Postpartum

While pregnant mothers often get plenty of attention, after the birth, most of this attention can be focused on the baby. Mothers can often neglect their own health, perhaps because they don’t wish to bother others with their own problems. It takes a while for your body to adjust following childbirth. If you had a cesarean section you will also need time to recover from the operation. 

Caring for children can be fun and rewarding, however babies need a lot of attention during the early weeks and this can make life tiring. Some of the following ideas may help: 

  • trying not to expect too much from yourself. It may help to do what is essential and catch up later if or when you have more time and energy 
  • asking your partner, family, and friends to help with housework and childcare. They often enjoy being needed and accepting offers of help may make life easier for you 
  • making time to relax, cuddle, and play with your children 
  • resting and relaxing while your baby is sleeping 
  • trying not to over-tire yourself with visitors. Visitors may like to help you by making a drink, a meal or helping around the house 
  • planning time out with your partner, family and friends 
  • talking about your feelings, with your partner, family, friends, or health professionals particularly if you are stressed or feeling depressed 
  • joining a local Well Child Provider or parent group, which will give you the opportunity to meet, talk, share experiences and advice with others in your situation 

 

Recovering from birth

When to alert your LMC urgently

When to alert your LMC urgently:

If you have any of the following symptoms:

  • temperature over 38°c 
  • increased pain in your tummy or on your wound such as: tenderness to touch, burning sensation, redness, discharge or ooze from your wound, unpleasant odour from the wound, or the abdomen feels harder or more firm 
  • smelly vaginal discharge 
  • heavy bleeding that soaks a pad within an hour, or large clots 
  • swollen, red painful area in the leg 
  • burning sensation or pain when passing urine 
  • unable to pass urine or are severely constipated

Lochia

After your baby is born, it’s normal to have vaginal bleeding and discharge called lochia - whether you have had a vaginal birth or a caesarean. Lochia comes from the area inside your uterus where the placenta was attached as your body heals.

The bleeding is usually heavier at first and gradually becomes lighter over time. In the first few hours, you may need to use two maternity pads at once, then move to one pad as the flow settles.

Lochia typically changes colour as healing progresses. It starts off bright red, then becomes pinkish or brown, and eventually fades to a yellowish-white discharge.

Some bleeding can continue for around 3 to 6 weeks after birth.

If you pass blood clots larger than a 50 cent piece, let your LMC know and keep the pad in a plastic bag to show them if needed. This can sometimes happen if small pieces of placenta remain in the uterus after birth.

Lochia should not have a strong or unpleasant smell. If it does, contact your LMC, as this may be a sign of infection.

Pain Relief

Pain relief 

Take any pain relief that has been recommended or prescribed. It is important to continue taking pain relief regularly so you can avoid any breakthrough pain.

Early postnatal care

Early postnatal care

If your baby is born in a hospital, the length of time you spend there following the birth will vary depending on where you live and the type of birth you experienced. Once you are at home, your LMC will visit for 4-6 weeks and later your Well Child Provider will visit you to provide support and answer any questions or concerns.

 

Birth recovery

Birth recovery

Whether you have had a vaginal birth, a vaginal assisted birth (forceps, kiwicup or ventouse) or a cesarean birth you will be feeling tired, sore and bruised in many places.

It is important to

  • eat healthy and nutritious food to help your recovery. Foods high in protein will aid healing 
  • rest when baby is sleeping 

 

Changes to your tummy

Changes to your tummy

You may feel swollen, or think you still look pregnant after you’ve given birth. This is normal - it takes a while for your uterus to contract back to its normal size. Breastfeeding helps the uterus to contract too.

Your stomach muscles and the skin on your tummy will likely be quite loose after the birth too. Pregnancy stretches the abdominal muscles and the skin, and often leaves stretchmarks and some excess skin. The stretchmarks will fade, and stomach muscle tone will improve with time and exercise.

Once you’ve recovered from the birth, you can start doing some gentle exercise to help tighten up your tummy muscles. If your abdominal muscles separated during pregnancy, seek advice from a women’s health physio on safe exercise.

Recovering from a vaginal birth

Recovery

We often forget that there are many areas of our bodies physically that need to heal after birth, not to mention the emotional and physiological changes of giving birth that we need to adjust to. It is really important that you prioritise yourself and your baby in the first few weeks following birth. During birth the perineum stretches to make room for the baby to be born. The perineum is the area of skin between the opening of the vagina and the anus. Leaning forwards while passing urine can also reduce the stinging as the urine is less likely to be in contact with the tender area. 

    Perineum/Vulva care

     

    After giving birth, it’s normal to feel tender, swollen, or bruised around your perineum and vulva, even if you haven’t experienced any tearing or grazing. Some women may have tears or an episiotomy. The good news is that this area usually heals very well after birth because it has a rich blood supply.

