Afterpains After Birth: How Long They Last and What Helps

Afterpains are the cramps you feel as your womb contracts after delivery. They are normal, they are commonly felt for the first two or three days, and they are often more intense with a second or later baby and while you breastfeed. Heat, an empty bladder and suitable pain relief can help. Pain that is severe, steady or getting worse is not typical afterpain and needs checking.

What are afterpains after birth?

During pregnancy your womb grows to about 25 times its normal size. After birth it has to contract back down, a process called involution. Cleveland Clinic explains that these contractions stop the bleeding from the area where the placenta was attached, and also help it shed extra tissue (lochia).

NHS maternity guidance describes afterpains as feeling like period pains or slightly less strong contractions. Cleveland Clinic says you may feel intense cramping lasting about five minutes that then gradually eases.

When do afterpains start, and when are they worst?

Cleveland Clinic notes that in the first 12 hours after birth, uterine contractions are regular and strong, and you may feel cramps as this happens. A Cochrane review says afterpains are commonly felt for two or three days, and NHS guidance says they usually subside by the third day. The womb keeps shrinking for longer: it can take up to six weeks to return to its usual size, but Cleveland Clinic says afterpains themselves are typically only noticeable for a few days.

Why are afterpains worse with a second baby?

Several sources agree that afterpains often seem stronger after a second or later pregnancy, and MedlinePlus notes that the contractions are most often mild but can be stronger if you have already had several babies. The Cochrane review gives two likely reasons. A womb that has carried babies before has lost some muscle tone, so it contracts and relaxes alternately. And childbirth can cause changes in the nervous system that increase the tendency to feel pain during the postpartum period.

Why does breastfeeding bring on afterpains?

When your baby suckles, or when you pump, your body releases oxytocin, the hormone that makes the womb contract. The NHS says you may feel quite painful period-like cramps while you are feeding, and that this helps because it makes your womb contract. The Cochrane review notes that oxytocin released during breastfeeding increases the severity of afterpains.

What helps afterpains?

• Heat. A hot water bottle, heat pack or heating pad on your lower tummy can bring relief.
• Empty your bladder often. NHS guidance notes that a full bladder can make afterpains worse.
• Lie on your stomach with a pillow under your lower belly.
• Walk gently.
• Use the breathing and relaxation techniques you may have learned for labour.
• Drink plenty of water.

On medicines, NHS and Cleveland Clinic guidance mentions over-the-counter pain relievers such as paracetamol (acetaminophen) or ibuprofen, and Cleveland Clinic says ibuprofen may work better than acetaminophen for afterpains. A Cochrane review found that NSAIDs, the group ibuprofen belongs to, are probably better than placebo and probably better than opioids for this pain, while the evidence for paracetamol was too weak to be sure either way. The NHS advises that if you are breastfeeding, you check with a pharmacist, midwife or GP before buying over-the-counter painkillers. Your pharmacist or provider can tell you what suits you and how much to take.

Afterpains after a C-section

A C-section delivery does not skip this step. The womb still contracts after surgery, and MedlinePlus notes these contractions may be somewhat painful but are important. Breastfeeding helps the womb contract after surgery too. The difference is that afterpains sit on top of wound pain, and MedlinePlus says most women need pain medicine for the first few days to two weeks after a C-section. It is fine to ask for pain relief when you need it.

Cleveland Clinic advises seeking medical attention after a C-section if you have a fever, notice foul-smelling discharge, or your pain gets worse instead of better.

Is back pain after delivery normal?

Pain conditions such as back pain are common in pregnancy and may continue after birth. A systematic review describes postpartum back pain as discomfort in the lower back that can come from a mix of mechanical, hormonal, circulatory and psychosocial factors. The NHS adds that problems can come from the things you do while caring for a baby, such as lifting and bending.

• Does it go away? For most women, yes. A published review says pregnancy-related low back pain generally has a good outlook, falling quickly in the first three months after delivery, though some women still have symptoms months later. The same review names back pain in a previous pregnancy as one of the most important risk factors for back pain after birth.
• Was it the epidural? That meta-analysis found no statistically significant association between back pain after delivery and epidural or spinal anaesthesia.
• What helps? The NHS suggests keeping your back straight and bending your knees when lifting, and sitting with your back well supported while feeding, with a small cushion behind your waist. It also says you may need exercises to strengthen your back. The review notes that physiotherapy and exercise are among the conservative treatments used, and that conservative management is the treatment of choice.

When to call your midwife or doctor

Cleveland Clinic says cramps that come and go and last no longer than about five minutes are normal, but pain that is severe or steady is a reason to contact your provider. Constant tummy pain can be a sign of endometritis, an infection of the womb lining. Contact your midwife or doctor if you have:

• A fever over 100.4°F (38°C) or severe chills.
• Severe cramping or tummy pain that pain medicine does not relieve, or pain that keeps increasing.
• Foul-smelling vaginal discharge.
• Heavy bleeding: needing more than one pad an hour, or passing large clots.
• Bright red bleeding that continues beyond the third day, or bleeding that gets heavier again after slowing down.
• Pain, burning or trouble passing urine.
• More pain, redness or discharge from a C-section wound, or the wound opening.
• Severe pain, swelling or redness in one leg more than the other.
• Warm, red, painful areas on your breast.

Sudden or very heavy bleeding, especially with feeling faint or a racing heart, needs help straight away. Cleveland Clinic advises going to the nearest emergency department if you have excessive bleeding at home.

MatraBloom's week-by-week recovery timeline, set to how you gave birth, can help you see whether cramping and bleeding are following the usual pattern, and the daily check-in keeps a simple record you can show your midwife or doctor.

Read how long postpartum bleeding usually lasts

Frequently asked questions

Know what is typical this week

MatraBloom's recovery timeline shows what is common in each week after a vaginal birth or a C-section, and the daily check-in gives you a simple record of pain and bleeding to share with your provider.

Continue reading