Leg pain after pregnancy

Postnatal symptoms you should never ignore

After you’ve given birth, it’s normal to have some bleeding, discomfort and tiredness. Time, rest and self-help are usually all that’s needed for you to feel better.
Most women make a full and uncomplicated recovery after their baby is born. But occasionally, real medical emergencies happen in the days and weeks following birth.
Knowing what the warning signs are, and what you should to do if they happen, could make all the difference.
After you’ve had your baby, ask your midwife how you can get hold of urgent maternity care, if you need it. She may give you a contact number for the maternity unit triage or the postnatal ward, rather than the ambulance service (NICE 2006).
It’s also a good idea to share this article with your partner and family. Some of the symptoms may be easier for them to spot. In particular, friends and family may recognise the symptoms of a mental health issue, such as postnatal depression, before you do.

Which postnatal symptoms are an emergency?

You should get immediate medical help if you have any of these symptoms. That means calling an ambulance or going to accident and emergency (A&E).
Sudden and heavy blood loss, or increasing blood loss, including clots (postpartum haemorrhage)
If you have postpartum haemorrhage, you can lose 500ml or more of blood very quickly and will need urgent treatment (RCOG 2016).
If you bleed heavily in the 24 hours after your baby is born, you’re likely to be in hospital, in which case you’ll be treated quickly by the staff there (Begley 2014).
If you’re at home and you start to bleed heavily, call an ambulance if:

  • the bleeding suddenly increases, and soaks more than one pad an hour
  • you pass lots of large blood clots that are bigger than a 50p piece
  • you start to feel faint or dizzy
  • your heart starts to race, or your heartbeat becomes irregular
  • (NICE 2006)

Signs of postnatal depression Suffering from something more than post-baby blues? Check your symptoms and find out how to get the support you need.More life as a parent videos Severe or persistent headache
A severe headache after birth could be a symptom of pre-eclampsia. Call an ambulance if you get a severe headache, and have the other symptoms of pre-eclampsia:

  • vision problems such as blurring and flashing lights
  • vomiting
  • severe heartburn
  • swollen ankles
  • (NICE 2006)

Symptoms of pre-eclampsia usually come on within 72 hours of giving birth (NHS 2015a).
Upper abdominal pain
There is a rare condition called HELLP syndrome that can develop while you’re pregnant and through until about a week after your baby is born (BMJ 2017). It’s a bit like pre-eclampsia (BMJ 2017). The main symptoms are:

  • pain in the top part of your tummy, or on the upper right side of your tummy
  • feeling sick and being sick
  • feeling weary and worn out
  • headache
  • (BMJ 2017)

HELLP affects how well your liver works and how your blood clots. It can be very serious and potentially life-threatening. If you have all the symptoms of HELLP you should call the number you have been given for urgent maternity care or go to your nearest A&E.

Shortness of breath and/or chest pain
If you have chest pain and feel short of breath then it could be a symptom of pulmonary embolism (Knott 2015). Other symptoms include coughing up blood and feeling faint (Knott 2015). If you have any of these symptoms, don’t ignore them. Call an ambulance.
A pulmonary embolism happens when a blood vessel in your lungs gets blocked, usually by a blood clot. If blood isn’t reaching your lungs properly, it can be life-threatening, so getting treatment quickly is vital.
Very high fever (38 degrees C or over)
High fever can be a sign of sepsis, which is an infection that’s spread from just one part of your body to the whole of your body (NHS 2016b).
As well as having a high temperature, you’ll probably feel shivery and have a fast heart rate and breathing (NHS 2016b). Depending on where the infection started, you may have other symptoms such as:

  • severe abdominal (tummy) or groin pain, which doesn’t get better after you take painkillers
  • smelly discharge from your vagina
  • sore and tender breasts
  • a red and painful caesarean-section wound with smelly fluid coming from it
  • pain when you wee, needing to wee quickly or more often than usual and smelly wee
  • (RCOG 2012)

If you develop sepsis you can become very ill, very quickly (RCOG 2012). If you have these symptoms, you should call for an ambulance.

