Introducing afterpains aka postpartum cramps. Now that your baby has entered the world and exited your body, your uterus needs to get back to its pre-pregnancy size. The uterus also needs to quickly close off all of the blood vessels that were bringing your baby nutrients during pregnancy so that you don’t lose too much blood. It does those two things with the help of oxytocin!
What does oxytocin do? Just as it did during labor, oxytocin makes your uterus contract. The postpartum cramping can be very intense, feeling like period pain or even labor contractions. They will decrease with time; and remember, it is your uterus actively contracting to go back to its normal size, so this needs to happen.
Strong postpartum cramping mean efficient contractions – hang in there!
When do these postpartum cramps start and stop?
Women usually feel afterpains the day after birth – maybe just because there are so many other things happening the day of that you just don’t notice! They may come as a surprise when you first feel them due to their strength, and they tend to be most painful on days 2&3. On average, they last 10 days, but continue until your uterus is back to pre-pregnancy size, so don’t be alarmed if you still feel them after 10 days.
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Why do I feel postpartum cramping when I breastfeed?
Remember one of the many advantages of breastfeeding is that while your baby is feeding your body produces more oxytocin. Among other things, oxytocin causes uterus contractions hence postpartum cramps.
Try to empty your bladder before your breastfeed – this will help make the cramps less painful.
Does that mean if I don’t breastfeed my uterus will take longer to contract?
Yes, but your body produces oxytocin even if you do not nurse and your uterus should contract back to pre-pregnancy size at the 6-week mark just as nursing moms.
What can I do to help the pain?
Heat and NSAIDs (ibuprofen, advil) can help. Just like during pregnancy, you can take NSAIDs, but not paracetamol (tylenol) if you breastfeed.
Try to keep your bladder empty – while making sure to stay hydrated. If you are nursing you should be drinking 16 eight ounce cups of water or 3.7 liters a day.
How can I tell if my uterus is back to pre-pregnancy size?
Right after birth
Your uterus weighs 2.2lbs and it is very firm – you can feel the top of it right around your belly button level. Ask a midwife or nurse when they check on you at the hospital to show you how to feel it.
By the end of the first week
Your uterus will have already lost half of that weight, and be around 1lb. Now, the top of the uterus will be much lower, right about where a cesarean-section incision would be. It will also be less firm, as the muscle tone goes back to normal, so it won’t be the same hard ball you felt just after giving birth.
By six weeks
Your uterus should be back to normal size – 2 ounces – this is something that your doctor will check at the 6-week appointment
After my second birth the postpartum cramps are so intense, is something wrong?
Some women do not experience afterpains at all, and some women only on subsequent births.
While labor and delivery tends to be less painful the second or third time around, the third stage of labor – the birth of the placenta – and afterpains tend to be more painful. The cramps are more intense because there is more oxytocin in your body to make sure that your uterus, which has less muscle tone as compared to your first pregnancy, contracts and blood flow is restricted (to prevent hemorrhage).
There are some reports of postpartum cramping being more intense after a c-section, but there is little research in this field to provide strong evidence.
Either way, the cramps are certainly not comfortable, but they are part of the normal recovery process and will ease with time. There are also difference that you may notice in the composition and duration of you stages of lochia for subsequent births.
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