Recovery After Natural Birth
A week-by-week guide to what is normal after a vaginal birth, what to watch for, and how to support your own recovery.
Week-by-Week Recovery Timeline
| Period | Physical | What to Do |
|---|---|---|
| Days 1-3 | Perineal soreness, heavy bright-red lochia, afterpains (uterine cramps, worse with breastfeeding), breast engorgement around day 3 | Rest, ice packs on perineum first 24hr then warm sitz baths, paracetamol, gentle walks only |
| Days 4-14 | Lochia becomes pink-brown and lighter; perineal soreness decreasing; stitches dissolving (if any) | Start pelvic floor exercises; use squeeze bottle to rinse perineum after toileting; avoid lifting more than baby |
| Weeks 2-6 | Lochia becomes yellowish then stops by week 6; most perineal pain gone; uterus back to pre-pregnancy size | Gradual increase in activity; short walks; pelvic floor exercises daily; no high impact |
| 6-week check | Cleared for most activities if recovery uncomplicated | See O&G; discuss exercise, sex, contraception, pelvic floor; request physio if needed |
| Months 3-6 | Hair loss peaks (telogen effluvium); hormones stabilise; most women feel physically back to normal | Gradual return to running and higher-impact exercise after physio clearance |
Perineal Care: Tears, Stitches and Comfort
About 85% of women have some degree of perineal tear during vaginal birth. Minor first-degree tears may not need stitching. Second-degree tears (into muscle) and episiotomies are sutured with dissolvable stitches that take 2-4 weeks to dissolve and about 4-6 weeks to fully heal.
What helps
- - Squeeze bottle: rinse with warm water during and after urinating
- - Sitz baths 2-3 times daily from day 2-3 onwards
- - Soft maternity pads (no tampons until 6 weeks)
- - Paracetamol or ibuprofen as prescribed
- - Cotton underwear; avoid anything tight
- - Stool softeners to ease first bowel movement
See your O&G if:
- - Pain is getting worse (not better) after day 5
- - Wound has opened or stitches feel like they have come apart
- - Redness, swelling, or discharge from the wound
- - Fever above 38°C
- - Difficulty controlling bowel or bladder movements
Pelvic Floor Recovery
The pelvic floor is a group of muscles and connective tissues that support the bladder, uterus, and bowel. Vaginal birth stretches and sometimes tears these tissues. Mild incontinence (leaking when you cough, laugh, or sneeze) is very common in the weeks after birth and usually improves with consistent pelvic floor exercises.
Start pelvic floor exercises (Kegel exercises) from day 1-2 postpartum, even if you have stitches. The exercises do not stress the wound and actually promote healing by improving circulation.
If leakage persists beyond 6 weeks, or if you have difficulty controlling bowels, request a referral to a women's health physiotherapist. In Singapore, pelvic floor physiotherapy is available at KKH, NUH, and numerous private physiotherapy clinics. Sessions cost $80-150 at polyclinics (on referral) or $150-300 at private clinics. Most women need 4-6 sessions.
Do not rush back to running, jumping, or high-impact exercise before seeing a physiotherapist. These activities stress the pelvic floor and can worsen incontinence or prolapse. Most physiotherapists recommend waiting until at least 12 weeks postpartum before returning to running.