Postpartum cramping is very normal and, in most cases, a positive sign; however, it doesn’t mean it’s comfortable. Here's what to know—and when to give your doctor or midwife a call.
What Is Postpartum Cramping?
Postpartum cramping is a symptom of the uterus’ process of shrinking or ‘involuting’ back down into the pelvis after childbirth. This is a reassuring sign that the body is continuing to work after you have given birth to help prevent heavy bleeding and encourage normal healing.
What Causes Postpartum Cramps?
After the birth of the baby and the placenta, there is essentially a large wound left on the inside of the uterine wall where the placenta was attached. This wound is a site of open blood vessels and where postpartum bleeding aka lochia stems from. (Read previous article “How Long Does Postpartum Bleeding Last?” for more). To slow the bleeding, the uterus compresses the blood vessels by contracting and making the surface area of the wound smaller.
Additionally, while nursing your baby, your brain releases the hormone oxytocin which is the same hormone that produces labor contractions. This is in turn will make your uterus contract again after the birth. Thus, another benefit of early initiation of breastfeeding is to encourage uterine cramping and minimize bleeding in the early postpartum period.
Afterpains
These uterine contractions after the birth are considered afterpains. It will feel very menstrual-like in location and are akin to the sensations of early labor contractions. With subsequent births, the afterpains tend to feel more intense right away. This is due to the uterus stretching larger with every baby and pregnancy and thus working harder afterwards during the involution process to contract back down to its pre-pregnant size and location.
You may feel the afterpains more strongly in a hospital birth setting due to the routine use of intravenous Pitocin. With the birth of the baby, Pitocin is given immediately (if not already administered during labor) as a prophylaxis to prevent uterine fatigue and postpartum hemorrhage especially after medically induced labors and cesareans. (Planned out-of-hospital settings and providers also carry Pitocin and is only used only for the postpartum period if medically indicated ie active bleeding.)
C-Section
Postpartum cramping can occur after both a vaginal birth and cesarean section. However, there is usually additional abdominal discomfort while recovering from surgery specifically soreness around the incision and the surrounding tissues as they continue to heal.
Constipation/Full bladder
It’s normal to not have a bowel movement for the first 2-3 days after birth. This is due to the prescribed bed rest and lack of physical activity in the early days recovering postpartum. However, compacted bowels beyond this time and/or a full bladder can get in the way of the uterus contracting back down into the pelvis. This can cause more painful cramping due to the uterus having to work harder. It can also increase bleeding as the site of the placental wound stays open longer. Additionally, constipation can cause other abdominal discomforts such as bloating and pressure.
Infections and medical causes
While less common, it’s important to be able to differentiate between normal postpartum cramping and pelvic/abdominal pain from an infection.
- Urinary Tract Infection (UTI): Holding your urine for long periods of time and/or persistently having a full bladder can be a cause for a bladder infection. Other symptoms of a UTI include fever, an increased frequency and urgency to urinate but very little is passed, pain during and/or immediately after urination, and cloudy colored urine.
- Endometritis: Inflammation of the uterine lining caused by an infection. Once you have given birth and are in recovery mode, it’s important to keep the vagina clean so as to reduce the risk of bacteria ascending into the uterus. This means nothing goes inside your vagina ie fingers, tampons, sex objects, etc. and change your pads often until you have stopped bleeding (usually up to 4-8 weeks postpartum). You can use witch hazel and aloe in your peri bottle to aid in healing any external or internal lacerations from the birth. Also, baths are safe post-vaginal birth but just make sure the tub has been cleaned prior to use as to reduce potential introduction of bacteria.
How long do postpartum cramps last?
Postpartum cramps can begin immediately after the birth, peaking in intensity at 24-48 hours after the birth and can last up to 2 weeks and/or whenever the uterus returns to its pre-pregnant size.
How to get relief from postpartum cramps.
Make sure to stay hydrated. A dehydrated muscle is an irritable, tight muscle. This is true in pregnancy as well. Often signs of preterm labor can be stopped with oral and/or IV hydration alone. A breastfeeding mother should be drinking around 3 liters or 128 ounces of liquids/day. With that, also make sure to relieve your bladder regularly. Nursing with a full bladder will make for painful afterpains and an increase in bleeding.
Drink warm teas to soothe the uterine muscle – specifically red raspberry herbal leaf for its benefits of toning the uterus. It’s also a source of calcium which when combined with magnesium (can be applied topically to the lower abdomen in the form of an oil or cream) are important minerals for nourishing sore muscles.
Eat warm, fibrous, and collagen-rich foods to encourage the needed building blocks for healing and to promote smooth digestion.
If constipated, increase hydration, incorporate eating dried prunes and/or taking an OTC stool softener to help regulate your digestive system. Try to avoid cruciferous or gas promoting foods like broccoli, cabbage, lentils, beans as trapped gas whilst recovering from a cesarean can cause shooting abdominal pains.
Heat can be applied to the lower abdomen in the form of a hot water bottle or heating pad.
Hydrotherapy can help soothe uterine afterpains (and is also a useful tool for labor pains). A shower is safe after either mode of delivery, but a full submersion bath should be reserved for mothers recovering post-vaginal birth. You can use Epsom salts in the bath to aid in relieving whole body aches and pains.
Lastly, OTC medication such as Ibuprofen and/or a homeopathic remedy called Arnica are great pain relievers that are also safe to take while breastfeeding. I would encourage this option if you have exhausted the others and sleep is interrupted due to the severity of afterpains. Sleep (albeit not continuous) is incredibly important during the postpartum for optimal milk supply, mood, immunity, and an overall healthy recovery. Consult with your primary provider about a safe amount for you to take.
When should I be concerned about postpartum cramping?
You should reach out to your primary provider and/or seek urgent care if cramping persists beyond 2 weeks post-birth and/or…
- Is getting stronger in sensation/discomfort
- There’s an increase in bright red bleeding
- The abdomen is tender to the touch
- You have a fever of 100.2 degrees F or higher
In general, healing after birth can be timely however the discomforts of the immediate postpartum should continue to decrease in the days and weeks after birth. If not and/or pain is increasing, then this is definitely a sign that the body requires further investigation and support from your medical provider.