    There are many simple ways to stay comfortable while supporting your body’s natural healing.

    Keeping the Area Clean

    Change your maternity pads regularly to help keep the area clean and reduce the risk of infection. Avoid using tampons for the first six weeks after birth, as they can increase the risk of infection in your uterus.

    Reducing Swelling and Discomfort

    Cold therapy can be very soothing in the first few days. You can make frozen pads by soaking a pad with water (witch hazel can be added if you like) and placing it in the freezer. Applying an ice pack to the perineum for up to 10 minutes at a time, every four hours or so, can help reduce swelling and ease discomfort.

    Some women find herbal preparations, such as hypericum cream, helpful for comfort and healing.

    Supporting Healing

    • Gentle pelvic floor exercises, started when you feel ready, help increase blood flow to the area and support healing.
    • A witch hazel–based perineal spray can also feel soothing - it can be helpful to choose a bottle that sprays upside down for easier use.
    • Arnica drops are sometimes used to support healing and may help reduce bruising and support tissue repair.

    Comfort Measures

    • Warm baths can be very relieving. You might choose a regular bath, a sitz bath, or a bath soak with herbs or essential oils if you enjoy these.
    • Using a peri bottle or squeezy bottle to pour warm water over your perineum while passing urine can reduce stinging, especially if you have had a tear or episiotomy.
    • Ural sachets can help reduce the acidity of your urine. These are often started soon after birth and taken a few times a day if needed.
    • If sitting is uncomfortable, a donut cushion can help relieve pressure.

    Caring for Your Perineal Tear

    If you have had a tear that required stitches, the stitches will usually dissolve within 1 to 2 weeks. It is common for the area to feel quite sore during this time, so good hygiene is especially important.

    Shower at least once a day and gently clean the perineal area using water only. Pat the area dry carefully with a clean towel rather than rubbing. Continue to change sanitary pads regularly to keep the area clean and dry.

    Drinking plenty of water can help prevent constipation, which reduces pressure on the stitches. Eating a healthy diet that includes fibre, such as fruit and vegetables, is also recommended. Regular pain relief can help keep you comfortable while healing.

    Bowel Motions & Haemorrhoids

    Bowel Motions 

    Thinking about passing the first bowel motion after birth can be stressful. It may be a few days after birth before this happens. 

    • putting your feet on a footstool, or something similar, that raises your knees to above your hips can help 
    • avoid straining and take your time 
    • passing a bowel motion will not affect your stitches 
    • take regular laxatives in the first few days and for as long as you feel you need them. Discuss this with your LMC 

     

    Haemorrhoids

    You may have haemorrhoids, which are swollen and inflamed veins in the rectum and anus that can be painful and cause bleeding. These should shrink over time but there are medications to help you that your LMC can prescribe. During a vaginal birth you put a lot of extra pressure on your rectum so it’s common to develop haemorrhoids postpartum. You also may have developed them during pregnancy.

    Here are some tips that may help:

    • it’s important to prevent constipation and avoid straining to pass a bowel motion as these can make haemorrhoids worse 
    • keep poo soft by drinking plenty of fluids and eating a high-fibre diet. You can also take a laxative which your lmc can prescribe 
    • apply a cold compress to the area and sit in a warm salt bath (sitz bath) 
    • there are topical cream that your LMC can prescribe or you can buy over-the-counter at your local chemist

    Your bladder & pelvic floor

    Changes to your bladder and pelvic floor are very common after birth. During pregnancy and vaginal birth, the pelvic floor muscles stretch significantly to support your baby and allow birth to happen. This can sometimes lead to symptoms such as leaking urine, urgency, or a feeling of heaviness while your body recovers.

    While these symptoms are common, they are not something you need to just live with. Pelvic floor exercises and the right support can make a big difference.

    Getting Started with Pelvic Floor Exercises

    You can practice pelvic floor exercises sitting, lying down, or standing - they’re discreet and can easily fit into your day.

    To contract your pelvic floor:

    • Imagine you are stopping yourself from passing wind
    • Then gently lift and squeeze around the vagina as if holding a tampon
    • Finally, imagine stopping the flow of urine

    You should feel a gentle squeeze and lift. Keep breathing normally and try not to tighten your tummy, thighs, or buttocks.

    Hold the contraction for a few seconds (or as long as you can comfortably), then fully relax before repeating. Aim to repeat several times throughout the day, gradually building up your strength.

    Avoid doing pelvic floor exercises while you are actually passing urine, as this can interfere with proper bladder emptying.

    When to Seek Support

    If you notice leaking, urgency, heaviness, difficulty emptying your bladder or bowel, or if exercises feel difficult, speak with your LMC, GP, or a pelvic health physiotherapist. These symptoms are common but not considered normal long term, and support is available.

