The first year after birth

Recovery is measured in months, not in the six weeks the appointment calendar suggests. Knowing what is expected makes it much easier to spot what is not.

The first weeks

Bleeding after birth, called lochia, is heaviest in the first days and then gradually reduces in volume and changes colour from red to brown to a pale discharge, usually over two to six weeks. Some variation is normal, and bleeding often increases briefly with activity or breastfeeding.

Cramping during breastfeeding in the early days is normal and reflects the uterus contracting back down.

Perineal soreness after a vaginal birth is expected. Stitches dissolve over a few weeks. Cool packs for short periods, pain relief as advised, and avoiding constipation all help. A caesarean wound has its own timeline: soreness for a few weeks, numbness around the scar that may persist for months, and a restriction on heavy lifting.

Passing urine may sting initially, and there may be a temporary difficulty in knowing when the bladder is full. Opening the bowels for the first time is often more frightening than difficult; a stool softener and a footstool help, and stitches do not come apart.

Warning signs in the early weeks

These matter and are worth memorising rather than looking up later. Any of them requires urgent contact with a midwife, general practice or emergency service.

• Bleeding that suddenly becomes heavy, soaking a pad in an hour or less, or passing clots larger than a small coin.
• An offensive smelling discharge, fever, or feeling generally unwell, which may indicate infection.
• Severe headache, visual disturbance, upper abdominal pain, sudden swelling of the face or hands, which can indicate high blood pressure in the postnatal period.
• Pain, redness or swelling in one calf, or breathlessness or chest pain, which can indicate a blood clot.
• A wound that becomes increasingly painful, red, hot or begins to discharge.
• Thoughts of harming yourself or the baby, which need immediate help.

The six week check

Usually a short appointment covering physical recovery, contraception, mood and the baby. It is not a discharge from care, and the things most likely to be missed are the things least likely to be volunteered. It is entirely reasonable to raise urinary leaking, difficulty controlling wind or stool, a feeling of heaviness in the vagina, pain at a scar, pain with sex, or mood.

Requesting a referral to pelvic health physiotherapy is reasonable, particularly after an assisted delivery, a significant tear, a long second stage or a large baby.

Pelvic floor

Gentle contractions can usually start within a day or two, and structured training from around six weeks. Leaking is common early and expected to improve; leaking that persists at three months should be assessed. Any loss of bowel control, at any point, needs assessment rather than patience. This is covered in detail on the pelvic floor after childbirth.

Mood

Feeling tearful, irritable and overwhelmed in the first two weeks is extremely common and usually settles. Symptoms that persist beyond that, that begin later, or that are severe from the start need assessment. Postnatal depression is common, treatable, and frequently concealed because of the fear that admitting to it implies inadequacy or risk to the baby.

Postnatal anxiety, including intrusive frightening thoughts, is also common and treatable. A small number of women develop a much more severe illness in the early weeks, with confusion, agitation, unusual beliefs or hallucinations; that is a medical emergency and needs immediate help.

Sex

There is no correct date. Bleeding should have stopped and any tear should have healed. The first attempts are often uncomfortable, and there are three usual reasons: scar tissue at the perineum, low oestrogen causing dryness particularly while breastfeeding, and pelvic floor muscles that are guarding after injury.

All three respond to straightforward measures. Use a lubricant generously. Take considerably more time than before. Choose positions that allow control of depth. Perineal scar massage, once healing is complete, reduces tenderness. If pain persists beyond the first few occasions, ask for assessment rather than waiting a year, since it is treatable and the longer it continues the more guarding develops. See painful sex.

Desire is frequently low in the first months, for reasons that are entirely sufficient on their own: exhaustion, constant physical contact with a baby, hormonal change and a body that feels unfamiliar. See low libido.

Contraception

Ovulation can return before the first period, and in some women within a few weeks of birth. Contraception is generally recommended from around three weeks after birth if it is wanted, and the suitable methods depend on breastfeeding and on how the birth went. Breastfeeding provides some contraceptive effect only under specific and quite strict conditions, and relying on it loosely is unreliable. See the contraception overview.

Periods returning

Without breastfeeding, periods typically return within a few months. With exclusive breastfeeding they may not return for much longer. The first few cycles are often irregular or heavier than usual. Bleeding that is very heavy, or bleeding between cycles, should be assessed.

Longer term

Several things are commonly still resolving at six months to a year: abdominal wall strength, pelvic floor function, hair shedding, and sleep. Others should not still be present, and are worth raising specifically: leaking, heaviness or a bulge, pain with sex, bowel control problems, and persistently low mood.

Last reviewed: September 2026