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In the hours, days and weeks after you give birth, there’s a certain running commentary in your brain, at least part of the time. It tends to veer from a kind of hell, yeah pride (“I made an actual tiny human with my actual body!”) to a shocked disbelief at the changes your body is going through yet again (“FFS, what is that trickling down my...” and “this can’t be right…” and “oof, why does that hurt?”).
Your body undergoes a major transformation during pregnancy—and an equally major one after labour and delivery. And while there’s plenty of week-by-week information about your growing belly, your health and body after birth often get overlooked, as you cope with the admittedly big issues of caring for baby and functioning on little sleep. Trish Perrin Chang*, the Mississauga, Ont., mother of four-month-old Eric*, says she felt completely blindsided by her post-baby body, which included lots of vaginal bruising from a long, rough labour and delivery, episiotomy stitches and brief Hulk-like swelling in her legs and feet. “I did all my reading on being pregnant and our delivery options, all of that, but I realize now I was really unprepared for afterwards,” she says. “I was healthy and strong while I was pregnant, so maybe that’s why I felt kind of defeated after delivery.”
So while, yes, there is a ton of stuff to learn about being pregnant, delivering and caring for your sweet babe, it’s also crucial to do some homework on those early days after birth. A number of studies have found that when moms feel unprepared or are struggling to cope with all the changes to their physical health after they’ve had a baby, they are more likely feel overwhelmed, stressed, anxious or depressed—which is the very opposite of how you want to feel as a new mom.
Giving birth is deeply awesome, but giving yourself the tools and time to restore your nutrient levels, hormones, muscles and everything else is going to affect how you experience the early days of motherhood.
Here’s your cheat sheet to your body after baby.
It’s no wonder you don’t feel like the old you—your life has changed drastically and so have your hormones, at least for a little while. “Some of your hormones go from the highest they ever will be to the lowest, just before delivery to just after,” says Ann Dunnewold, a Dallas psychologist and co-author of Life Will Never Be the Same: The Real Mom’s Postpartum Survival Guide. Right after giving birth, your estrogen and progesterone levels drop dramatically, which can contribute to the “baby blues” (mood swings, anxiety, sadness or irritability, which resolve within a week or so of birth) or postpartum depression (similar symptoms that are more intense, last longer and interfere with your daily life).
Meanwhile, oxytocin, which is called the “bonding hormone,” floods your system right after delivery. “It turns on mothering behaviour, and one aspect of that behaviour is being able to see danger in your child’s world,” says Dunnewold. “So when oxytocin goes up, so can anxiety.” These hormones influence one another in a complex dance and affect your energy and mood, she explains. Your body could use more progesterone, which is a natural anti-anxiety substance, but it’s low right after birth. “So you can see how that combination can lead to postpartum anxiety.” Dunnewold adds that for milder mood problems, it can be helpful to realize and accept, “Hey, my hormones are giving me a run for my money here,” rather than beating yourself up with “Why can’t I get it together?” It’s totally OK to feel all over the place with your mood for several months, as your hormones eventually level out. And if you’re struggling, be sure to talk to your midwife or doctor, or a counsellor to discuss ways to deal.
Thyroid hormones, which help regulate body temperature, metabolism and organ function, can be affected by giving birth, too. According to the American Thyroid Association, five to 10 percent of women have postpartum thyroiditis, an inflammation of the thyroid gland, and the exact cause isn’t known. Symptoms can include insomnia, anxiety, rapid heart rate, fatigue, weight loss and irritability (one to four months after birth) or fatigue, weight gain, constipation, dry skin and depression (four to eight months after birth). Your doctor can monitor your thyroid levels with blood tests and prescribe medication if necessary.
Hormones also do a number on your brain structure, and not necessarily how you’d expect. Check this out: In one small study in New Haven, Conn., researchers did MRI scans of women’s brains shortly after birth and again several months later. They found increases in the amount of grey matter (that is, extra brain cells and nerves—take that, “baby brain”!). The various brain areas affected are responsible for helping to both activate your mama instincts of fierce love, protection and worry, and to fine-tune your response to your baby’s cries and expressions. (Seriously, how cool is this?) Because the research is so new, it’s not clear whether those changes are short or long term.
