During a vaginal birth, your vulva and vagina need to stretch a lot, especially while your baby is crowning. Just as your body is made to make your baby, it is designed to accommodate this to some extent, but sometimes tearing can occur. Tears can happen in the perineum, inside the vagina, or in other parts of the vulva, including the labia. Up to 9 in every 10 first-time mothers who have this kind of delivery will experience some sort of tear, graze, or episiotomy. If you have had a caesarean birth, your body has been through significant abdominal surgery and needs time to heal and recover as well. Let’s look at both kinds of birth, how you’ll be feeling, and how you can best support your own recovery.

How will I feel after a vaginal birth?

We often have a lot of different emotions after birth, and at times it can feel a bit overwhelming. Something that can help reduce part of the overwhelm is knowing how to take care of yourself after birth. Thinking about recovery in advance and being prepared can make a big difference in the early hours, days, and weeks after birth.

Your perineum, vagina, and vulva will feel and look swollen. They’ll also be tender and probably painful.

You may notice that your bladder control has changed and that you leak urine on the way to the bathroom. Contact your doctor or midwife if you have no bladder sensation or have no bladder control.

Similarly, you may have trouble controlling your bowels as well, especially if you’ve had a tear that involves your anus. If they don’t improve over the initial postnatal weeks, contact your doctor or midwife.

It’s normal to experience postpartum bleeding for about four to six weeks, but the amount does vary. If it seems more severe than a heavy period or smells bad, seek medical advice.

You can pass blood clots after birth, which you might see on your maternity pad. If you are concerned about the size of these, please speak to your midwife and take a picture of the clot so you can show it to them.

It can also be normal to feel a heavy or dragging sensation in your vagina, though speak to your doctor if this persists after six weeks.

How can I physically recover from a vaginal birth?

Take it slowly—you've just had a baby! In the early days, being home, taking care of your baby, and keeping on top of any pain while getting any sleep that you can should be the priority.

Move little and often. Take a stroll around the block every day once you feel ready, then increase that distance over time.

Wet a clean sanitary pad with water and freeze it. Then wrap it in an old flannel and put it over the perineum for a maximum of 10 minutes at a time. Try this every few hours to help reduce swelling and discomfort.

To sit comfortably, roll up towels and place them under your thighs so your perineum isn’t in contact with the chair. This will take pressure off any areas of stitches, grazes, and swelling.

Hold a clean maternity pad over the perineum to support any stitches when you need to open your bowels. Make sure you don’t strain. Raise your feet, lean forward, and take some relaxed, deep breaths when sitting on the toilet.

How will I feel after a caesarean birth?

Your tummy will feel very sore, tender, and painful, and it is likely to look bruised. It’s important to understand that your postpartum period is a recovery from surgery and to give yourself appropriate grace. One of our experts had a vaginal birth with her first baby and a caesarean with her second, and she has written about the difference.

You will have a wound dressing that will be removed when it’s appropriate, and midwives will monitor the wound in the early days and weeks. Some of you might have stitches that will be removed when appropriate as well. It is important to monitor for any signs of infection. If there is an area of the wound that looks more red, is more painful, has a yellow discharge, and/or you feel unwell with a temperature, then please flag this to your midwife or doctor.

You will have some postpartum vaginal bleeding, called lochia, as well. Monitor this for any changes, for example if it gets suddenly heavier, lasts longer than 6 weeks, or has a foul smell.

You may feel more constipated and gassy and struggle to go to the toilet. Do not suffer in silence. Sometimes it can be helpful to use laxatives for a few weeks to help you open your bowels more easily.

How can I physically recover from a caesarean birth?

Go very slowly and take all your painkillers as prescribed. Now is not the time to feel the pain and power through, but to listen to how your body feels.

Early mobilisation seems counterintuitive, but it is usually recommended within 24 hours to help manage swelling and pain. So if you have your baby in the morning, you’ll usually be told to try to get out of bed that day.

Getting in and out of bed more carefully reduces strain on your abdomen. To get out, roll onto one side, let your legs come gradually off the side of the bed, and push up with your arms the way you would when heavily pregnant. Do the opposite to get it back: lie on your side, bring your legs up, and then roll onto your back.

Apply pressure to your scar to support the wound. Cover it with a blanket or towel, and press it if you need to cough, sneeze, or laugh.

Put a pillow under your knees when you're lying on your back, or under your tummy if lying on your side. This will prevent any pulling or dragging on your scar in the early days.

When can I begin my pelvic floor exercises again after birth?

