The post-partum week by week: what really happens in the body

Nobody really told us: childbirth is not the end of something. It is the start of another kind of labour, slower and quieter, during which the body undoes what it spent nine months building. Uterus, breasts, pelvic floor, hormones, sleep: everything shifts at once.

Knowing what happens, and when, does not make these weeks any shorter. But it does help you recognise what is expected, and spot what is not. Here is the post-partum week by week, from the delivery room to the postnatal consultation.

The post-partum week by week: the overall picture

Every post-partum has its own rhythm. Vaginal birth or caesarean, first or third child, breastfeeding or bottle: the markers vary. Following the post-partum week by week gives you an outline, not a timetable.

Period	Uterus and bleeding	Perineum or scar	Breasts	Emotions and sleep
Days 1 to 3	Afterpains, heavy red lochia	Tender, swollen, stitches or dressing	Colostrum	Euphoria, intense tiredness
Week 1	The uterus descends, bleeding eases	Pain easing little by little	Milk coming in, breasts tight	Baby blues possible
Week 2	Pinkish or brown lochia, small bleed around day 10 to 15 possible	Healing in progress	Feeding settling in, or milk drying up	Broken nights
Weeks 3 and 4	Lighter lochia, uterus almost back in place	Milder discomfort	A more settled rhythm	Underlying tiredness
Weeks 5 and 6	Lochia usually ending	Scar closed, pelvic floor still fragile	Stable	First milestones

Days 1 to 3: the body the day after

Just after the birth, the uterus contracts to close over the wound left by the placenta. These contractions are called afterpains. Often stronger after a second child, they intensify during feeds.

The bleeding is heavy and red, sometimes with small clots. This is lochia. The perineum is swollen and tender, sometimes stitched. After a caesarean, it is the scar on the lower abdomen that makes itself felt, and getting up requires help.

The first trip to the toilet is often a worry. Transit is slowed by hormones, lack of movement and apprehension. Drinking plenty and eating fibre helps.

The breasts produce colostrum, a first milk that is thick and scant. This is normal. It is enough for the first few days.

Week one: the milk coming in, and the tears

Around the second or third day, sometimes a little later, the milk comes in. The breasts become heavy, tight and warm. If you are not breastfeeding, it happens too; it settles within a few days.

The uterus gradually descends back into the pelvis. The lochia stays red, then lightens. Night sweats are common: the body is shedding the water it stored during pregnancy.

And then, often between the third and tenth day, the tears. For no reason, or for a tiny one. The baby blues affects a large proportion of women and passes on its own. To tell it apart from depression, read our guide to the baby blues or postnatal depression.

Week two: coming home

This is often the week you come home, and find your first real rhythm. The bleeding fades: pinkish, then brown. Somewhere between the tenth and fifteenth day, a redder bleed may return for one to three days. This is the small bleed around day 10 to 15, common and expected. Everything is detailed in our article on how long lochia lasts.

The perineum heals. Stitches usually dissolve on their own. After a caesarean, the scar closes, but the abdomen stays tender and lifting should be avoided.

The midwife who visits you at home checks on healing, on breastfeeding or how the baby is feeding, and on your mood. This is the moment to ask every question you have.

Weeks 3 and 4: the underlying tiredness

The uterus can barely be felt any more through the abdomen. The lochia turns yellowish, then whitish, and lighter.

What you feel most of all is tiredness. The kind that sets in when the adrenaline of the first days wears off and the nights stay short. It says nothing about your ability to cope. It says you need someone to take over for a while.

The abdomen stays soft, sometimes rounded. The abdominal muscles separated during pregnancy; they close back slowly. No classic abdominal exercises at this stage.

Weeks 5 and 6: the first milestones

The lochia usually comes to an end. The uterus has returned to a size close to its pre-pregnancy size. The episiotomy, tear or caesarean scar is closed, even if it remains tender.

The perineum after childbirth needs more time. Leaking on exertion or a feeling of heaviness may persist. Raise it at the next consultation.

Without breastfeeding, the first period, the return of periods, often comes back at around six to eight weeks. With exclusive breastfeeding, much later. Ovulation can come before the period: contraception needs thinking about beforehand.

The postnatal consultation and the postnatal interview

In France, the postnatal consultation usually takes place within six to eight weeks of the birth, with a midwife, a GP or a gynaecologist. It checks on healing, the pelvic floor, your mood and contraception. If needed, it opens the way to pelvic floor rehabilitation.

The early postnatal interview, between the fourth and eighth week, is a time to talk about how you are living through these weeks. Two appointments to note down as soon as you get home.

And after the sixth week

The post-partum does not stop at the consultation. Rehabilitation, a gradual return to exercise, going back to work, the hair loss that often comes a few months later: the body carries on its way for months. Most of the milestones fall within the first year. There is no rush.

Signs that call for medical advice

Most of these weeks pass without difficulty. Some signs, however, call for prompt advice from your midwife, your doctor or the maternity unit:

• a fever of 38 °C or more, or shivering;
• very heavy bleeding, large clots, or strong-smelling lochia;
• a scar that is red, hot, weeping or opening up;
• a red, hard, painful breast, with fever;
• pain, swelling or warmth in a calf;
• sadness that lasts beyond two weeks, or dark thoughts.

In the event of heavy bleeding, fainting, sudden breathlessness or chest pain, call 15 (the French emergency number).

Frequently asked questions

How long does the post-partum last?

Medically, people often speak of the six to eight weeks following the birth, up to the postnatal consultation. But body and mind go on recovering for several months. Many women consider the whole first year to be post-partum.

When does the uterus return to its normal size?

The uterus descends back into the pelvis over roughly the first two weeks. It returns to a size close to its pre-pregnancy size around the sixth week. Afterpains mostly accompany the first few days.

When does the milk come in?

Most often between the second and fourth day after the birth, sometimes a little later, especially after a caesarean. It also happens when you are not breastfeeding, then settles within a few days.

Is it normal to be this tired after giving birth?

Yes. Childbirth, blood loss, broken nights and hormonal changes explain a deep tiredness. If it comes with breathlessness, palpitations or great sadness, talk to your midwife or your doctor.

When does the postnatal consultation take place?

In France, it usually takes place within six to eight weeks of the birth. It can be carried out by a midwife, a GP or a gynaecologist. Book the appointment as soon as you get home.

A body that rebuilds itself

There is no right speed for these weeks. There is a body at work, day after day, without asking to be watched too closely. Looking at it with patience is already a great deal.

And when something seems strange to you, you are allowed to ask. Always.

To approach these weeks prepared, read our guide to preparing for your post-partum.