Postpartum Cramping: Causes and How to Get Relief

Postpartum cramping, also known as afterpains, is a normal part of recovery that signifies that your uterus is shrinking back to its pre-pregnancy size.

While they can feel uncomfortable, for most new moms, they’re mild. However, if you’re breastfeeding or have had multiple pregnancies, they might feel a bit more intense. Over-the-counter pain relievers, such as ibuprofen or acetaminophen, along with heat and rest, can help manage discomfort.

What Is Postpartum Cramping? 

Cramping after labor and delivery is a symptom of the uterus’s process of shrinking or ‘involuting’ back down into the pelvis after childbirth. This is a positive sign of healing, as well as helping prevent heavy postnatal bleeding. 

What Causes Postpartum Cramps? 

After the birth of the baby and the placenta, there is essentially a large wound on the inside of the uterine wall where the placenta was previously attached. There are open blood vessels, which is where postpartum bleeding, aka lochia, stems from. 

To slow bleeding, the uterus contracts, compressing the blood vessels and reducing the surface area of the wound. 

Additionally, while nursing your baby, your brain releases the hormone oxytocin, which is the same hormone that produces labor contractions. This also triggers your uterus to contract, which is yet another benefit of breastfeeding.

Afterpains 

These uterine contractions that occur after birth are considered afterpains. They can feel similar to menstrual cramps or early labor pains and occur mainly in the lower abdomen.

With subsequent births, afterpains tend to intensify due to the uterus stretching larger with every pregnancy. This stretching forces the uterus to work harder during the involution process to contract back down to its pre-pregnant size and location. 

You may notice afterpains more strongly in a hospital birth setting, because of the routine use of intravenous Pitocin, a medication that simulates oxytocin. A nurse or doctor will typically administer Pitocin right after the baby is born (if it wasn’t already administered during labor) to help prevent uterine fatigue and reduce the risk of postpartum hemorrhage—especially following medically induced labors or cesarean births. Providers also carry Pitocin in out-of-hospital settings, but rarely use it unless medically necessary.

C-Section 

You can also have postpartum cramping after a cesarean section. Additionally,  discomfort at and around the incision can make it feel like your cramps are more intense or uncomfortable. 

Constipation/Full Bladder 

It’s common not to have a bowel movement for the first 2-3 days after birth, mainly due to prescribed bed rest and reduced physical activity during early recovery. However, constipation or a full bladder can interfere with the uterus's contraction and can cause more intense cramps. Postpartum constipation can also increase bleeding and discomfort, such as bloating and abdominal pressure.

Infections and Other Medical Issues

While less common, it’s essential to be able to differentiate between normal postpartum cramping and pelvic/abdominal pain caused by an infection.  

Urinary Tract Infection (UTI)

Consistently holding urine or keeping the bladder full can increase the risk of developing a UTI. Signs of a UTI include fever, frequent or urgent urges to urinate with little output, pain during or after urination, and cloudy urine.

Endometritis

An infection of the uterine lining that can occur postpartum if bacteria travel into the uterus. To lower risk:

• Keep the vagina clean: avoid inserting anything (fingers, tampons, sex, etc.) and change pads often until bleeding stops (usually 4–8 weeks). 
• Baths are safe after a vaginal birth as long as the tub is thoroughly cleaned. 
• Using witch hazel or aloe in a peri bottle can also support laceration healing.

How Long Do Postpartum Cramps Last? 

It varies from woman to woman. Cramps may start immediately after delivery, peak during the first 24-48 hours, and last between two and six weeks. They may also last longer, since it depends on how quickly your uterus returns to its pre-pregnancy size.

Each experience is individual, so cramping three weeks postpartum or longer is perfectly normal. Here are some factors that impact the duration of postpartum cramping:

• Type of delivery: Vaginal births tend to come with stronger afterpains than C-sections (though both are normal).
• Number of pregnancies: With each subsequent pregnancy, the uterus has to work harder to contract back down into the pelvis. 
• Breastfeeding: Nursing triggers the release of oxytocin, which stimulates uterine contractions. You may experience cramping more frequently, especially during the early weeks.

How To Relieve Postpartum Cramping

• Hydration: Drink plenty of fluids—about 3 liters (128 oz) daily while breastfeeding. Dehydration can tighten muscles and even trigger preterm labor during pregnancy. Staying hydrated helps soothe afterpains and supports recovery.
• Empty your bladder: Relieve yourself often. Nursing with a full bladder can intensify afterpains and increase bleeding.
• Warm tea: Warm Herbal teas can soothe cramping. One variety, red raspberry leaf, is purported to alleviate pain and help tone the uterine muscles.
• Digestion: Eat warm, fibrous, collagen-rich foods to aid healing and digestion. For constipation, boost hydration, add prunes, or use an OTC stool softener. Avoid gas-promoting foods (broccoli, cabbage, beans, lentils), which can worsen post-cesarean abdominal pain.
• Heat therapy: Apply a hot water bottle or heating pad to the lower abdomen for relief.
• Hydrotherapy: Showers are safe after birth, and warm baths (for vaginal deliveries) can ease afterpains. Add Epsom salts to relieve soreness and body aches.
• Over-the-counter pain relief: If afterpains interfere with rest, Ibuprofen or Arnica, a plant known for its pain relief properties (safe while breastfeeding), can help when other methods aren’t enough.
• Rest: Prioritize rest, even in short stretches. Sleep is vital for milk supply, mood, immunity, and overall recovery.
• Supportive belly band: Wearing a soft belly band can provide gentle compression and provide extra support.
• Gentle abdominal massage: A light circular massage over your belly can help relieve pain.

Postpartum Cramping: When to Worry

If you’re still cramping after 6 weeks, or:

• The cramping is increasing in severity as time goes on 
• There’s an increase in bright red bleeding 
• The abdomen is tender to the touch 
• You have a fever of 100.2 °F (37.96 °C) or higher

You should reach out to your primary provider and/or seek urgent care.

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 a definite sign that the body requires further investigation and support from your medical provider.