Which postnatal symptoms mean I need to get medical advice the same day?

Call the number your midwife has given you for urgent maternity care, or your GP surgery to speak to a doctor or midwife, if you have any of the following:
Calf pain
If you develop pain in your lower leg, usually just in one leg, then it could be a sign of deep vein thrombosis (DVT) (NICE 2006). Your leg may also look red and swollen and feel warm to touch (NHS 2016).
DVT is a blood clot in the deep veins of your leg. It can be life-threatening if the clot moves and travels through your body to your lung (a pulmonary embolism).
Many women get sore and tired legs after pregnancy (Knott 2015), and DVT can also develop without any symptoms at all (NHS 2016a). But, if you develop the symptoms of DVT you should always get it checked.
Sudden changes to mental health, such as being agitated, depressed, confused or having manic behaviour
In the month after having a baby, some mums experience a dramatic change in their emotional and mental health (SIGN 2012). If you have hallucinations and delusions, or become confused or depressed, it could be the beginning of a rare condition called postpartum psychosis (SIGN 2012).
Postpartum psychosis can happen to any woman, whether they’ve had mental illness before or not. Mild symptoms can develop into serious mental illness within a matter of hours, so it’s important that you get treatment as soon as you can (SIGN 2012).
Postpartum psychosis can be a frightening experience for everyone involved, but women usually make a full recovery (RCP nd).
Suicidal thoughts
If you’re having thoughts about harming yourself, including thinking about suicide, get help as soon as you can (RCP nd). You may have severe postnatal depression, which can be serious for you and your baby if it’s not treated.
Having thoughts like this doesn’t mean that you are a bad mum, or that your baby will be taken away from you if you tell someone (MIND 2016).
Contact your GP, midwife, or health visitor, or talk to a friend or member of your family, so they can get help for you. You’ll be given the support you need to look after yourself and your baby.
Unable to wee within six hours of your baby’s birth
If you haven’t been able to wee in this time, you may have urinary retention (NICE 2006). This is when your bladder doesn’t empty and you can’t wee (Tidy 2015b). It can be extremely uncomfortable and if it’s not treated it can cause severe pain, infection and damage to your kidneys (Tidy 2015).
If you’ve had your baby in hospital, your midwives will keep an eye on how much wee you pass. If you’re at home, having a warm bath or shower may help (NICE 2006). If you still can’t wee, seek advice the same day from your midwife or doctor.
Severe headache after an anaesthetic
Having an epidural or spinal during labour and birth can sometimes cause a severe headache within the week after birth.
The headache is caused by the needle containing the anaesthetic accidentally puncturing the membrane round your spinal cord (OAA 2011).
The headache can feel like a bad migraine that’s worse when you sit up or stand, and you may also have neck pain, feel sick and dislike bright lights (OAA 2011).

Which postnatal conditions are urgent, but can wait until morning?

Give your midwife, health visitor or GP a call if you have any of the following:
Symptoms of an infection, without a fever (high temperature)

  • Unpleasant, smelly vaginal discharge. This could be an infection in your womb (uterus) or vagina.
  • A painful and red caesarean section wound. You may have smelly liquid coming from the wound too.
  • A tender tummy, which could be a symptom of an infection in your womb.
  • Pain in your side and problems weeing, such as needing to go urgently and pain when you wee. This could be a urine infection.
  • Swollen and tender breasts, which could be mastitis (breast infection).
  • Pain, swelling and discharge in the area between your vagina and anus (your perineum). This could be an infected tear or episiotomy wound.
  • (Wong 2017)

Leaking from your bottom
When you have a vaginal birth, sometimes the ring of muscles that controls your bowels can get damaged (NHS 2015b). If this happens, it can cause faecal incontinence (NHS 2015b). This is when you can’t control your bowel movements so you’re leaking poo before you get to the loo (NHS 2015b).
Severe, swollen or prolapsed piles
Many women develop piles when they’re pregnant, but these can become more painful after your baby is born (Payne 2016).
Piles are varicose veins just inside the anus, but they can pass outside (prolapsed piles). If you have severe, swollen or prolapsed piles, or any bleeding from your rectum, talk to your midwife or GP (NICE 2006).
Baby blues that don’t go away within a few days
It’s common to feel moody, weepy, tired or anxious two days to three days after giving birth. These baby blues usually pass within a few hours or days. But if you continue to feel very low, and aren’t enjoying being a mum, you could be suffering from postnatal depression (SIGN 2012).

