Post-birth changes in the mother

After the birth of your baby, your brain secretes a hormone called oxytocin. This hormone helps to separate and expel the placenta and membranes from the uterus and maintain contraction of your uterus afterwards. It is important your uterus remains contracted following childbirth to reduce the risk of excessive bleeding (postpartum haemorrhage). The action of oxytocin is complemented and enhanced by the injection of the synthetic hormone Syntocinon during active third stage management by your obstetrician and midwife. The baby’s suckling action during breastfeeding also causes the release of oxytocin to keep your uterus contracted.

Once the placenta and membranes have been birthed your uterus should now be empty and the internal walls will have come together to compress the bleeding site where the placenta was attached. The powerful uterine muscle fibres form natural ligatures that bind the bleeding blood vessels within the uterus and further prevent excessive blood loss.

During pregnancy, at full term, the uterus was sitting high up near your ribs. Following childbirth it is now at or just below the level of your umbilicus (belly button). You can feel your own uterus following childbirth by gently pressing down at or below the level of your umbilicus. It should feel firm and well contracted and be in a central position (not beside your belly button). Your midwife will also check the level and firmness of your uterus as part of her/his assessment and monitoring of your condition following birth.

The uterus will increase in size again above the umbilicus and feel less firm or shift sideways if there is any excessive internal bleeding (postpartum haemorrhage), retained fragments of placenta or membranes, or if your bladder fills with urine following childbirth.

Anatomically, the urinary bladder sits on top of your uterus and if full, it can prevent your uterus from contracting well to control bleeding, so it is important to keep your bladder empty following childbirth, even if you don’t feel the urge to pass urine.

Your uterus will continue to shrink in size (this process is called involution) over the next six weeks or more to its non-pregnant size. At about 10 days following childbirth your uterus will rest within your pelvis where it can no longer be felt abdominally.

Over the course of your pregnancy and childbirth, towards the completion of the postnatal period, your amazing uterus will have gone from a size that holds one or more babies, to approximately the size of a pear! Despite the shrinking of the uterus, however, some women will still appear pregnant in the postpartum period. This is because the abdominal muscles have been stretched during pregnancy and will take longer to return to their normal state. Postnatal exercises can assist with this process. Please see the chapter Postnatal wellbeing and support.

Although the uterus is empty and well contracted following childbirth you will still continue to bleed vaginally because the uterus takes time to heal and decrease in size. Most of the bleeding comes from the area inside the uterus where the placenta was attached.

The length of time vaginal loss continues varies greatly among women but the average is around 24 days. Approximately 1 in 10 women will still experience some amount of bleeding by 8 weeks after childbirth. The vaginal bleeding may look like a heavier period for the first few days and then start to change in colour, from red to reddish brown, to pink to a pale colour, over the next six weeks or more, but this will also vary greatly among different women.

Your vaginal loss should not be excessive (e.g. generally not more than one pad soaked in an hour) or contain large or many blood clots or have a bad odour. Your midwife will likely question you about your vaginal loss and/or check your uterus and vaginal loss immediately following childbirth and at intervals during your stay in the hospital. You may experience a gush of vaginal blood loss when you breastfeed your baby due to the release of oxytocin from your brain causing the uterus to contract. This may be accompanied by labour-like pains called after-pains. You can discuss this with your obstetrician and midwife and please let her/him know immediately if you experience anything different from what you might expect, particularly if you experience heavy bleeding.

If you had an epidural in labour it may still be effective immediately following the birth. Once this wears off you will likely start to feel after-pains. Most women will feel after-pains, and women who have had more than one pregnancy and childbirth may experience more painful after-pains.

After-pains may range from feeling similar to period pains to quite painful labour-like contractions, and these may increase with breastfeeding due to further releases of oxytocin making the uterus contract. Your uterus should not be overly tender to touch and the pain should not be constant. The after-pains may also cause more bleeding from your uterus as it contracts and continues to shrink in size. Women who have had caesarean births also feel after-pains.

Depending on your pain relief options during labour and birth and the mode of birthing you underwent, you may also experience pain in the vaginal and perineal area, particularly if you had an assisted birth, or a tear or episiotomy.

If you had a vaginal birth, your vagina may be swollen and bruised. Over the next few days, any swelling usually starts to decrease and your vagina begins to regain muscle tone. Small tears in your perineum that do not require stitches may heal quickly and usually cause little discomfort. You may feel slight stinging when you pass urine. There could also be a degree of swelling and tenderness in the perineal area but please inform your midwife immediately if you feel severe pain, excessive bruising or swelling of your perineum and any gaping of stitches or redness in the area. You can discuss your pain relief options and how to care for your perineal area following childbirth with your midwife. The chapter on Postnatal wellbeing and support discusses perineal care and pelvic floor exercises in more detail.

In addition to the more noticeable physical changes related to birthing the baby, placenta and membranes, your body also undergoes various other changes that might impact on your emotions.

Childbirth is an emotionally intense experience. Initially after the birth, many women feel a sense of relief that the labour is over. Emotions can vary greatly from excitement and elation at the birth and feelings of closeness to the baby and birth partner, to feelings of being overwhelmed and exhausted. All of these are normal and usually settle over time during the postnatal period as mothers adjust to their new role as a mother.

Hormonal changes can also impact your emotions. Because the placenta was a major producer of pregnancy hormones, the levels of pregnancy hormones will fall rapidly over the next few days once the placenta has been birthed. This can lead to changes in your mood.

Different women will react in different ways depending on any pre-existing medical or pregnancy conditions, their experience of labour and childbirth, and their body’s way of adjusting to these changes. About 8 in 10 women will experience the “baby blues” at around the third to fifth day following childbirth and the symptoms can last for a few days to a week. Symptoms include tiredness, tearfulness, anxiety, depression, confusion, headaches, difficulty in sleeping and irritability. The baby blues usually resolve without any medical treatment required. Your midwife will be able to support you and advise you accordingly.

However, it is important to know the difference between the baby blues and the more severe condition called postpartum or postnatal depression. You can find more information about emotions, the baby blues and postnatal depression in Coping with tiredness and emotions in the chapter Postnatal wellbeing and support.

Additionally, if you have experienced any aspect of the birth that has caused you concern during this birth or in the past, it will be very important that you discuss your feelings and debrief your experience of childbirth with your midwife and/or obstetrician soon after the birth. Refer to the chapter Support following complications and unexpected outcomes during labour and birth in the Labour and Birth section.