. Once this swelling goes down, in about three to four days (or until you stop breastfeeding), your breasts will probably begin to sag as a result of the stretched skin. You may also experience milk leakage for several weeks, even if you don't breastfeed. The nipple may also look displaced.

"Once pregnancy and nursing end, most women lose breast volume, retain stretch marks, and experience some sagging," explains Robert Brueck, M.D., a board-certified plastic surgeon in Ft. Myers, Florida.

Postpartum breast engorgement or enlargement is normal, but it can be painful. If you are not nursing or pumping, you can help ease the discomfort by using cold compresses to reduce pain and swelling and wearing a supportive bra. If you are nursing or pumping, you can try a warm shower or compress, gentle massage, and even pumping to help get the milk moving.

Pronounced Stomach Pooch

Your belly undergoes more changes during pregnancy than any other body part. Depending on your age, genetics, and the amount of weight you gain, these changes can mean stretch marks and excess skin and fat (or a "pooch") postpartum. That bulge is likely the result of pregnancy-related distension and laxity of the abdominal wall, particularly the fascial layer beneath the muscles, which is the strongest layer that keeps your internal organs in.

It can take as long as six weeks for your belly to start looking normal again. But since the abdominal skin has been stretched and pulled, it may never again be as taut as it was. Abdominal muscles also stretch and separate during pregnancy, which can result in a condition known as diastasis recti.

"Keeping the core muscles [abdominals and back] strong during pregnancy helps the abdominals recover faster," says Megan Flatt, a trainer and fitness educator in San Francisco and creator of Bump Fitness, a prenatal and post-baby workout program.

Stretch Marks

These thin scars on the stomach, hips, breasts, or butt usually start out red, purple, or dark brown and then lighten within a year. "Whether you get stretch marks depends a lot on genetics and how quickly you gain weight," says David J. Goldberg, M.D., director of laser research in the department of dermatology at Mount Sinai School of Medicine, in New York City.

Prescription topical ointments like tretinoin cream can diminish the stretch marks, but they're not safe to use while you're pregnant or nursing, and they're most effective when used soon after childbirth.

In one study, researchers found that stretch marks cannot be prevented, but their severity can be reduced by using moisturizers during pregnancy. They also found that products that claim to have specific ingredients to get rid of stretch marks and scars are not effective.

Varicose Veins

As many as 40% of pregnant people develop dilated blood vessels near the skin's surface, most often on the calves and thighs. "Heredity, hormones, and the pressure on the veins of pregnancy pounds all play a role," says Lisa Masterson, M.D., an OB-GYN at Cedars-Sinai Medical Center in Los Angeles.

While the condition is usually temporary and varicose veins may improve after childbirth, it can take up to 12 weeks postpartum to clear up. During pregnancy your body will increase its blood volume, which puts pressure on the veins, making it easy for hemorrhoids and varicose veins to develop.

According to Ceders-Sinai, it is safe to use sitz baths, cold packs, and stool softeners to find relief. Your doctor may even be able to prescribe medications to help ease the discomfort.

Back Pain

Because it will take some time for your core to become strong again, your body is putting extra weight on the muscles of your back, which can lead to a backache. Postpartum people can also experience back pain due to postural changes of pregnancy and frequent hunching over the newborn for holding and feeding. Generally, these postpartum problems should clear up in the first six weeks after giving birth. Being mindful of posture, using a postpartum support binder, doing exercises to strengthen your core, and seeing a chiropractor or physical therapist can help reduce back pain.

Vaginal Pain and Tearing

Those who have a vaginal delivery can experience tearing of the perineum (the area between the vaginal opening and anus) or episiotomy (a surgical incision through the perineum), both of which need at least six weeks to heal.

To help prevent a tear in the perineum, Suzanne Aceron Badillo, P.T., W.S.C, clinical program director of the Women's Health Rehabilitation Program at the Rehabilitation Institute of Chicago, suggests a daily massage of the area in the final weeks of pregnancy.

Another way to prevent tearing is to use a warm compresses on the perineum in between pushing during labor.

Urinary Incontinence

Toward the end of your pregnancy, the weight of your baby puts a strain on your pelvic floor muscles, which help support your bladder control. Those weakened muscles may cause you to leak a bit of urine when coughing, sneezing, or lifting something heavy.

Kegel exercises, which help to strengthen your pelvic muscles, are the best method for preventing leaks. Do kegels throughout the day by contracting and releasing these muscles.

"Start doing these exercises as soon as you give birth, ideally every time you urinate, and try holding the squeeze for a few seconds longer each time," advises Rakhi Dimino, M.D., an OB-GYN at The Woman's Hospital of Texas, in Houston. By the end of the first month or so, you should start to notice an improvement.

Sore, Weak Arms

Many parents-to-be don't stick to a regular upper body workout during pregnancy, leading to weakness. Additionally, your body produces the hormone relaxin in larger amounts during pregnancy, and this can weaken the joints afterward. Sore wrists, aching shoulders, and tired arms are all part of the postpartum body package.

