The first six weeks after birth: bleeding, stitches and warning signs

In the first weeks after birth, your body is recovering from a huge change. Some symptoms are expected during this time, while others need medical help right away. Knowing which is which helps you care for yourself with confidence.

Postpartum bleeding

After birth, you'll have vaginal bleeding, even if you had a cesarean. It's heavy in the first days, then gradually lessens over a few weeks, turns brownish and finally stops. While you breastfeed, the bleeding may look redder and heavier because your uterus contracts, and you may feel period-like cramps. To lower the risk of infection, use pads rather than tampons until your postpartum checkup; change pads often and wash your hands before and after. If you're passing large clots, tell your midwife or doctor.

Caring for stitches

If you had stitches for a tear or an episiotomy (a small cut made during birth), they usually heal within a month; pain lasting longer than 2–3 weeks is unusual. These may help:

• Wash daily with warm water and pat dry gently.
• Pouring warm water over your outer genital area while you pee can reduce stinging; drinking plenty of water also helps.
• When you have a bowel movement, press a clean pad gently over the stitches and try not to strain.
• Ice wrapped in a towel can ease pain; don't put ice directly on your skin.
• Pelvic floor exercises help healing; ask your midwife or doctor to show you how.
• If you're breastfeeding, check with your pharmacist or doctor before taking painkillers.

If your stitches become more painful, there's a foul-smelling discharge, or the area around them is red and swollen, it may be an infection; see your doctor or midwife as soon as possible.

When to get help right away

Postpartum hemorrhage usually happens in the first 24 hours but can occur up to 12 weeks after birth. Preeclampsia can also develop after birth; it's most common in the first 48 hours but can appear up to 6 weeks later, even if your blood pressure was never high during pregnancy. If you have any of the following, contact your doctor or the hospital without waiting:

• Sudden or very heavy bleeding: soaking through one or more pads in an hour or passing clots bigger than an egg, especially with dizziness, feeling faint or a racing heartbeat
• A severe headache that won't go away or keeps getting worse, blurred vision or flashing lights, pain under your ribs, nausea and vomiting, or sudden swelling of your face or hands
• A fever of 38°C or higher, chills, or a sore, tender belly
• Foul-smelling vaginal discharge
• Pain, swelling or redness in one leg, especially the calf
• Chest pain, shortness of breath or a racing heartbeat
• Thoughts of harming yourself or your baby

In an emergency such as very heavy bleeding, chest pain, severe shortness of breath, fainting or a seizure, call your local emergency number.

“After birth, your own health matters just as much as your baby's.”

Checkups and self-care

After care in the first 24 hours, the World Health Organization recommends at least three more checkups in the first 6 weeks: at 48–72 hours, between days 7 and 14, and in week 6. These checkups look for danger signs in both you and your baby and also assess your mental health; plan your appointments with your doctor or family physician. Rest whenever you can and ask for help. If you feel very tired, sad or anxious, tell your doctor. It's usually recommended to wait about 6 weeks (40 days) after the birth before having sex again; after that, talk with your doctor and start when you feel ready. Remember that you can get pregnant again as early as 3 weeks after birth, and talk with your doctor about contraception.