Which patient is most likely to experience strong and uncomfortable afterpains?

Buckle up for another wild ride — here comes the postpartum stage.

As if being pregnant for 9 long months and giving birth wasn’t enough, you may experience a host of aches and pains after delivery that you didn’t quite expect. Even if you’re a seasoned parent, there are different situations and sensations you’ll have with each baby.

Cramping is definitely a thing in the days and weeks after delivery. Often it has to do with your uterus returning to its normal state of being. Other times, though, it may be a reason for concern.

Here’s what you need to know about postpartum cramping, what causes it, and when you should contact your doctor.

Again, it’s normal to experience cramping in your lower abdomen after you give birth. After all, your uterus grows to many times its original size throughout pregnancy — all while its lining thickens and its blood vessels enlarge to support the placenta and your baby.

When your baby is born, your body begins the process of getting back to its starting point.

Afterpains

The most common reason you have cramping after your baby is born is that your uterus contracts to shrink back down to its original size. While it contracts, your body is also working to compress blood vessels in the uterus to prevent too much bleeding.

The contractions are like mini versions of labor contractions and they’re sometimes called “afterpains” because, well, you get these pains after you deliver your little one.

The cramps may feel a lot like menstrual cramps — from mild to possibly severe at times — and they tend to be more noticeable with second or third pregnancies.

Afterpains are generally most uncomfortable in the first few days after delivery. They tend to fade away after that, but you may find they’re more noticeable when you’re breastfeeding.

Cesarean delivery

Afterpains don’t only affect people who give birth vaginally. Your uterus also contracts this way after you have a C-section. So, the same rules apply to the uterus and its need to return to its pre-pregnancy size.

That said, it’s important to note that you may have additional discomfort in your lower abdomen after a cesarean delivery. After all, it’s major surgery! You may feel cramping and soreness as your incision and the surrounding tissues heal.

Constipation

That’s right — constipation. The thing nobody really talks about is pooping after delivery, but we went there.

You’ll likely have your first postpartum bowel movement within a few days of delivery. But you can also develop constipation, which may be caused by high progesterone levels in pregnancy, your diet (for example, low fiber intake), and lowered activity levels.

Constipation comes with cramping — and you may also just feel backed up or have some bloating and pressure.

This condition may be particularly likely if you’ve had a cesarean delivery. Why is this? Well, you may be spending some extra time in bed recovering after surgery. And certain pain medications may also slow down your digestive system and back you up, leading to cramping.

Infections and more

While less common, it’s possible to develop infections after giving birth. Some types of infections are more likely to develop than others. And it’s also important to note that you might feel pain and cramping that aren’t related to giving birth at all.

Possibilities include things like:

• Endometritis is inflammation of the uterine lining caused by infection. Other symptoms include fever, constipation, unusual vaginal discharge, and pelvic pain.
• Bacterial vaginosis is an infection caused by too much bad bacteria in the uterus. Other symptoms include a burning sensation when urinating, foul-smelling discharge, and itching/pain in the vulva.
• Urinary tract infection (UTI) impacts the ureters, bladder, urethra, and kidneys. Other symptoms include fever, painful or frequent urination, urgency to urinate, cloudy/bloody urine, and pelvic pain.
• Appendicitis is inflammation of the appendix. While completely unrelated to childbirth, researchers note that it’s possible to experience appendicitis (and other conditions) in the postpartum period, but that with everything else going on, diagnosis may be delayed. Other symptoms include low-grade fever, nausea/vomiting, abdominal pain that gets worse with movement, and diarrhea/constipation.

Afterpains may begin immediately after you give birth to your baby. They tend to peak in their intensity on days 2 and 3 after birth. Then they continue for the first week to 10 days after delivery, or until your uterus returns to its pre-pregnancy size.

Cesarean section discomfort is also more likely in the first few days after delivery. However, you’ll still likely experience general afterpains, which follow the timeline above.

Cramping that’s caused by other conditions, like constipation or infection, will last for different amounts of time. And without treatment, the cramping may continue until you address the underlying cause.

So, if you’re in pain — don’t delay. Get checked out so you can feel better ASAP.

Your uterus does need to go through the work of contracting and shrinking after the birth of your baby. There’s no treatment that will stop it — nor would you want to stop it — but you can treat the cramping and pain you experience to make it a bit more comfortable.

• Pain medication. Over-the-counter (OTC) medications, like ibuprofen, can take the edge off. For particularly painful cramping, your doctor may also give you a prescription for a short course of pain meds that are a bit stronger.
• Movement. It may sound unappealing, but getting up and gently walking around as soon as you’re able may ease your afterpains. Bonus: Moving your body is also good for constipation.
• Relaxation. Try some deep breathing exercises when you get the pains. This may help you move through them and stay calm.
• Heat. Heating pads or hot water bottles may also provide some relief and are easy to find at big box stores and pharmacies. (Or you can make your own.)
• Other suggestions. Keep your bladder empty; if you’re breastfeeding, try to do so frequently; and remember that this, too, shall pass.

If you’re constipated, consider taking OTC stool softeners or laxatives to get things moving. Your doctor or pharmacist can point you to specific ones that are OK to take while breastfeeding.

Lifestyle changes that may help include:

• engaging in light exercise (keyword light — like walking)
• eating a high fiber diet with lots of fresh fruits and vegetables
• drinking more water

How much more water do you need? Experts recommend that you drink 13 cups of fluids a day if you’re breastfeeding.

For infections, you’ll need to see a doctor and get a prescription for appropriate medications. Your doctor may also be able to suggest at-home methods to ease your discomfort, like taking OTC pain medications.

While cramping can be common, severe pain and other symptoms aren’t — and may be a sign of infection. Be sure to check in with your doctor if you experience any of the following warning signs.

• Fever. If you feel unwell, try taking your temperature. Any reading that’s 100.4°F (38°C) or higher may indicate an infection.
• Discharge. You’ll experience varying degrees of bleeding and discharge after delivery. But if the discharge is a strange color or smells foul, you may have an infection like endometritis or bacterial vaginosis.
• Bleeding. With cramping, you may experience increased bleeding and discharge. Bleeding is considered heavy if it soaks through more than one pad every 1 to 2 hours.
• Painful urination. Frequent or painful urination may be signs of a UTI or other infection. Without treatment, UTIs can lead to kidney infections or sepsis.
• Severe abdominal pain. While cramping can be strong at times, it shouldn’t last more than a few days or persist when you aren’t breastfeeding. If you’re in tremendous pain, you may have an infection.
• Redness around your incision. If you have pain, redness, discharge, or warmth around your incision after a C-section, the area may be infected.

The American College of Obstetricians and Gynecologists shares that you should reach out to your healthcare provider within the first 3 weeks of giving birth. That way, you can explain anything that you think might be off with your recovery.

From there, you should also schedule a full postpartum appointment no later than 12 weeks after your baby is born.

And remember: It’s also possible to have cramping or pain in your abdomen that’s caused by something not related to your pregnancy or delivery. When in doubt, get checked out.

There’s a lot going on in those early weeks after you have your baby — but self-care is super important.

Between all the diaper changes, feedings, and sleepless nights, try your best to find moments of peace and quiet for yourself as well. Tune in with your body and make note of anything that doesn’t feel quite right.

For most people, uterine cramping should subside within a week or so of delivery. If it continues or you have other concerns, don’t hesitate to contact your doctor.