What to Expect During the First Month of Postpartum Recovery

Alexandra Paetow MS, RD, CDN

Registered Dietitian and Postpartum Nutritionist

When we talk about postpartum, the focus is often on adjusting to life with a newborn: bonding with baby, breastfeeding or bottle-feeding, sleep deprivation, and soothing infant cries. The details around postpartum recovery seem shrouded in mystery, brushed over in favor of discussing the baby.

Most moms enter into the fourth trimester, relatively unaware of the realities that recovery entails which can make an overwhelming situation even more confusing and difficult. Even just having a more clear concept of what postpartum recovery involves can help remove a layer of anxiety that is entwined with the unknown.

Today we’re presenting what to expect during the first month of postpartum recovery to provide some clarity about what your body is going through, tips on how to nurture yourself in each stage, and most importantly, to remind all new mamas of their strength and resilience.

Important note: Any questions or doubts about your own postpartum recovery should always be addressed with your health care provider.

First days:

Uterus: Your uterus begins to contract back to its pre-pregnancy size. The endometrial lining of the uterus starts to regenerate.1
Bleeding: Lochia is the official name for the bleeding that occurs after delivery. This bleeding takes place regardless of mode of delivery (vaginal or c-section) because it is the blood, tissue and fluid being expelled from the uterus.2 There are three stages of lochia. Lochia rubra is the bright red discharge that happens immediately after delivery.1
Breastfeeding: After delivery of the placenta, a drastic change in maternal hormones begins. This shift is responsible for the ability of the body to support lactation. A simplified explanation of this shift is that the drop in progesterone allows for prolactin to stimulate milk production.3 In the first days, colostrum is produced which provides immunological properties, proteins, and nutrients.4
Healing: Pain from vaginal deliveries and cesarean section scars is most severe during the first days. You may require pain medications, ice packs, and topical care.
Bowel Movements: Due to pain medications, stitches, fear, and discomfort, the first bowel movement can be very challenging. Avoid straining, hydrate well, focus on fiber-rich foods, and relax your pelvic floor muscles to promote easier bowel movements.

How to support your body:

Nutrition Tip: Given the blood loss that occurs during delivery and afterward during this phase, we can look to nutrition to help support the body. Focusing on iron-rich foods like beef, shellfish, and legumes can help to replenish this mineral which plays an important role in healing.
Mindset Tip: Lean into the idea that rest is productive. Even though you may feel compelled to start moving around with baby and returning to activities, remind yourself that prioritizing rest will allow for a quicker and more effective recovery.

First 2 weeks

Uterus: The most significant shifts in the size of the uterus have occurred by now.
Bleeding: Lochia rubra transitions over to lochia serosa, a thinner reddish-brown discharge typically by the end of the first week.1 Continue to monitor for any signs of late postpartum hemorrhage, or excessive blood loss, which is a rare but serious event.
Breastfeeding: Breastmilk is considered “transitional” as composition changes from colostrum closer towards mature milk.4
Healing: Tissues continue to heal including c-section scars, perineal tears, and the internal wound caused by the placental delivery. Any stitches may start to dissolve and pain starts to dissipate though may not disappear completely.6
Mood: As the adrenaline of the delivery and the first several days subsides, the hormone shifts and sleep deprivation can start to have an impact on maternal mood. Sadness or irritability during this time could be reflective of the common “postpartum blues”. If your mood changes, feels more severe, and you’re noticing feelings like worthlessness, anxiety, hopelessness that are impacting your quality of life, it could be a perinatal mood and anxiety disorder (PMAD) and it’s never too early to reach out for mental health support.5

How to support your body:

Nutrition Tip: Focus on nutrition that promotes tissue repair. Ensure that you are eating enough calories and protein to support the energy-intensive process of healing. Surround yourself with easy-to-grab snacks and meals to stay nourished. For more details on nutrition for postpartum recovery, review our past article here.
Mindset Tip: Accept support. Embrace any family and friends offering meals, help with cleaning, an extra set of hands, or emotional support during this transition. You could also consider hiring a postpartum doula, meal delivery service, or housekeeping help to lighten your load.

2-6 weeks

Uterus: Your uterus has returned to approximate pre-pregnancy size, (often slightly larger) and the endometrial lining has largely regenerated by 6 weeks.1
Bleeding: Over the course of several weeks, the final stage begins which is lochia alba which is the lightest in both color (a yellowish tinge) and quantity.1 The transition and overall duration of lochia varies by individual but typically lasts about 5-6 weeks though for a smaller percentage of women it lasts longer.2
Breastfeeding: Breastmilk has typically transitioned to fully “mature” milk providing the optimal balance of nutrients for baby for months to come.4
Healing: Most of the acute healing is nearing completion at the end of this stage though your body may still feel foreign.6 Changes such as pelvic floor, abdominal muscles, sleep routines, body composition, hormone balance, breast physiology, stamina, mood and more can take much longer to regulate. Many factors may be permanently different in this new phase of motherhood and may require professional support.
Movement: As your body heals you will likely be incorporating more movement into your daily routine. Continue to be mindful of healing tissues and reach out to your health care provider with any increase in pain or concerns. Gentle movement can be beneficial for digestion, mental health, energy levels, and physical strength if done with careful consideration to your body’s needs.

How to support your body:

Nutrition Tip: Nourish yourself so you can nourish your little one. Whether you are breastfeeding and literally synthesizing your baby’s nutrition from your own body, or providing formula, or a combination…a nourished mama is essential in order to care for her baby. When it becomes hard to prioritize your own meals and snacks, remembering this can help.
Mindset Tip: Postpartum isn’t over. Know that just because you have been cleared to return to sex, exercise, and swimming…your body will likely not feel “back to normal”. Postpartum recovery can take far longer. Trust your body and give yourself the grace of time to adjust to this new reality.

The course of each postpartum mama’s recovery will transpire a bit differently. Knowing that we are not alone in the midst of challenging transitions can be comforting and help us persevere through difficulties, and be stronger for it.

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