    For a full guide on recovery timelines, strengthening safely, warning signs, and when to see a physio, see the full Pelvic Floor Health section.

    Afterpains

    Afterpains

    Your uterus starts contracting back to its pre-pregnancy size after your baby is born. It’s normal to feel period-type pains, or quite painful twinges or tummy cramps. This is especially common if it’s not your first baby. Breastfeeding also makes the uterus contract, so you may get tummy pain while you’re feeding. This is due to the release of oxytocin when your baby feeds. A full bladder makes the pain worse, so try to wee regularly, and make sure you wee before breastfeeding.

     

    Recovering from a caesarean

    Recovery

    Emotional Recovery and Adjustment

    The first six weeks of recovery after a caesarean birth can feel very different compared to recovering from a vaginal birth. You are healing from major surgery while caring for a newborn and adjusting to significant physical and emotional changes.

    Accept that your caesarean birth is a personal journey. It can bring up unexpected feelings and may feel triggering or emotional at times. Be gentle with yourself and stay open with your support people and your LMC about how you are feeling. Some women feel completely comfortable with their caesarean birth, while others may feel disappointed or sad that they were unable to give birth vaginally. If your caesarean was unplanned or an emergency, the sudden change in plans can sometimes come as a shock.

    Birth is a huge time of transition for all women, so keeping communication open with those close to you can make a real difference.

    Sensations Around Your Scar

    It is very common to experience itchiness, tingling, or numbness around your caesarean scar and lower abdomen. Some women notice numbness from their belly button down to just below the scar, which is usually caused by small nerves being affected during surgery.

    For some, sensation begins to improve after about 4 to 8 weeks, while for others the area may remain numb long term. This happens because the tiny nerves in the skin can take a long time to heal.

    Getting Moving Again

    You will usually be encouraged to get out of bed around 8 to 12 hours after your operation, with hospital staff helping you the first few times. Gentle movement is important to reduce the risk of post-operative complications such as blood clots and lung infections.

    Take things slowly but try to move regularly. Start with short walks around your room on the first day, then gradually increase the distance. Once you are home, if you feel up to it, aim for a slow five-minute walk most days and build up gradually as your body allows.

    Bowel Changes and Constipation

    It is common to notice changes in your bowel movements after a caesarean, particularly constipation. This can be due to the effects of surgery, pain relief medication, and reduced activity levels.

    Staying well hydrated, eating fibre-rich foods, and gentle movement can help. You will likely be offered laxatives in hospital - it is safe to continue taking them for as long as you need to keep your bowels regular and comfortable to pass.

    Your Incision (cut)

     

    Your caesarean wound will usually be along or just below your bikini line and will either have dissolvable stitches or staples covered with a dressing. 

    Your first shower may feel intimidating, which is understandable. Take your time and be careful not to scrub your incision; simply let soapy water run over it. Bruising, numbness, or itching around your wound is common and it can take time for these sensations to ease. Try to keep comfortable by wearing loose cotton clothing that doesn’t press or irritate your incision space. Using a pillow to support your abdomen when coughing, sneezing, or laughing can help alleviate pain and protect the incision site. It is really important to monitor your incision for signs of an infection. 

    With any surgery there is a risk of wound infection. If you notice any of the following you may have a wound infection: 

    • an unpleasant smell from the wound 
    • discharge or drainage from the wound (a little discharge at the beginning is normal) 
    • feeling feverish or a temperature above 38°c 
    • the incision progressively seems puffy, red and more painful to touch 
    • your lower abdomen seems harder or more firm 
    • you develop flu-like symptoms 

    Some women choose to use specially designed silicone strips after 6 weeks (When the initial healing is completed) to help the appearance and continued healing of their incision. These strips reduce moisture loss from the scar and help prevent the outermost skin layer from getting dehydrated. They create conditions similar to normal healthy skin, which helps the scar recover quicker and reduces its appearance. 

    Caesarean Scar Care and Management

    A caesarean section is major abdominal surgery, and caring for your scar as it heals can support comfort, movement and appearance over time. Every scar heals differently, but there are simple steps you can take at each stage of recovery.

    Immediately After Surgery (first few days to 2 weeks)

    Your body’s priority during this time is healing the incision and preventing infection. 

    Focus on:

    • Keeping the wound clean and dry
    • Following your care team’s advice about dressings
    • Watching for signs of infection (increasing redness, swelling, heat, discharge, fever or worsening pain)
    • Supporting your incision when coughing, laughing or standing (using your hands or a pillow)
    • Gentle walking to support circulation and recovery

    Avoid heavy lifting, intense stretching or any pressure directly on the scar. 

    Early Healing Phase (2 to 6 weeks)

    As the incision closes, you may notice tightness, numbness or pulling sensations. This is normal as tissues begin to repair.

