5 Things I Wish I'd Known About Postpartum Cramping

A planner by nature, I wanted to be as prepared as I could be for pregnancy, labor, birth, and postpartum recovery. I thought I'd researched it all, but after my first baby was born, I was still in a lot of pain. The pain was very similar to contractions or really bad menstrual cramps. I just assumed the 12-plus hours of labor that ended in an episiotomy and quick delivery was to blame.

Turns out, what I was experiencing was actually postpartum cramping (sometimes referred to as after-birth pain). I was completely unprepared not just for it to happen (why didn't anyone warn me?) but also for how much it could hurt.

After going on to experience postpartum cramps with each of my next three pregnancies, I finally realized that not only is postpartum cramping very real, but it can be extremely intense for some people. Postpartum cramps are a real thing, so why aren't more people talking about them?

Here's what I wish someone had told me about postpartum cramping.

1. Postpartum Cramping Can Feel Like Labor

Postpartum cramping pain is commonly described as feeling like contractions or severe menstrual cramps. Some people might experience these cramps within days of birthing their baby—others might experience four weeks postpartum cramps, for example—both are normal. For me, it felt like a fire in my pelvis and lower back that came and went with timed surges. It was intense and, at times, almost as intense as labor.

I had not learned about postpartum cramping in my pre-childbirth research, but when I talked to my mom, who had four children of her own, I learned that she also experienced it, and she knew right away the name of the pain I was feeling.

Research has found that there may be a genetic link to how some pregnant people experience pain during labor, so perhaps there is a genetic link to after-birth pain and postpartum cramping as well.

2. Postpartum Cramping Has Different Causes

While postpartum cramping can be very painful, the experience is also very normal, says Rachel Borton, PhD, FNP, director of the Family Nurse Practitioner (FNP) online program and assistant professor of nursing at Bradley University. And when you consider all that is happening in your postpartum body, that pain makes sense. Here are some common causes of postpartum cramping:

The uterus shrinks

The cramping is caused by the uterus shrinking back to its normal, smaller size, explains Dr. Borton. Typically, the process of your uterus shrinking back down to its pre-pregnancy size can take around six weeks, but for some people, it can take even longer than that.

Postpartum constipation

Postpartum constipation is a common condition and can be triggered by different factors, including as a side effect of certain pain medications. Constipation can cause cramping or pressure and bloating. To help move things along, talk to your doctor about stool softeners.

Cesarean section

For people who have cesarean section surgery, postpartum cramping can be caused by the wound healing process as the incision and surrounding tissue begin to heal. The healing process can include skin, nerves, and blood vessels, all of which may have been impacted by surgery.

Postpartum infections

Some postpartum cramping could be a sign of infection. Here are a few types of infection to watch for:

• Endometriosis: Endometriosis is a chronic condition in which uterus lining-like tissue grows on the outside of the uterus. There is no cure; however, there are treatments that can treat symptoms, which can include fever, pelvic pain, bloating, nausea, and fatigue.
• Urinary Tract Infection (UTI): UTIs are a common and painful infection that occurs when bacteria enters the urethra and causes an infection in the urinary tract. Pregnant people are at a higher risk of contracting a UTI. Symptoms can include a burning sensation during urination, pelvic pain and cramping, and blood in the urine.
• Bacterial Vaginosis (BV): The vagina naturally has bacteria and yeast present, but sometimes certain bacteria can grow more than others, causing an infection. Signs of a BV infection include a strong "fishy" odor and grey or green discharge.
• Kidney Stones: People have an increased risk of kidney stones after delivery, and these can cause pain in your lower back, abdomen, or sides.

If you suspect an infection of any type, talk to your doctor about screening and treatment options.

Retained Placenta

If some of the placenta remains in your uterus after childbirth, it's called "retained placenta." This occurs in 1-3% of deliveries, and it can cause severe pelvic pain along with other symptoms (delayed heavy bleeding, blood clots, chills, fever, foul-smelling discharge, flu-like symptoms, etc). Retained placenta can cause postpartum hemorrhage, so make sure to report symptoms immediately.

Postpartum Cramps Are Contractions

What causes postpartum cramping? You guessed it: Oxytocin, the hormone that causes contractions during labor, is also responsible for after-birth contractions as well.

Oxytocin is also released during breastfeeding and chestfeeding, so if you're pumping or nursing, you may experience an increase in postpartum cramping when your baby is eating or you're attached to a pump.

Postpartum cramps aren't limited to people who give birth vaginally; people who have given birth via C-section can also experience them. These contractions can happen in any uterus after giving birth, but the pain is individual.

"Not all people experience postpartum cramps," says Sharyn N. Lewin, MD, FACS, FACOG, a board-certified gynecologic oncologist, women's health and wellness specialist, and medical director at Holy Name Medical Center's gynecologic oncology division in Teaneck, New Jersey. "For the majority, discomfort is mild and relieved with Motrin or Tylenol," she adds.

Postpartum Cramping Happens More in Later Pregnancies

I experienced postpartum cramping after all of my pregnancies, but by the time I had my fourth child, the pain had intensified. It turns out my experience of my postpartum cramps being more painful after subsequent births is relatively common, too.

"Sometimes with first-time deliveries, [the cramps] aren't as noticeable, but typically with the second delivery the body is quick to remember, and [people] will report that pain quickly and a little more severe," says Dr. Borton.

The cramps are also more likely for people who are carrying multiple babies. "Afterpains are more common when the uterus was over-distended," explains Dr. Lewin.

Postpartum Cramping Pain Can Be Treated

Thankfully, afterpains don't usually last as long as it takes for the uterus to go back to its normal size. The cramping "typically only lasts two to three days following delivery," says Dr. Borton. Dr. Lewin confirms that postpartum cramps are typically "mild," and they should "resolve within one week of delivery."

There are also ways to ease the pain, and people experiencing afterbirth pain can opt for over-the-counter medicine. Dr. Borton says non-steroidal anti-inflammatory drugs (NSAIDs), such as Advil or Motrin (ibuprofen), as well as painkillers like Tylenol (acetaminophen), are usually enough to ease the pain, and they're safe to take while nursing.

The same tricks that work during a painful period or early labor can help bring comfort, too. Think of things like applying a heating pad or a hot water bottle on your lower abdomen.

After my fourth pregnancy, I opted for both a compression garment (which Dr. Lewin agrees is safe to use after delivery) and NSAIDs, and those steps made the postpartum cramping pain level far more tolerable.

When to Call a Doctor About Postpartum Cramping

Postpartum cramping is usually mild and can be relieved with an over-the-counter pain reliever. But there are times when afterbirth cramps may be a cause for concern.

Dr. Borton says you should call a doctor for your postpartum cramping if you notice:

• Motrin (ibuprofen) or Tylenol (acetaminophen) do not relieve the cramps.
• The cramping feels like a sharp, stabbing pain.
• You notice any unusual vagina discharge or smell.
• You have a fever.
• You're bleeding heavily and/or passing tissue.

Dr. Lewin adds that any temperature at or above 100.4 degrees Fahrenheit for at least two days within the first 10 days of giving birth (but not including the first 24 hours after birth) is a cause for concern, whether you're experiencing postpartum cramps or not. "This [symptom] requires workup by your physician," says Dr. Lewin.