Recovery after birth: what changes and what you can test

Your body spent nine months building a pregnancy, and it does not undo that in a week. Roughly six weeks after birth most women are over the worst physically, but full recovery, including your hormones, can take months. In this article you will read what changes, what is normal and which blood values you can check if something lingers.

I notice that new mothers mostly hear how to care for the baby, and much less about their own recovery. Yet that is exactly when your hormones, your iron and your thyroid are shifting a lot. Below I set it out calmly, so you know what belongs to the postpartum period and when a blood value can tell you something.

How long does recovery after birth take?

Physical recovery after birth takes about six weeks on average, the so-called postpartum period. During that time your uterus contracts, the bleeding (lochia) slowly stops and your pelvic floor recovers. According to Thuisarts.nl many women feel reasonably recovered physically after six to eight weeks, though this varies a lot from person to person.

That average says little about your situation. A caesarean, a hard birth or little sleep can stretch recovery. Breastfeeding also keeps your hormones in a separate mode for longer.

Your hormonal recovery often lags behind your physical recovery. The bleeding can have stopped while your cycle stays away for months.

So six weeks is a guideline, not a finish line. If you still do not feel yourself after a few months, that is a good reason to look into it with your midwife or GP.

What happens to your hormones after birth?

After birth your oestrogen and progesterone drop sharply within a few days, because the placenta no longer makes those hormones. At the same time prolactine rises, the hormone that starts your milk production. That rapid switch is one of the biggest hormonal changes your body ever goes through.

That drop can affect all sorts of things: your mood, your sleep, your skin and your hair. Many women notice extra hair loss around three months, which is linked to this hormone shift. You can read more in our article on hair loss after birth.

If you breastfeed, prolactine keeps your oestrogen low. That is why your cycle often stays away longer with full breastfeeding. What exactly happens to your values and when a hormone test for women is useful depends on your symptoms and your situation.

If you want to understand which hormones are usually measured in women, also read hormone testing in women.

Which symptoms after birth are normal, and which are not?

Many complaints in the postpartum period are normal and pass on their own: fatigue, changing mood, some hair loss and slightly pale skin from the blood loss at birth. The tricky part is that several of these can also point to something like anaemia or a thyroid that is off balance. A blood value helps to tell those two apart.

The table below sets a few common complaints side by side. It shows what often belongs to the postpartum period and which blood value and test you can have look along.

This table is meant to help you think, not to give yourself a diagnosis. A result always means something in combination with your story and your symptoms. Ongoing low mood or anxiety after birth always belongs with your GP or midwife, whatever a blood value shows.

Which blood values can you test after birth?

After birth there are roughly three groups of blood values that can clarify something: your iron status, your thyroid and your hormones. Which ones are useful for you depends on your symptoms. You can have them drawn at Lunara without a referral, as an addition to your midwife's care.

Your iron and Hb make sense after a birth with a lot of blood loss. A low ferritin or Hb can be linked to fatigue and hair loss. You can read more in anaemia after birth, and you can have your iron status measured separately.

Your thyroid can become disrupted in the months after birth, sometimes temporarily. This is called postpartum thyroiditis. The signals resemble ordinary postpartum complaints, and that is exactly why a thyroid test can help to tell it apart. We cover it in thyroid after birth.

And then your hormones: oestrogen, progesterone and sometimes prolactine. They give a picture of where your cycle stands. How your recovery and cycle relate is covered in hormones after pregnancy.

Important: blood testing through Lunara does not replace the regular postpartum check-ups. It is an extra way to bring something into view if a complaint lingers.

When does your period return after birth?

When your period returns depends mostly on breastfeeding. If you do not breastfeed, your cycle often gets going again within six to twelve weeks. With full breastfeeding it can take months, sometimes well past the first half year, because prolactine suppresses your ovulation.

That first cycle is also often irregular. The first time can even happen without ovulation, or with an ovulation before you bleed.

That last point is exactly why you can get pregnant before you have had a period again. If you want to avoid a short gap, discuss contraception in good time with your GP or midwife. You can read more about cycle recovery in the article on hormones after pregnancy.

This postpartum phase is the logical next step after everything that gets measured during pregnancy. For that period itself, read our overview of blood testing during pregnancy.

