Your Postpartum Body: 20 Ways It Changes After Baby

"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 women 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.

You may have heard about the vaginal discharge known as lochia, but you weren't expecting it to be so, well, bloody. Although it's not pretty, lochia is only 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 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.

"During pregnancy your body produces roughly 50 percent 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 foot to increase by half a size. 

It can take weeks for all the extra fluids to leave your system. To speed up the process, though, "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.

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 Fort Myers, Fla.-based board-certified plastic surgeon with 30 years of experience in mommy makeovers. 

Your belly undergoes more changes during pregnancy than any other body part. Depending on your age, genetics, and the amount of weight you gain, this can mean stretch marks and excess flab, or a "pooch," postpartum. It can take as long as six weeks for the uterus to revert back to its old size, which will decrease the size of your belly. But since the abdominal skin has been stretched and pulled, it may never again be as taut as it was. 

"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. As for that extra pooch, most experts recommend abdominal work. Targeted abdominal exercise will get most women the results they want with their postpartum body. 

These thin scars on the stomach, hips, breasts, or butt usually start out red 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 nursing, and they're most effective when used soon after childbirth.

As many as 40 percent of pregnant women 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. Varicose veins may improve after childbirth, but they won't go away completely on your postpartum body.

Because it will take some time for the stretched abdomen muscles to become strong again, your body is putting extra weight on the muscles of your back. This can lead to a backache. A new mom can also be suffering from back pain due to poor posture during pregnancy. Generally, these postpartum problems should clear up in the first six weeks after giving birth. If not, you may want to see a chiropractor.

Women who had a vaginal delivery often experience tearing of the perineum (the area between the vaginal opening and anus) or had an 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. A daily postpartum massage will help a scar become more pliant.

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 now 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. Get a feel for targeting the right muscles by peeing and stopping the flow of urine midstream about ten times. "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.

Many moms-to-be don't stick to a regular upper body workout during pregnancy, leading to flabbiness and 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, wait six weeks before starting to exercise again.

"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 Dawson. To shed pounds gradually, experts recommend a mix of exercise and well-balanced nutrition. Low-calorie, high-fiber foods, such as vegetables, promote a feeling of fullness, making it easier to eat less. As for exercise, Flatt recommends moves that work multiple muscles.

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, take one of those crib pads you bought for the baby and place it on your side of the bed to keep the mattress dry.

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 moms also fret that they'll rip their stitches, so they hold it in, which makes 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; they might smart a bit, but 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.

As many as 10 percent of women 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, women are 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. She may want to give you a thyroid test.

Up to 70 percent of expectant moms get melasma (the "mask of pregnancy"). Hormonal fluctuations 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 patients see improvements within a few weeks. (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.)

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, since even topical medicine can pass into breast milk. To be absolutely safe, consider going the natural route: The drying and lightening properties of lemon juice make it an effective spot treatment.

On the energy front, some new mothers say that they feel more energetic than they ever did before pregnancy. In fact, a woman's aerobic capacity can increase up to 20 percent in the first six weeks postpartum. Other women say that the sheer exhaustion of childbirth, caring for a newborn, and excess body weight makes their postpartum body feel sluggish and moody.

Hormones, as well as other physical and emotional changes a postpartum woman 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. Anxiety that escalates to panic attacks (or feelings of hopelessness or being completely overwhelmed) should be discussed early on with your doctor. This may be a sign of postpartum depression, which can be treated with medication.

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.

Call your doctor immediately if you experience any of the changes on this list during the six weeks after you give birth, since they can signal a health problem.

• Chills or fever of 100.5 degrees or higher
• Sudden heavy bleeding (soaking more than one pad an hour) or lots of large clots
• Foul-smelling vaginal discharge
• Severe pain or redness surrounding, or discharge from, a C-section incision or an episiotomy (this could indicate infection)
• Fainting, nausea, or vomiting
• Frequent urination or burning with urination
• Constipation that lasts three days or more
• Swelling, redness (or red streaks), and pain in your breasts, accompanied by fever
• A tender, swollen, or red area anywhere in your leg or calf (this could indicate DVT)
• Persistent headaches or vision changes
• Excessive swelling of the face, fingers, or feet
• Intense sadness or feeling that you can't care for yourself or your baby