If you’re feeling very anxious and worried all the time, feeling panicky, obsessing about things, or you can’t concentrate because you’re feeling so down, speak to your health visitor or GP. They can give you the help and support that you need (NICE 2006).
Discover what to expect at your six-week postnatal check.

Visit our community

If you have any concerns about your emotional or physical symptoms, always speak to your GP or health visitor.
But in the meantime, you may find it helpful to talk over your worries in the friendly BabyCentre community. Last reviewed: August 2017 BMJ. 2017. HELLP Syndrome. . BMJ Best Practice. bestpractice.bmj.com
Begley C. 2014. Physiology and care during the third stage of labour. In: Marshall J, Raynor M. eds. Myles Textbook for Midwives. 16th ed. Edinburgh: Churchill Livingstone, 395-416
Knott L. 2015. Venous Thromboembolism in Pregnancy. PatientPlus
MIND. 2016. Postnatal depression and perinatal mental health. www.mind.org.uk
NHS. 2015a. Pre-eclampsia. NHS Choices, Health A-Z. www.nhs.uk
NHS. 2015b. Bowel incontinence – Causes. NHS Choices, Health A-Z. www.nhs.uk
NHS. 2015c. You and your body just after birth. NHS Choices, Health A-Z. www.nhs.uk
NHS. 2016a. Deep vein thrombosis. NHS Choices, Health A-Z. www.nhs.uk
NHS. 2016b. Sepsis. NHS Choices, Health A-Z. www.nhs.uk NICE. 2006. Postnatal care up to 8 weeks after birth. Last modified February 2015. National Institute for Health and Care Excellence, Clinical guideline, 37. www.nice.org.uk
OAA. 2011. Headache after an epidural or spinal injection: what you need to know. Obstetric Anaesthetists’ Association. www.oaa-anaes.ac.uk
Payne J. 2016. Postnatal Care (Puerperium) . PatientPlus
RCOG. 2012. Bacterial Sepsis following Pregnancy. Royal College of Obstetricians and Gynaecologists, Green-top guideline, 64b. www.rcog.org.uk
RCOG. 2016. Postpartum haemorrhage, Prevention and Management. Royal College of Obstetricians and Gynaecologists, Green-top guideline, 52. www.rcog.org.uk
RCP. nd. Postnatal depression. Royal College of Psychiatrists. www.rcpsych.ac.uk
SIGN. 2012. Management of perinatal mood disorders: a national clinical guideline. Scottish Intercollegiate Guidelines Network. www.sign.ac.uk
Tidy C. 2015. Acute urinary retention. PatientPlus.
Wong A. 2017. Postpartum infections. Medscape. emedicine.medscape.com

Pregnancy has a profound impact on your body. While pregnancy and motherhood bring on new challenges and experiences, it’s almost impossible to be prepared for them all. We are your partners in a healthy, mobile, pain-free body. We hope you find this article on post-childbirth pain informative. If you’d like to speak with a women’s health physiotherapist one on one, we invite you to book an appointment at our clinic.

Typical Areas of Pain After Childbirth

Every woman experiences pain in different ways. Please treat the information below as a guide- it goes without saying that persistent or significant pain, especially immediately post-partum, should be assessed by your doctor.

Back Pain

A growing baby has profound impacts on your back. There are two core reasons for this: first, that as the baby grows, it places new weight and stresses on the spine and supporting muscles; second, your posture may change as the baby grows.

Back Strain

A 2010 study found that an estimated 50% of women experience strained muscles/ligaments in their lower back as a result of pelvic alignment due to pregnancy and childbirth.

