The postpartum period is just as much a period of change and adjustment as the first three trimesters. In fact, the American College of OB/GYNs now call it the "fourth trimester." During this time your body adjusts to not being pregnant anymore and begins returning to its pre-pregnant state, while producing hormones that enable you to breastfeed your baby.
Two to six days after delivery, the colostrum in your breasts will change to breast milk. It is not unusual to have discomfort when your milk comes in, or to develop sore nipples from nursing, but keep in mind that swollen, painful, and tender breasts may be a sign of infection. (See below.)
The site where the placenta was attached to your uterus bleeds and this bleeding is called lochia. For the first few days after birth, the lochia will be bright red and your flow will be fairly heavy. After three or four days, the flow will decrease and change to a pale pink color. It will eventually slow and become brownish. The flow may continue for as long as six weeks.
The site of an episiotomy will be very sore for several weeks, especially when you go to the bathroom. Take sitz baths and follow your health care provider's instructions to prevent infection and help the area heal.
Be aware that most infections of the uterus, urinary tract, and episiotomy incisions occur within a few days after birth. If you have any of the following signs or symptoms of an infection, postpartum illness, or postpartum depression, call your health care provider immediately:
- Temperature of 100°F or higher
- Foul smelling lochia
- Increase in vaginal bleeding
- Abdominal pain and/or cramping
- Unrelenting feelings of depression
- Swollen, tender, or painful breasts
Postpartum depression or PPD is a common and treatable condition after childbirth. If you’ve had a history of depression, you might be more likely to develop PPD after your baby is born. PPD is probably caused by your hormone levels adjusting to not being pregnant anymore. If you experience symptoms of insomnia, loss of appetite, fatigue, irritability, crying, and intense feelings of sadness or anxiety—that make it difficult to complete daily tasks and bond with your baby—it is important to call your health care provider. For more information, download the Postpartum Depression Facts brochure at www.nimh.nih.gov.