And it’s not just your mental state that’s altered—hormonal changes affect your bones and joints, too. During pregnancy, your body makes a hormone called relaxin, which makes all of your joints looser. It can take up to five months for joints to return to their earlier stability, so stick to lower-impact exercise if your joints are sore. Feel like your shoes don’t fit right anymore? Relaxin combined with weight gain during pregnancy may make your feet slightly bigger and your arches a bit flatter, sometimes permanently. Your hips may stay wider, too.fizkes/ Getty Images
Feeling shaky and exhausted is pretty common in the first few weeks after delivery (hello, multiple wake ups every night), but these symptoms can also be linked to low iron levels. “New moms are at higher risk of iron deficiency following childbirth, due to blood loss during delivery,” says Sarah O’Hara, a Calgary registered dietitian who specializes in pre- and postnatal care. Her advice: Keep taking a prenatal multivitamin with iron for the length of time you’re breastfeeding, or if you’re not breastfeeding, for as long as you have post-delivery bleeding. Plus, eat iron-rich foods, such as red meat, fortified whole-grain products, beans, lentils and leafy greens. You should feel better within a couple of weeks of boosting your iron intake, but more severe deficiencies (indicated by shortness of breath, pale skin, dizziness, a swollen tongue, cold hands and feet or cravings to eat non-food items like ice cubes) may take longer to sort out. You can ask your doctor to order a blood test to check your iron levels.
If you’re breastfeeding, you need vitamins A, E, C and B complex, choline, chromium, copper, iodine, selenium and zinc, says O’Hara. “The best and simplest approach is to eat a variety of healthy foods and aim to eat some protein paired with complex carbohydrates, such as fruit, veggies, pulses like beans and lentils, and whole grains.” Some research suggests vitamin D deficiency may lead to a higher risk of postpartum mood disorders, but it isn’t conclusive, so ask your doctor about taking supplements.mixetto/ Getty Images
Those bras you bought when you were pregnant? They’re probably going to be too small for a while. Right after giving birth, estrogen and progesterone levels drop, and prolactin, the hormone that helps you make breastmilk, kicks in. This change usually makes your breasts even bigger than they were during pregnancy, because of increased blood flow and milk, and yes, this is the engorgement your friends warned you about. It peaks two to three days after birth, and your breasts will be pretty hard and sore. If you’re nursing, the engorgement will settle down within a few days as your baby breastfeeds. Applying warm packs before breastfeeding and cold packs afterwards, as well as taking a mild anti-inflammatory (such as ibuprofen, which is safe during breastfeeding), expressing a bit of milk in the shower or tucking a clean, slightly crushed cabbage leaf against your breast all help, says CJ Blennerhassett, a Toronto midwife. If you’re not breastfeeding, engorgement may take up to a week to resolve, and a snug bra, ibuprofen and ice packs can help relieve some of the pain and discomfort.
As for your eventual after-pregnancy boob size—who knows? Your breasts could stay bigger, get smaller or revert to their pre-pregnancy size. And as for sagginess, it’s not the breastfeeding that’s responsible, but breast weight gain during pregnancy, as well as age and smoking that could be to blame.SelectStock/ Getty Images
Your uterus has seen a lot of action, and it isn’t over yet. While recovery from a vaginal delivery versus a C-section will pose different challenges, there are also many similarities: Afterpains, which feel like menstrual cramps, begin shortly after you deliver and last for two or three days. These contractions help your uterus start to shrink to its pre-baby state. Over about six weeks, your uterus contracts to its original size, eventually lowering itself behind the pubic bone. (This helps flatten your tummy, as well.)
You’ll also have a bloody discharge, called lochia, for up to six weeks after delivery. That blood and mucus, which becomes lighter in colour and flow over time, comes from an area about the size of your hand, where the placenta was attached to your uterine muscle, says Blennerhassett. And how’s this for a fun fact: If you’ve had a baby, your cervix often will forever afterwards look like it’s “smiling,” in comparison to the “O” appearance of the cervix of a woman who hasn’t given birth.
If you had a vaginal delivery, you’re almost certainly going to have a swollen, bruised and sore crotch for a while. Similarly, a C-section means a puffy belly and painful incision. Both will gradually get better over several weeks. Rest and painkillers are your friends. You can also soothe your sore and stitched perineum (the area between your vulva and anus) with a sitz bath or by tucking a frozen maxi-pad sprayed with witch hazel into your undies. A sitz bath can help ease hemorrhoids, which can develop during the pushing part of labour. “The most important thing to remember about post-delivery pain is that it should be getting a little better every day,” says Blennerhassett. New pain, blood or discharge means you need to talk to your healthcare provider pronto so you can be checked for infection.