Recovery after a caesarean: what is different?

After a caesarean recovery usually takes a bit longer, because a surgical wound heals too. In the first weeks heavy lifting, driving and intense exercise are often discouraged, and you feel the scar when getting up, laughing and sneezing. Your hormonal recovery runs broadly the same as after a vaginal birth, because the placenta leaves here too.

You still have the bleeding after a caesarean, though it is sometimes a little less. Fever, a red or leaking wound or rising abdominal pain are reasons to contact your GP or midwife.

Give yourself some extra time here. Surgery on top of it means your body is working on two things at once.

Nutrition that can support your recovery

Good nutrition can support your recovery after birth, certainly if you breastfeed. The Voedingscentrum advises a varied diet with enough iron, protein, vegetables and wholegrain products. Iron matters extra after a birth with blood loss, and vitamin C helps your body absorb plant-based iron better.

If you breastfeed, you need a little more energy, fluid and certain nutrients. The Voedingscentrum recommends continuing vitamin D and discussing the rest with your midwife or GP.

Nutrition does not always fix a real shortage. If you stay tired or lose a lot of hair despite eating well, a blood value like ferritin can show whether more is going on.

Do not take supplements on your own initiative, because too much of some substances is not without risk. What fits you, you decide together with your GP.

Your pelvic floor and belly after birth

Your pelvic floor and abdominal muscles stretched a lot during pregnancy, and they recover gradually. Involuntary urine loss when sneezing or coughing is common in the first weeks and slowly improves for most women. Gentle pelvic floor exercises can support that recovery.

If the urine loss persists after a few months, or you feel a heavy or bulging sensation below, discuss it. A pelvic physiotherapist can help with this specifically.

This does not belong directly to blood testing, but it does belong to the full picture of your recovery. I mention it because women often keep walking around with it for a long time without reporting it.

Mood after birth: baby blues or more?

Many women are emotional and tearful in the first days after birth. These baby blues belong to the sharp hormone drop and usually pass on their own within one to two weeks. They are unpleasant, but not in themselves a sign that something is wrong.

It becomes different when the low or anxious feelings last longer than two weeks, or get heavier. Then it may be postnatal depression, and that is something to take seriously. According to Thuisarts.nl this happens to about one in ten women after a birth.

A blood value is not a diagnosis here. But your GP sometimes has your thyroid or iron look along, because those can amplify complaints. The mood itself you always discuss directly with your GP or midwife.

You do not have to be tough about this. Asking for help is a sign that you are caring well for yourself and your child.

Frequently asked questions

Is hair loss after birth normal?

Yes, extra hair loss around two to four months after birth is very common and usually temporary. It is linked to the drop in your oestrogen. If it lasts a long time or is really heavy, a ferritin or thyroid test can be useful. Read more in hair loss after birth.

Can I get pregnant before my period returns?

Yes, you can. Your ovulation returns before your first period is visible, so you are fertile without noticing. If you want to avoid a short gap, discuss contraception with your GP or midwife.

When should I contact my GP about postpartum complaints?

Get in touch with low mood or anxiety that lasts longer than two weeks, with ongoing extreme fatigue, with palpitations, or if you are worried. Also discuss a complaint that does not fit this article. You do not have to wait for the check-up.

How long does full hormonal recovery take?

That varies a lot. Without breastfeeding your hormones are often back in their old rhythm within a few months. With breastfeeding it can take longer, because prolactine suppresses your cycle. A blood value gives a snapshot, not an exact end date.

If I could give you one thing to take away: be as gentle with your own recovery as you are with your baby's. Most postpartum complaints belong to the period and pass, but you do not have to keep walking around with vague symptoms. If something lingers, a targeted blood value can help you further, together with your GP or midwife.

References

1. NHG and Thuisarts.nl. Just given birth (postpartum period). Dutch College of General Practitioners.
2. RIVM. Pregnancy, birth and the postpartum period. National Institute for Public Health and the Environment.
3. Voedingscentrum. Nutrition during breastfeeding and after birth. Voedingscentrum.

Every blood test result through Lunara includes a professional assessment by a BIG-registered doctor. Blood testing through Lunara does not replace the regular postpartum check-ups. For treatment decisions, discuss your results with your GP or midwife.