The First Six Weeks After Delivery: What to Expect, What to Watch

Nine months of appointments, scans and advice end the day the baby arrives — and then, for most women, the attention moves entirely to the baby. Yet the six weeks after delivery are when a mother is most likely to run into a serious problem, and they are the weeks she is least likely to be watched.

India's maternal mortality ratio has fallen a long way, from 130 per 100,000 live births in 2014-16 to 93 in 2019-21. Most of what remains happens after the birth rather than during it, and much of it in the first week. Almost all of it is preventable by acting early on a small number of warning signs.

Week 1: the week that needs watching

Bleeding. Lochia is heaviest in the first few days, bright red, and often with small clots when you stand up. It should steadily reduce. A gush when you feed is normal — feeding makes the uterus contract.

Afterpains. Cramping while you feed, stronger with each baby you have had. It means the uterus is shrinking back as it should.

The perineum, if you had a tear or a cut: sore, swollen, worst on days two to four. Stitches dissolve over two to four weeks. Keep it clean and dry, rinse with water after passing urine, pat rather than rub, and take the painkillers you were given rather than enduring it.

A caesarean wound is covered for the first day or two, then kept clean and dry. Expect numbness around the scar for months. Support the wound with a pillow when you cough or laugh, and move early and often — walking reduces the risk of clots.

Passing urine and stool. Both can be frightening the first time and both get easier. Drink, eat fibre, take the stool softener if offered; straining is the enemy of stitches and of haemorrhoids.

Milk coming in around day three, with full, tender, sometimes hard breasts. Feed often, soften the breast before latching, and get the latch checked early rather than after damage is done.

Weeks 2 to 6: the slow half

• Bleeding fades to brown, then to a yellowish-white discharge, usually stopping somewhere between two and six weeks. An occasional brief return of red bleeding after over-doing things happens; a proper return of heavy red bleeding does not.
• Energy comes back unevenly. Broken sleep, not weakness, is why the afternoons are hard.
• Hair fall often starts around three months and settles by itself.
• Sweating at night is common as the extra fluid of pregnancy leaves.
• The abdomen stays soft for weeks. Gentle walking first; core and pelvic-floor work properly from the six-week check.
• Pelvic floor exercises can start as soon as you are comfortable, and they are the single best protection against leaking and prolapse later.

The warning signs

Two of these deserve emphasis because they are so often waited out. Secondary postpartum haemorrhage — heavy bleeding from 24 hours up to twelve weeks after birth — usually means infection or retained tissue, and it responds well to prompt treatment; our page on retained tissue explains that. And postpartum pre-eclampsia catches women out precisely because the pregnancy is over; if you had raised blood pressure in pregnancy, get it checked in the first week even if you feel well. See blood pressure in pregnancy.

Feeding, honestly

Most feeding problems in the first month are latch problems, and most latch problems are fixable in one session with someone who watches you feed. Sore, cracked nipples are a sign the latch needs adjusting, not a rite of passage. Blocked ducts respond to feeding through, warmth and massage; a blocked duct with fever is mastitis and needs review.

Worry about supply is nearly universal. The reliable signs are wet nappies, weight, and a baby who settles after feeds — not what you can express, and not how full the breast feels. If feeding is not working, that is a reason to be seen, not a reason to feel you have failed. Formula, where it is needed, is a solution and not a moral event.

Mood: the part that gets skipped

Baby blues — tearfulness, irritability and feeling overwhelmed around days three to ten — affect most women, and lift on their own.

Postnatal depression is different: low mood, hopelessness, anxiety that will not settle, inability to sleep even when the baby sleeps, no pleasure in anything, guilt, or frightening intrusive thoughts. It can start any time in the first year. It is common, it is nobody's fault, and it responds to treatment — including treatments that are compatible with breastfeeding.

If you cannot sleep even when the baby is asleep, or you have stopped being able to eat, or the thoughts frighten you, tell your doctor plainly. If you have thoughts of harming yourself or the baby, that is urgent: call 14416 or go to hospital the same day.

Periods, fertility and contraception

• Periods usually return around six to eight weeks if you are not breastfeeding, and often much later if you are feeding exclusively.
• Ovulation comes before the first period, so waiting for a period is not a method.
• Contraception is needed from about three weeks after delivery if you are not exclusively breastfeeding. Progestogen-only pills, the implant and the copper or hormonal coil are all compatible with breastfeeding; combined pills usually wait. See contraception options.
• Spacing. Leaving at least 18 months between the birth and the next conception lowers the risks in the next pregnancy.

Sex, when you are ready

There is no fixed date. Most couples wait until bleeding has stopped and the six-week check is done, and many wait longer. Dryness is very common while breastfeeding, and a lubricant helps. Pain that persists is not something to push through — see why sex hurts and what helps.

The six-week check

This visit is for you, not only the baby. A proper one covers blood pressure, bleeding, wound or stitches, breasts and feeding, mood, contraception, pelvic floor and any bladder or bowel symptoms, plus haemoglobin if you bled heavily. Two follow-ups are often forgotten:

• If you had gestational diabetes, a glucose tolerance test six to twelve weeks after delivery — see diabetes in pregnancy.
• If you had high blood pressure, a blood-pressure review, because it can persist or return.

What happens at the clinic

Postnatal check-ups, wound and stitch review, blood pressure, blood tests, feeding support, contraception including implant and coil insertion, and mood assessment all happen at the clinic. Scans are arranged by referral. Admission, transfusion and any surgery are at hospital — and if a warning sign above applies, go there directly rather than waiting for an appointment.

You do not need to be certain something is wrong before asking. Being checked and reassured is the point of the six weeks.