The physical changes that follow childbirth are dramatic, varied, and often entirely underdiscussed. Many new mothers are surprised — sometimes alarmed — by what happens to their bodies in the weeks and months after birth. This guide covers the most common postpartum physical changes, what is within the expected range, and what warrants medical attention.
Lochia is the postnatal discharge that consists of blood, mucus, and uterine tissue shed as the uterus heals after delivery. It is not the same as a normal period and typically passes through three distinct phases:
Lochia rubra (days 1 to 4): Heavy red or dark red bleeding, similar in volume to a heavy period. Large clots can be normal at this stage, particularly after standing up, but clots larger than a 50-pence piece should be reported to your midwife.
Lochia serosa (days 4 to 10 approximately): The discharge lightens in colour to pinkish-brown and reduces in volume.
Lochia alba (up to 6 weeks): The discharge becomes yellow or white and continues to reduce.
Total lochia typically lasts between 4 and 6 weeks. It is normal for it to become heavier again temporarily when you are more active, and many women notice an increase around day 10 as the eschar (the protective tissue covering the placental site) detaches.
When to seek urgent help: Fresh red bleeding that soaks more than one maternity pad per hour, large clots, or lochia that is offensive-smelling can indicate haemorrhage or infection and require immediate medical attention.
After delivery, the uterus contracts to return to its pre-pregnancy size — a process called involution. These contractions are painless or barely noticed after a first birth, but tend to be more intense with each subsequent baby. Breastfeeding, which triggers oxytocin release, intensifies afterpains, which is why many mothers notice more cramping when feeding in the first few days.
Afterpains typically peak on days 2 and 3 and resolve over the first week. Paracetamol or ibuprofen (if not contraindicated) taken before feeds can help manage them.
For women who have had a vaginal birth, particularly those with perineal tears or an episiotomy, perineal healing is a significant concern in the first weeks.
First and second-degree tears (tears involving the skin and superficial muscle) typically heal well within 2 to 4 weeks. Third and fourth-degree tears (involving the anal sphincter) take longer to heal and require follow-up through the obstetric team or a specialist perineal clinic.
Pain, swelling, and discomfort in the perineal area are normal in the first week. Cooling the area with an ice pack wrapped in a cloth, keeping the area clean with warm water rather than soap, and using a rubber ring or padded seat for sitting can all help.
Signs of perineal infection to watch for: Increasing rather than decreasing pain after the first few days, redness, swelling that is getting worse, discharge that is yellow, green, or offensive, or fever. These should be assessed by a midwife or GP.
Whether or not you are breastfeeding, your breasts will change significantly after birth.
Colostrum to milk transition: In the first two to four days, the breast produces colostrum — the early, concentrated first milk. Around day 3 to 5, milk "comes in" and the breasts become significantly fuller, firmer, and sometimes engorged. Engorgement is uncomfortable but usually resolves within 24 to 48 hours as supply regulates. Feeding or pumping frequently, warm compresses before feeds, and cold compresses after feeds all help.
Engorgement: More severe engorgement can be relieved with gentle massage and hand expression before feeds to soften the breast and allow the baby to latch. Avoid heavy pumping to relieve engorgement, as this signals the body to produce more milk.
If not breastfeeding: Milk will still come in. Binding the breasts firmly (not tightly), wearing a well-fitted supportive bra, and applying cold compresses can help manage discomfort. Milk suppresses naturally within a few days to two weeks without stimulation.
The rectus abdominis muscles (the "six-pack" muscles) run down the centre of the abdomen, joined by a band of connective tissue called the linea alba. During pregnancy, the growing uterus stretches and separates the two sides of the rectus abdominis. This is a normal part of pregnancy, not damage.
After birth, this gap — called diastasis recti — varies in size. A gap of up to two fingers' width is common and generally closes or becomes functionally adequate with appropriate rehabilitation. A wider gap, or a gap where the linea alba has very poor tension even if not wide, can cause abdominal weakness, lower back pain, and pelvic floor dysfunction.
A simple self-check: lying on your back, lift your head and shoulders slightly. Run your fingers along the midline from the navel upward and downward, pressing gently. A soft gap in the midline is the separation. The width of the gap matters less than the tension of the tissue — functional assessment by a women's health physio is more useful than self-measurement.
Avoid sit-ups, crunches, and planks until assessed, as these exercises can worsen separation with poor linea alba tension.
Between 3 and 6 months postpartum, many women experience significant hair shedding. Handfuls of hair in the shower, on the pillow, and on hairbrushes are alarming but almost always normal.
During pregnancy, elevated oestrogen extends the growth phase of hair, so less falls out. After birth, as oestrogen levels drop, all the hair that would have shed normally over the previous months falls out in a relatively short period. This is called telogen effluvium. It is temporary — hair regrowth begins within a few months and most women notice significant improvement by 12 months postpartum.
If hair loss is severe, accompanied by other symptoms (extreme fatigue, feeling cold, weight changes), or does not improve, thyroid function should be checked, as postpartum thyroiditis is relatively common and can cause hair loss among other symptoms.
Hormonal fluctuations postpartum can cause a range of skin changes: breakouts in women who did not have acne in pregnancy, dry skin, melasma (patches of darker skin on the face), and stretch marks. Most of these are normal and improve over time as hormones stabilise. Sun protection helps prevent melasma from darkening further.
Stretch marks do not fade entirely but lighten over time from red or purple to silver-white.
Your postpartum body is not broken. It has done something extraordinary and is continuing to recover and adapt. If anything concerns you — about healing, pain, or how you feel physically — raising it with your midwife or GP is always the right thing to do.
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