You can start pelvic floor exercises again after you’ve done your first post-birth pee. Your medical team will usually check to see if you’ve done this within six hours of giving birth or having the catheter you had during birth removed. They may ask to measure the amount of urine to check if it’s a good volume. You can take their check as a prompt to start again. Don’t panic if you don’t feel much movement in your pelvic floor after a vaginal birth, especially if you’ve had some tearing. Pain and swelling make it more challenging. This is only the beginning of reconnecting with your body.

What are some physical postpartum red flags I should be aware of?

Severe pain that cannot be efficiently managed with painkillers or anti-inflammatories.

An angry-looking vaginal or abdominal wound, with or without a bad odour

Loss of bowel control

Reduced bladder sensation and control

When can I return to physical activity (including sex!)?

Some mums can’t wait to get back in the gym; others can’t picture feeling that ‘together’ again. Rates of recovery differ, and it’s important to listen to your body. Six weeks is the general recommendation, based on the general healing timescales of soft tissues (such as skin and muscle). However, it is very much just a vague guideline. Most of us are not ready at 6 weeks postpartum to return to the same exercise routine we were doing before pregnancy or even during. Our body has been through a lot, and we need to give it time to recover.

Think of returning to activity and exercise in phases.

Recovery: the initial days and weeks
Rehabilitation includes the pelvic floor, tummy muscles, and full body.
Reintroduction: reintroduction to the activities we used to love, including higher-impact exercise.

Thinking about it in phases means that we remove pressure on certain timescales or feel we have to be'ready’ by a certain number of weeks and instead more easily move with our body at the right time for us.

Signs and symptoms to look out for:

Incontinence
Heaviness or dragging sensations in the vagina
A doming up or dropping down of the tissues down the middle of the tummy (which can be a sign of diastasis recti abdominis)
Any pain

If you experience any of these when being active or after exercise, then please stop and seek an assessment.

Intercourse is often the last thing on your mind after birth; however, it is important to consider when we feel ready as well as how to prepare our body. It is usually okay to return to intercourse after around 6 weeks when all wounds have healed and vaginal bleeding has stopped. If you have a vaginal tear, it is important that it be fully healed. If you have had an infection, this often delays the healing time, so you might need to wait a bit longer. It can help to gently massage a healed vaginal tear, as you will have some scar tissue, which can be a bit more sensitive or feel tight. You can use a similar technique to perineal massage to gently stretch the area once the wound has fully healed.

When you are breastfeeding, the vaginal and vulval tissues are often drier as our levels of oestrogen are lower. Therefore, this can make intercourse less comfortable, so using lubricate is advised, and you might also benefit from using a vaginal moisturiser.

In your postnatal check, usually around 8 weeks with your doctor, they will often talk about contraception. Though you might not be even thinking about intercourse at this stage, it is an important discussion. You can conceive even if your period has not returned or you are breastfeeding, so it is best to be prepared and decide on the best contraception for you.

What activities and exercises can I do before six weeks?

The 24/7 care of a newborn will keep you busy, and so finding time to be active or return to exercise can feel quite hard. It is normal to find the physical changes postpartum quite hard, and we can feel quite disconnected from our bodies. We can feel pressure to ‘bounce back’ or return to the same body we had before pregnancy right away; however, the key is to nurture our body through what we eat, gentle movement, and sleep (when we can). Starting with a short daily walk as soon as you feel up to it is the best place to start.

Alongside walking, introduce diaphragmatic breathing and pelvic floor exercises.

To do diaphragmatic breathing:

Lie on your back on a flat surface (or in bed) with your knees bent. You can use a pillow under your head and/or your knees for support.
Place one hand on your lower ribs and the other on your tummy.
Breathe in slowly through your nose, working on expanding the lower ribs into your hand. Let your tummy gently rise up as well, without your upper chest rising too much.
Slowly exhale at a pace that is comfortable for you.
You can also practice this exercise by sitting in a chair with your shoulders, head, and neck relaxed. Practice for this for 10 breaths a few times a day, if possible.

Other exercises that can help are:

Pelvic tilts. However, you may like to do these lying down instead.
Arm openings, which can help with any up-back tension that is common in the early days and weeks with a newborn.

Lie on your side with your arms out in front of you and your head on a pillow.
Reach one arm up and own the body, and follow this arm with your head.
Don’t let your pelvis rotate.
Go as far as is comfortable before bringing your arms back together.

How do I physically recover after birth (incl. perineal healing)?