Involution: How to deal with postpartum afterpains

Giving birth is physically taxing and, chances are, you’ll notice a few post-delivery aches and pains—including an all-over muscle ache to rival anything you’ve ever experienced at the gym. And some birth afterpains are actually worse for second-time moms or for women having their third, fourth or fifth (!) kid than they are for first-time moms.

Involution (AKA afterpains) Ah, the cramps. You spent nine months expanding and now, remarkably, your uterus is shrinking back to its normal size. This six-week process, called “involution,” can sometimes be a painful one. Also referred to as afterpains—short, sharp, cramps that you may feel in your abdomen a couple of days after giving birth, often while nursing—are the sensation of your uterus contracting, which helps expel blood clots.

Some first-time moms may not notice these contractions at all (regardless of whether you had an epidural or not). But many moms of multiple kids report that afterpains can get worse with each baby you deliver.

"With my first I felt absolutely nothing—beyond the god-awful nipple pain of learning how to nurse," says Christen Brownlee, a mom of two. "But I definitely noticed the afterpains in the hospital when I had my second child. I told the nurse about it, and she shared that she had four children, and she said the afterpains by the fourth baby were worse than the labour!"

The contractions caused by involution are triggered by the hormone oxytocin, which is released by breastfeeding and skin-to-skin contact with your baby.

“Involution feels different for every woman and is often worse with each subsequent pregnancy, but the good news is it’s OK to take pain relief,” says Noor Ladhani, a maternal fetal medicine specialist at Sunnybrook Hospital in Toronto. “Short-acting, non-steroidal anti-inflammatories, like ibuprofen, are best and if you take them as recommended, there’s less than a one percent transfer to breastmilk.”

Courtney Graham, a registered midwife with Kensington Midwives in Toronto, tells her patients that afterpains usually take five to seven days to subside. "As long as there are no allergies, you can take up to the maximum dose of acetaminophen (1000 mg) and ibuprofen (400 mg) while breastfeeding. If you want to explore non-pharmaceutical options," she adds, "everyone seems to have their own remedy: catnip tea, cherry juice, After Ease extract or Monthly Comfort Tea. I wouldn't say any of them are a perfect science, but it's about exploring what works for each individual person."

Some moms swear by using a heating pad, hot water bottle or a microwaveable bean bag (like a Magic Bag), the same way they would for relieving menstrual cramps.

"Mine were bad after baby number two and horrible after baby number three," says Martha Flower, a mom who lives in Vancouver. "For the first week after my third I took Tylenol around the clock. And it was much worse during breastfeeding. I wouldn't say that after-pains were worse than labour, but it was bad."

"I find women start really feeling them once they have a third baby," confirms Graham. "But I tell my patients that if you're having them, you're probably doing breastfeeding right—that's the oxytocin release and your uterus contracting down. You might feel some gushes of blood, too—that's completely normal."

Episiotomy and tearing If you’ve had an episiotomy or tearing, invest in a ring to sit on to help take the pressure off. A spray bottle also comes in handy when it comes to relieving that post-baby stinging sensation you feel when you pee. (Wiping can be agonizing because urine is acidic and burns any small cuts or tears that may have cropped up during delivery.)

When is pain a problem? While the early postpartum days can be a literal pain, it’s quite normal. Still, if you’re ever worried that what you’re experiencing isn’t normal, check with your doctor to rule out infection. If abdominal pain is extremely intense and doesn’t resolve, or the pain is elsewhere other than the uterus, call your doctor, Ladhani says. Ditto if you experience prolonged heavy bleeding, blood in your stool or if you have a fever.

While you may be tempted to think you can jump right into a new routine, don’t push yourself right away, says Ladhani. This is the time to cocoon at home and heal. And if you’ve had a C-section, remember: no lifting, driving or running for at least six weeks, even if the pain killers make it tempting to do otherwise.

Read more:
How long will it take for my postpartum belly to go away? Postpartum incontinence: What to expect