    Helpful tips:

    • Continue gentle movement like short walks
    • Stand tall and avoid staying hunched forward
    • Wear comfortable clothing that doesn’t rub on the scar
    • Wait until the scar is fully closed with no scabs before starting massage

    If you have concerns about healing, speak with your LMC, GP or specialist.

    When the Scar Is Fully Healed (usually around 4 to 6 weeks) – Scar Massage

    Once the scar is completely closed with no scabs or open areas, you can begin scar massage (usually around 4 to 6 weeks after birth).

    Scar massage helps improve mobility, reduce tightness and may improve the appearance of the scar by encouraging healthy collagen remodelling. It can also mobilise skin tissues, reduce scar tissue build-up, stimulate blood flow, relieve itching and may help restore sensation to the area.

    If you do not feel ready to touch the scar itself, begin by gently massaging the surrounding area to get used to the sensation. You can gradually work up to massaging directly over the scar when and if you feel comfortable.

    Guidelines:

    • Start from around 4 to 6 weeks once fully healed
    • Massage daily for around 10 minutes
    • Continue for at least 6 to 8 weeks
    • Scars continue to remodel for up to 18 months, so you can continue as long as you notice benefit

    Use gentle pressure at first, gradually progressing to deeper movements as comfortable. You may like to use a natural oil or moisturiser to reduce friction.

    Scar Massage Techniques

    Up + Down, All Around

    Place your fingertips on the edges of the scar. Gently move you fingertips side to side along the incision. Start from the right side of your scar and gently run your fingers from the right side, through to the left side. Then gently go across the incision line from the left side, back to the right. Take your time, see how mobile the tissue is, as there may be some tightness in places. If you don’t feel comfortable working directly on the incision, you can do these movements just above or below the scar.

     

    Side to Side

    Place 2 or 3 fingers about 3-4 cms from scar on either side. You can gently stretch the skin by moving your fingertips up and down around the entire scar. Try stretching side to side and clockwise or counterclockwise. Massage completely around the scar, then repeating each movement 5-10 times, (this should only take a few minutes).

    Waves

    Again, you can work either on the scar itself or just above and below. Gently move the tissue under your fingertips in wave like movements.

    Scar Massage content kindly supplied by: Viva La Vulva - vivalavulva.co.nz

    Silicone Therapy

    Medical-grade silicone gels or strips are widely used to help improve scar appearance.

    They may help to:

    • Reduce redness
    • Improve hydration of the scar
    • Flatten raised scars
    • Improve overall texture

    Silicone is typically used once the wound is fully healed and can be applied daily according to product instructions for several weeks or months.

    Long-Term Care

    Scar healing is a long process, and changes can continue for up to 18 months or longer. 

    Over time you may notice:

    • Colour fading
    • Softening of the tissue
    • Improved flexibility

    Continuing massage, maintaining good posture, and staying active can support ongoing recovery.

    Manual Therapies

    Some parents find additional support from trained practitioners helpful.

    • Myofascial release: This gentle hands-on therapy can help release tightness in the surrounding tissues and improve movement. Practitioners often see improvements even in older scars.
    • Cupping: Scar cupping can help lift and mobilise tissue that feels stuck or restricted and may improve comfort and appearance over time.

    If you’re considering these therapies, seek a qualified pelvic health physiotherapist or trained practitioner.

    When to Seek Support

    Consider seeing a health professional if you experience:

    • Ongoing pain or sensitivity
    • A scar that feels very tight or stuck
    • Bulging or pulling with movement
    • Concerns about appearance
    • Symptoms affecting bladder, bowel or core function

    A pelvic health physiotherapist can provide individual assessment and treatment.

    Postpartum Bleeding

    Even though you’ve had a caesarean birth, you’ll still experience bleeding, clots and discharge. This is called lochia - a combination of leftover blood, mucus, and uterine tissue. Bleeding might be quite heavy in the first week and may also be heavy after exercise, when you first get up in the morning and after breastfeeding. After the first week your bleeding should gradually get lighter and change from red to dark-red to brown to yellowish-white. 

    Medication

    C-section pain typically spikes 18 hours after delivery, and painkillers will be prescribed to help with your pain management. It is usual to take mild pain relief like paracetamol for the first few weeks after your caesarean. After a C-section, compression stockings need to be worn to minimise the risk of blood clots and to encourage healthy circulation. 

    You will also be prescribed a blood thinner to prevent clots. Blood clots - a serious potential complication of any surgery, including a caesarean section. A blood clot in your body is called deep vein thrombosis (DVT) and a blood clot in your lung is called a pulmonary embolism (PE). A PE can be life-threatening. All women who have a caesarean section are given a medication called enoxaparin (Clexane) to reduce the chance of developing blood clots. Clexane is generally given in injection form.