Toning and strengthening the arms, back, and shoulder muscles can help relieve strain on your upper body. The best time to start is during pregnancy, says Flatt. After giving birth, you can begin exercising when you feel comfortable again (with a doctor's approval), keeping lifting restrictions in mind.

Thicker Thighs and Legs

"During pregnancy, very often a woman's activity and nutrition levels go down," says OB-GYN Michael Dawson, M.D., of Atlanta Women's Specialists. "These factors mean you gain weight. The extra fat then gets distributed to places where women most often put on weight: the backside, hips, and thighs."

It can take up to a year to lose the weight gained during pregnancy, says Dr. Dawson. To lose weight gradually, experts recommend a mix of exercise and well-balanced nutrition. High-protein, high-fiber foods promote a feeling of fullness and keep blood sugar levels stable, which makes it easier to eat reasonable amounts of food and helps your metabolism be more efficient. As for exercise, Flatt recommends moves that work multiple muscles.

Night Sweats

Night sweats in the first days after labor are part of your body's natural hormonal-adjustment process. You're still retaining lots of fluid from pregnancy, and sweating is one way your body expels it. The sweats should dry up in a few days, but in the meantime, keep comfortable by wearing breathable PJs and using fewer blankets.

On top of feeling uncomfortably sweaty, you may also feel irritable—and who would blame you? To help feel a little less clammy, try a few of these quick remedies:

• Sleep in your underwear or light, cotton pajamas.
• Open a window or lower the thermostat at night.
• Avoid caffeine and spicy foods when possible.
• Place a cold washcloth on the back of your neck.
• Try using a meditation app to help feel relaxed.

Constipation

After you give birth, it can take two to three days to have a bowel movement. Weakened ab muscles, bowels traumatized from delivery, or use of narcotic painkillers can cause the backup. Many parents also fret that they'll rip their stitches, so they hold it in, which can make matters worse.

To keep things moving along, have at least eight glasses of water a day plus plenty of fiber-rich fruits, vegetables, and whole grains. Try not to worry about those stitches; it's rare for them to tear, and resisting the urge to go can make you even more constipated. Walking around will help too. Just limit any strenuous activities, particularly if you've had a C-section.

Hair Loss

Many parents experience hair loss after pregnancy, the result of a drop in hormone levels. But relax—you aren't as bald as you feel. In fact, hair often thickens during pregnancy; in the months after giving birth, you're simply shedding that extra hair, explains obstetrician Shari Brasner, M.D. Things should return to normal after three months or so, but if your brush continues to resemble a small furry animal, consult your doctor. They may want to give you a thyroid test.

Skin Discoloration

Up to 70% of expectant parents get melasma (the "mask of pregnancy"). Hormonal fluctuations can cause these dark patches on the forehead, cheeks, and upper lips that often fade postpartum but don't go away completely.

Prescription bleaching creams, steroids, and tretinoin (the main ingredient in Retin-A) work either alone or in combination. Many people see improvements within a few weeks of treatment. (The downside: These creams can cause temporary redness, peeling, and dryness; you can't use them while you're nursing or pregnant; and not all insurance companies cover them.)

Acne

The same hormones that cause some infants to develop acne may also affect your complexion, says Dr. Dimino. While your skin usually clears up on its own by your six-week postpartum visit, you may be able to speed things along by using an over-the-counter acne cream with salicylic acid. But talk to your doctor first if you're nursing.

To be absolutely safe, consider going the natural route: The drying and lightening properties of lemon juice make it an effective spot treatment.

Change in Energy Levels

On the energy front, some new parents say that they feel more energetic than they ever did before pregnancy. In fact, your aerobic capacity can increase up to 20% in the first six weeks postpartum. Others say that the sheer exhaustion of childbirth, caring for a newborn, and excess body weight make their postpartum body feel sluggish and moody.

To increase your energy levels, try a few of these ideas:

• Start a workout routine.
• Get plenty of sleep.
• Eat a healthy diet.
• Stay hydrated with plenty of water.
• Manage your stress.

Anxiety

Hormones, as well as other physical and emotional changes a postpartum person experiences, can cause you to become anxious or have nightmares, says Dr. Dimino. As long as the anxiety doesn't get in the way of caring for your baby, doctors generally advise waiting for it to subside on its own rather than turning to medication.

If the anxiety is interfering with your relationships or ability to perform your responsibilities, you should speak to a doctor about treatment.

Postpartum anxiety and depressive disorders affect 20% of birthing people. Symptoms like panic attacks, severe insomnia, obsessive thoughts or compulsions, or suicidal ideation are serious and should be addressed right away by your health care team.

C-Section Scar

Though most C-section scars fade to a pencil-thin line in a year or two, they never completely disappear. "The key to making scars less visible is treating them early," says Debra Jaliman, M.D., a clinical instructor of dermatology at Mount Sinai School of Medicine, in New York City.