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Bleeding, healing, the warning signs to know before you leave hospital, how you feel, contraception from day 21, and what the six-week check should actually cover.
Reviewed by Dr. Grishma Ranjangaonkar, MBBS, DGO, ICOG Fellowship in Gynecological Endoscopy · Eva WomanCare Clinic, Vashi
Antenatal care is thorough and postnatal care usually is not. This guide is about you rather than the baby: what is normal in the weeks after birth, which symptoms need to be seen the same day, how healing actually goes for a tear or a caesarean, and the two things almost nobody is told in time, which are pelvic floor exercises and contraception by day 21.
Antenatal care is thorough and postnatal care, almost everywhere, is not. Enormous attention goes into the forty weeks before the birth and comparatively little into the twelve weeks after it, which is when most women feel least prepared and least well. This guide is about you rather than the baby, because that is the part usually left out.
The bleeding after childbirth is called lochia. It is heavier than a period at first, becomes lighter and browner over days to weeks, and then stops. Most women bleed for two to six weeks, and a sudden increase after several days of settling is worth reporting rather than watching.
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Roughly when
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What is expected
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What is not
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The following are the symptoms every woman should be told about before she leaves hospital, and very often is not. Each has a specific serious cause behind it, and none of them should wait for the six-week appointment.
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Symptom
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What it could indicate
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Shower the perineum daily, change pads frequently, and wash your hands before and after. Pain should reduce week by week. Pain that is not settling, that needs more medication rather than less, discharge with a strong or unpleasant smell, swelling, or a wound that appears to be coming apart all need review. A wound breakdown should be seen the same day. Persistent perineal pain is associated with low mood and with difficulties later, so it is not something to endure quietly.
Keep the wound clean and dry, look at it daily, and watch for redness spreading, increasing pain, discharge or a temperature. Support the abdomen with a pillow when you cough or laugh. Avoid lifting anything heavier than the baby for the first few weeks. Numbness above the scar is normal and can last months. The scar itself keeps changing for a year.
Cramping while feeding, particularly in the first few days and particularly after a second or third baby, is the uterus contracting back down. It is normal, it is strongest during feeds because of the hormone released then, and it settles within about a week.
Passing urine can sting at first and constipation is very common, made worse by iron and by codeine. Fluids, fibre and a stool softener are worth using early rather than heroically going without. Leaking urine when you cough or laugh is common and is not something to accept permanently: it responds well to pelvic floor physiotherapy, and it should be raised at the six-week check if not before.
Start them in the first days, gently, and keep going. They are the single most useful thing you can do for the next thirty years of continence and prolapse risk, they cost nothing, and they are the recommendation most often mentioned once and never followed up.
Engorgement around days three to five is normal and settles. Cracked nipples usually mean the latch needs adjusting rather than that you are doing it wrong, and that is fixable with help. A red, hot, painful area of breast with fever is mastitis. If it is still worsening after 24 hours of feeding through it and self-care, it needs seeing.
Emotional wellbeing is assessed at every postnatal contact, and it is meant to be asked about directly rather than left for you to raise. Feeling tearful, overwhelmed and unlike yourself in the first week or two is extremely common and usually settles. What matters is the pattern afterwards.
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The first week or two
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Worth talking to someone about
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This is the section most often skipped and the one with the clearest rule attached. Ovulation can return before your first period, so waiting for a period to reappear is not a plan.
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Method
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When it can start
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Notes
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On spacing: leaving some time between a birth and the next pregnancy gives your body a chance to restore iron stores and heal, and it reduces the risk of complications in the next pregnancy. If you had a caesarean, the interval before the next pregnancy matters more, and it is worth asking your own doctor for a figure based on how your surgery went rather than taking a general one from the internet.
Myth
“You cannot get pregnant while breastfeeding.”
What is actually true
You can. Breastfeeding is genuinely effective contraception only when three conditions hold at once: fully breastfeeding, no periods yet, and under six months since the birth. If any one of them stops being true, the protection stops with it. Contraception is needed from day 21 regardless.
Myth
“You have to wait until the six-week check to do anything.”
What is actually true
The six to eight week appointment is a review, not a starting gun. Pelvic floor exercises start in the first days. Walking starts in the first days. Contraception starts by day 21. And anything on the warning list is seen the same day rather than saved up for the appointment.
Myth
“Leaking urine after a baby is just something you live with.”
What is actually true
It is common and it is treatable. Pelvic floor physiotherapy works well, and the earlier it starts the better it works. Accepting it permanently at thirty is what leads to surgery at sixty.
Myth
“Feeling low means you are not bonding.”
What is actually true
It means you are exhausted, your hormones have shifted enormously and you may be unwell in a specific, treatable way. Postnatal depression and anxiety are common and respond well to treatment. Feeling this way says nothing about the kind of mother you are.
Myth
“A caesarean means you cannot have a vaginal birth next time.”
What is actually true
For many women a vaginal birth after a caesarean is a reasonable option, depending on why the first one was done, how the scar healed and what your circumstances are next time. It is a discussion with your obstetrician rather than a closed door.
At six to eight weeks after the birth there should be a proper assessment, and it is meant to be about you rather than a quick look at the baby. If yours was five minutes and a weight, ask for the rest.
The warning signs, the advice on postpartum bleeding and perineal healing, and the content of the six to eight week assessment follow NICE guideline NG194 on postnatal care. Timing of contraception after childbirth and the lactational amenorrhea criteria follow the FSRH guideline on contraception after pregnancy. This guide is general information and does not replace advice from your own doctor or midwife, who know your history and your delivery.
Every method compared, including which can start immediately after birth and which wait.
For when your cycles return, and how to tell whether what comes back is normal.
Plot weight, length and head circumference against the WHO standards, from birth.
The pregnancy counterpart to the warning list in this guide, sorted by urgency.
The six to eight week appointment is a review, not a waiting period. Bleeding that increases, a wound that is not healing, a headache that will not shift, leaking urine, or feeling persistently low are all reasons to be seen sooner, and all of them are easier to treat early.
