Understanding Your Postpartum Body: Why Recovery Takes Time
Oftentimes, I hear from new moms in my practice that they are shocked by how different their bodies feel after giving birth. This section will explain why you feel this way.
Remember, you body has undergone 9–10 months of growing a baby, with muscles and ligaments expanding, and depending on the type of delivery, the pelvic floor and abdominal wall is affected. The muscles don’t just 'bounce back.' In essence, your body experienced an injury. While it brought a beautiful gift, the body still needs time and care to heal.
Weight gain varies for women during pregnancy, and many new moms are eager to jump back into exercise to lose the extra weight. However, it's important to give yourself grace during this time. Let’s take a look at what happens after you give birth
Initially, you will lose about 10–13 pounds during childbirth, with an additional 5–9 pounds through excess urine production and the shrinking of organs (like the uterus).
Breastfeeding may not necessarily help with weight loss; research on this is mixed, so it's important not to rely on it alone.
Weight loss during this period involves both diet and exercise, and it’s never a quick process.
Weight Gain:
Weight Gain TIP:
Think of your postpartum period as a full year of recovery, rather than just 6 weeks or 6 months.
The uterus expands significantly to accommodate the baby during pregnancy and will need time to shrink, a process called 'involution.'
Approximately two weeks after birth, the uterus will move back down into the pelvis.
By around six weeks, the uterus will return to its 'new normal' size, though it won’t return to its pre-pregnancy size
Some women become concerned about vaginal discharge during the first three weeks postpartum. Here’s a look at what’s considered normal vs. abnormal.
Reproductive Changes:
Normal Discharge:
Small, bloody clots
Light pink blood discharge, decreasing amount
Discharge continues to decrease, will start to see white, cream or yellowish discharge color
Time frame:
1-3 days:
4-10 days:
11-21 days:
Abnormal Discharge:
Large blood clots, foul smelling, soaks through a pad
Excessive amount of discharge, foul smell, persistent red color
Persistent red discharge, foul smell
TIP:
Anything foul smelling, persistant bright red blood
Contact your Doc!
Ovulation and Menstruation:
Fun fact: ovulation can occur before your first period returns:
If you are not nursing, average time for menstruation to return is 7-9 weeks
If you are nursing, this can range from 8 weeks to 18 months
TIP:
Do not rely on breastfeeding as a form of birth control, you can still get pregnant during that time!
Skin and Hair Changes:
Hair loss can occur between 4–20 weeks postpartum, with hair typically returning to its normal fullness around 15 months.
Skin changes that occurred during pregnancy may improve postpartum, but if you’re breastfeeding, they can persist due to ongoing hormonal changes.
Stretch marks may fade over time but usually don’t disappear completely.
Estrogen, progesterone, and melanocyte-stimulating hormones decrease rapidly after birth, leading to the fading of melasma or linea nigra—see image.
Brain Changes:
Mommy brain is real!
Common symptoms include forgetfulness, emotional shifts, mood swings, and general brain fog.
One theory is that changes in the amygdala (the brain’s emotion processing center) increase activity. Additionally, lack of sleep, heightened focus on caring for the baby, and learning how to bond contribute to 'mommy brain.
However, this can also affect new dads, adoptive parents, and non-birthing same-sex parents.
Rest assured, you’re not going crazy—your focus has simply shifted to your little one.
Another common change is headaches. It’s normal to experience headaches during the first week after birth, but if a headache is persistent and doesn’t improve, contact your doctor.
Postpartum Depression:
What is normal? Approximately 80% of new moms will experience the “baby blues’. Common symptoms are worried, unhappy, fatigue, typically mild feelings of these symptoms that would not interfere with function. This will resolve in 1-2 weeks from delivery.
Postpartum depression is considered a major depressive episode with onset during pregnancy or within 4 weeks after birth according to the DSM-5. This can occur up to 12 months after birth.
Click on the screening tool below to assess if you are struggling with postpartum depression. Unsure where to begin, Colorado University has a department and support prgram to help you through this time.
Screening Tool:
Bowel and Bladder Changes:
Pregnancy can be tough on the digestive system. As the baby grows, it takes up more space in the abdomen, which can slow down bowel movements.
What happens immediately after delivery: Bowel motility remains slowed, the abdominal wall has been stretched, food and fluids may have been restricted during labor, and either a C-section incision or vaginal tearing can cause discomfort.
First bowel movement typically occurs within 2-3 days after delivery
More normal bowel movements occur around 8-14 days.
However, retraining your bowel system may be necessary to learn how to empty your bowels properly.
Bladder distension and urinary retention may occur in women due to:
Residual hormonal effects of pregnancy, increased bladder capacity, and decreased muscle tone.
Injury to the bladder or urethra, leading to reduced sensation of bladder filling.
It can take 6-8 weeks for the bladder and uterus to return to their pre-pregnancy state.
Urinary Incontinence (UI):
UI may occur, but there are treatments available to help manage it. By 3 months postpartum, about one-third of women report UI, and around 30% still experience it at 4 years postpartum.
If you had UI before or during pregnancy and had a vaginal birth, your risk of UI increases.
Muscle and Ligament Changes:
Wondering why you feel weak or uncomfortable when returning to exercise? Let’s take a look!
Typical body changes:
Abdominal muscles have stretched over the 40 weeks of pregnancy.
There may be abdominal separation (diastasis recti) and/or a C-section incision.
Breasts have grown, and the rib cage has widened.
Breastfeeding/lactation does not increase laxity or cause pain in the pelvic area.
Your gait changed during pregnancy, and this can persist for 3-4 months postpartum.
Pelvic floor muscles are affected by the pressure of carrying a baby and/or vaginal delivery.
Swelling and inflammation can lead to new nerve compression injuries, such as carpal tunnel syndrome.
Muscle recruitment around the trunk, pelvis, and hips is less effective due to the lengthening of muscles in these areas.
As pregnancy hormones decline, soft tissue laxity improves, but motor control deficits and pain may persist as this happens.
Difficulty staying consistent with an exercise routine can arise as you adjust to a new schedule with your baby.
When your OB-GYN clears you to return to activity at 6 weeks, they are referring to the uterus and bladder returning to their pre-pregnancy state. This doesn’t mean your body is ready to resume your previous exercise routine. It simply means it may take longer to reach your fitness goals due to the body changes mentioned above, but you will get there.