Your perineum or abdomen should be healed at the six-week mark (whew). Sometimes, however, the nerves have been injured, causing numbness or sensitivity, or there can be scar-tissue adhesions, says Céleste Bouffard, a pelvic health physiotherapist in Sudbury, Ont. If this is the case, a pelvic health physiotherapist can teach you how to massage the incision site to promote circulation and healing. Lower estrogen can cause vaginal dryness until your hormones go back to normal, so once you’re ready for sex again, grab some water-based lubricant.Ivan-balvan/ Getty Images
Not that you miss it, but when will your period come back? If you’re not breastfeeding, your period (and your fertility) will likely return in six to eight weeks; otherwise, your period probably won’t start as long as you’re exclusively breastfeeding. Once you start nursing less, usually around the six-month mark, your period may start up again, but the timing varies from person to person. And just a reminder: You ovulate the month before your period returns.Gingagi/ Getty Images
Stuff you take for granted, like going to the bathroom, may not go as planned. “Signals that your bladder sends to your brain to tell your body to release the urine may have been disrupted by all the pressure during labour and pushing, and the physical act of the baby’s head coming through and pressing against the urethra. Or, the labia and vulva are really swollen, which can pinch the urethra and make it difficult to pee,” explains Blennerhassett. Cold compresses or a warm sitz bath can help. On the other hand, you may be peeing (or sweating) a ton in the first week or two after delivery, as your body adjusts to changing hormones and works to get rid of excess fluid. Pee can also sting your sore bottom, which is why your nurse or midwife likely gave you a super handy squirt bottle. Fill it with warm water to spray your perineum while you pee. Trust us.
Postpartum constipation is pretty common in the first week or so, because of dehydration, the side effects of pain meds, having a C-section (abdominal surgery puts the bowels on quiet mode) and a fear of pushing anything else out of that tender area of your body. Drink lots of water, try some prune juice or fruit and walk around when you’re able to. Your doctor or midwife may also prescribe a stool softener. Take it! Again, trust us.
If sneezing, laughing or exercise makes you pee your pants a little in the days, weeks and months after delivery, that’s a sign your pelvic floor needs some love and attention. The pelvic floor involves the muscles, ligaments, tissues and nerves that support your uterus, bladder, vagina and rectum. The weight of your baby, plus labour and delivery, can put a lot of stress on it. The good news is a pelvic health physiotherapist can help with that; the bad news is pelvic floor physio is usually not covered by provincial health plans. “When the pelvic floor is injured, it becomes weak. You have to retrain it after pregnancy,” says Bouffard. Bladder incontinence is most common, but occasionally fecal incontinence (leaking poo) can be an issue. Or a damaged pelvic floor can cause a prolapse, which is a weakened spot in the vaginal wall that allows the bladder, rectum or uterus to drop out of position; symptoms include frequent peeing or pee leaks, pain during sex or a feeling of pressure in your groin. We know it sounds a little (or a lot) scary, but physio can teach you how to strengthen your pelvic floor so it can do its supportive job again. At your pelvic floor assessment, usually done six weeks after delivery, a physio can show you a variety of tools, for example, how to do Kegel exercises properly—most of us don’t do them right.bymuratdeniz/ getty Images
After birth, your core muscles can be weak, meaning it may be surprisingly hard to, say, lift a box of diapers out of the grocery cart. Almost all pregnant women have some degree of diastasis recti, which is a gap between the left and right abdominal wall muscles that’s caused when connective tissue thins out in response to hormones (yes, hormones again). That gap may close on its own in the first eight weeks after birth, but it often doesn’t, leading to a belly that still looks kind of pregnant, back pain and core muscles that are inefficient at lifting, pushing and pulling. However, you don’t have to just put up with it: A pelvic health physiotherapist can teach you the right exercises to help regain abdominal strength and heal the gap. Diastasis recti aside, lots of women end up with a softer, floppier tummy, and how it firms up in the months after birth varies, depending on your genetics, posture and how much the skin and tissues stretched while you were pregnant.
The way your body changes after you have your baby is much like parenting itself: bizarre, awesome, frustrating, cool and inspiring—and it can help to remember that almost everything does get better with time. Your body grew a person, and there are endless ways it can bounce back and surprise you. —Bonnie SchiedelProstock-Studio/ Getty Images
Pregnancy weight gain can cause spider veins, varicose veins and stretch marks. And while they do become less prominent over time, they’ll likely stick around. Compression socks or leggings can help ease pain from varicose veins in the early days after delivery.Elena Nikonova/ Getty Images
Changing hormone levels can affect your facial skin, causing dry patches, acne or pigmentation. Talk to a dermatologist if you’re concerned about discoloration, or if the breakouts become inflamed and painful—a sign of more severe cystic acne. For regular acne, benzoyl peroxide is considered the safest choice but salicylic acid may also be recommended.Catherine Falls Commercial/ Getty Images
It’s normal to lose up to a third of your hair, starting when your baby is around three months old. High hormone levels during pregnancy cause you to grow more hair over the nine months. When hormone levels drop after birth, you lose some luscious locksand start a new phase of growth.urbazon/ Getty Images
Shifting hormone levels and blood volume during pregnancy can make you more susceptible to cavities and gum disease after baby, so don’t skip your usual dentist appointment. Noticing slightly blurry vision or dry eyes? That’s probably thanks to pregnancy hormones or fluid levels, too. Those eye issues can persist after birth if you’re lactating, so make an appointment with your optometrist.
*Names have been changedBrothers91/ Getty Images
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