Your Body After Birth: Physical Recovery

The First Days and Weeks

The immediate postnatal period is physically demanding in ways that are rarely described honestly. You are recovering from a significant physical event while simultaneously caring for a newborn, adjusting to disrupted sleep, and navigating a dramatic hormonal transition. Being gentle with yourself about the pace of recovery is not indulgence — it is physiology.

Lochia

Lochia is postpartum vaginal bleeding that follows birth regardless of whether the delivery was vaginal or by caesarean. It typically begins heavy and red, resembling a heavy period, and gradually lightens in colour and flow over 4–6 weeks. It is normal for lochia to increase temporarily when you become more active, or during breastfeeding (which stimulates uterine contractions). Contact your midwife if bleeding suddenly becomes significantly heavier, develops a foul smell, or is accompanied by fever — these can be signs of retained placenta or infection.

Perineal recovery after vaginal birth

Perineal soreness and swelling are common after vaginal birth, and significant if there was tearing or an episiotomy. Ice packs wrapped in cloth, cold gel pads, arnica gel, and sitting on a valley cushion can help in the first days. Salt baths soothe and support healing. Taking regular pain relief (paracetamol and ibuprofen, if appropriate) matters — being in significant pain makes everything harder. If your tear or repair feels particularly sore, smells unpleasant, or you develop a temperature, contact your GP or midwife.

Postpartum sweating

Night sweats in particular can be dramatic in the first weeks. The body is disposing of the extra fluid retained during pregnancy, and elevated oestrogen levels are falling rapidly. Sleep on a towel, keep a change of pyjamas nearby, and know that it resolves on its own — usually within two to six weeks.

Breast changes

Whether or not you are breastfeeding, your breasts will change significantly in the first weeks. Engorgement as milk comes in (days 3–5) can be uncomfortable and is managed by feeding frequently if breastfeeding, or by wearing a firm, supportive bra and applying cold compresses if not. If you are not breastfeeding and engorgement is severe, speak to your GP — medication to suppress lactation is available.

Your Pelvic Floor: The Full Story

The pelvic floor — the group of muscles, ligaments, and connective tissue that support the bladder, bowel, and uterus — is significantly affected by pregnancy and birth. Both vaginal delivery and caesarean section can affect pelvic floor function, because it is the weight of pregnancy and the hormonal changes during gestation, as much as the delivery itself, that create the vulnerability.

Pelvic floor dysfunction — which includes stress urinary incontinence (leaking when you sneeze, cough, or exercise), urgency incontinence, pelvic organ prolapse, and pain during sex — is extremely common after birth. It is also dramatically under-treated, because many people accept it as inevitable, are embarrassed to raise it, or are not aware that effective treatment exists.

Pelvic floor exercises: starting now

Pelvic floor exercises (Kegel exercises) can begin within 24 hours of birth, including after caesarean. Start gently — the goal initially is simply to reconnect with the muscles after the impact of birth. A pelvic floor exercise involves squeezing and lifting the muscles around the vagina, urethra, and anus, holding for a few seconds, and releasing fully. Ten repetitions, three times a day, is the standard starting point. Progress to longer holds as strength returns.

When to ask for physiotherapy

If you are experiencing any leaking (even occasional), pelvic heaviness or dragging (a sign of prolapse), pain during sex, or difficulty returning to exercise, ask your GP for a referral to a pelvic health physiotherapist. The 6-week check does not assess pelvic floor function — you need to raise it explicitly. NHS pelvic health physiotherapy is effective, available, and does not require you to wait until symptoms are severe.

Caesarean Section Recovery

A caesarean section is major abdominal surgery, and recovery is more significant and longer than is often communicated in postnatal care. The external wound typically heals in 4–6 weeks; internal healing continues for several months. Taking recovery seriously — rather than trying to match the pace you might manage after a straightforward vaginal birth — makes a real difference to outcomes.

• Wound care — keep the wound clean and dry. A shower rather than a bath for the first few weeks. Pat dry gently rather than rubbing. Watch for signs of infection: increased redness, warmth, swelling, discharge, or a temperature.
• Movement — the log-roll technique (rolling onto your side before sitting up) significantly reduces pain when getting in and out of bed. Move gently, but do move — light walking from the first day supports recovery and reduces DVT risk.
• Lifting restrictions — avoid lifting anything heavier than your baby for at least four to six weeks. This is not overcaution; it protects healing abdominal muscles and reduces the risk of wound dehiscence and hernia.
• Driving — most medical advice suggests waiting at least six weeks and ensuring you can perform an emergency stop comfortably before returning to driving. Check with your own GP and your insurance.
• Pain management — regular paracetamol and ibuprofen (as prescribed) are important, particularly in the first one to two weeks. Pain that is not managed is not strength; it is an obstacle to recovery and to caring for your baby.

Symptoms People Are Often Not Warned About

Some of the most common postnatal physical experiences are inadequately covered in standard postnatal care, which means many people encounter them with alarm rather than recognition. Here are the ones worth knowing about in advance.

Postpartum hair loss

Telogen effluvium — a temporary, hormonally-driven hair loss — typically begins around two to four months postpartum and can be dramatic. It resolves on its own by around nine to twelve months in most cases, and the hair grows back fully. No treatment is required, though a gentle approach to washing and styling during this period is sensible.

Afterpains

Afterpains — uterine contractions as the uterus returns to its pre-pregnancy size — are particularly noticeable during breastfeeding (when oxytocin release stimulates contractions) and are more intense with each subsequent birth. They typically resolve within a few days. Paracetamol and ibuprofen help; a warm wheat bag over the abdomen also provides relief.

Joint hypermobility and instability

Relaxin — the hormone that loosens ligaments during pregnancy to allow the pelvis to expand — remains in the body for up to five months after birth (longer if breastfeeding). This means joints, particularly the pelvis, hips, and knees, may feel unstable or uncomfortable. High-impact exercise should be reintroduced gradually, and any significant joint pain is worth raising with your GP.

Postpartum haemorrhoids

Haemorrhoids (piles) are very common after vaginal birth, due to the pushing phase of labour, and during pregnancy due to increased venous pressure. They are uncomfortable but usually resolve on their own. Treatment includes topical creams (available over the counter), a high-fibre diet and good hydration to prevent constipation, and witch hazel compresses for immediate relief. Significant or persistent haemorrhoids are worth raising with your GP.

The 6-Week Check: What to Raise

The 6-week postnatal check with your GP is an opportunity that many people leave without raising the things they most needed to discuss. The appointment is often brief, and it can feel difficult to bring things up unprompted. Going in with a list of what you want to cover helps enormously.

• Your mood and mental health — the GP should ask about this, but be ready to raise it yourself if they do not.
• Any physical symptoms — perineal pain that has not resolved, wound concerns, pain during or anticipating sex, leaking, pelvic heaviness.
• Contraception — you can become pregnant before your first postnatal period. If you are not planning a pregnancy, discuss contraception options. Some methods interact with breastfeeding.
• Return to exercise — get specific advice rather than a blanket clearance. High-impact exercise (running, HIIT) is not typically recommended before 12 weeks, and not before pelvic floor function has been assessed.
• Anything else that has been worrying you — the appointment is for you. Use it.