Muscle strain can happen for many reasons during pregnancy. Interestingly enough, one of the big reasons it occurs after childbirth is because the mother begins working out to get back into shape. Intense activity, especially if your back hasn’t fully recovered from pregnancy/childbirth, can exacerbate existing injuries or cause new ones.

Remember, your abdominals, lumbar spine, hip flexors, pelvic floor, and other parts of your body are very much in “recovery mode” once you have delivered the child.

Diastasis Recti

Approximately two-thirds of pregnant women develop diastasis recti, where the space of connective tissue between the left/right sections of your abdominals had widened allowing your stomach to be more visible.

During pregnancy, intense and consistent pressure against the abdominal wall can cause them to stretch. . If this happens, be mindful of your body when performing your daily activities- your connective tissue between your abdominals need time to heal, and straining them will cause the condition to worsen.

Working with a physiotherapist can help you heal faster, improve your pelvic floor health, and reduce pain associated with diastasis recti.

Hip Pain

Hip pain after delivery is quite common. The hip joints, ligaments, and muscles expand widely during delivery, often to the extremes (and beyond) of their mobility.

During labour, the body releases hormones that cause the ligaments in the hips to soften- this is to facilitate delivery of the baby. Endorphins are also released, which serve to minimize pain. Many women also have a pain-relieving epidural during delivery as well. The combination of the two cause many women to underestimate how much they were actually straining and pushing during birth.

Perineum Pain

A 2012 study found that approximately 90% of women experience pain in the perineum (the area between the anus and pubic bone). Most of this pain is due to the act of childbirth and the toll it takes on the entire pelvic region.

Pain is typically experienced when walking or sitting and can last for days or weeks post-delivery.

Leg Pain & Cramping

Leg pain that develops immediately or shortly after childbirth may be a result of nerve entrapment in the lumbar spine- a relatively common condition experienced by new mothers.

Pain from cramps can occur due to a nutritional imbalance (a lack of potassium) or a localized shortage of electrolytes in the legs (due to breastfeeding).

Headaches & Neck Pain

In a 2005 study of 985 new mothers, 39% (381) reported headaches and/or neck pain within a few days of childbirth. Reassuringly, only 4% were reported as incapacitating.

Most headaches after childbirth stem from a few sources:

  • Neck and shoulder muscle strain – Caring for a child is hard work. Carrying the baby, moving the car seat, pushing the stroller, loading the car, breastfeeding… all these activities constantly engage your arms, shoulders, neck, and lower back. Strain in your neck and shoulders pulls at the base of your head, causing muscle pain and headaches.
  • Fatigue – A child dramatically changes your routine. It’s not uncommon – especially in the early weeks and months – for new mothers to get less sleep and rest. Headaches are a common symptom of fatigue brought on by a lack of sleep.
  • Nutritional imbalances – Breastfeeding mothers give their babies a lot of energy, vitamins, and minerals in their breast milk. If your diet has been struggling to keep up with demand placed on your body, nutritional imbalances may present symptoms (including headaches).

Wrist & Hand Pain/Numbness

You may not realize that carpal tunnel is fairly common in new mothers. While the pregnancy itself doesn’t cause carpal tunnel, the requirements of child care (such as carrying a car seat, holding the baby, etc.). Adapting to new demands placed on your hands and arms often comes with a fair amount of soreness and strain.

Nerve impingement in the shoulders and neck are also fairly common. Impingements are usually caused by the position of the mother’s head and body during nursing, carrying the child, etc. These impingements manifest themselves as numbness and the “pins and needles” feeling in fingers.

Median nerve compression, which can bring about carpal tunnel (and other forms of repetitive stress injury) is experienced by 62% of pregnant women, though most will not develop injuries as a result.

Addressing & Treating Pain After Childbirth

In most mothers, pain after childbirth is a temporary problem that can be treated in a number of ways. We encourage you to visit your doctor if you have sharp or severe pain, or if your pain has become chronic and is not getting better (even with treatment from a physiotherapist).

Using Heat & Ice to Relieve Muscle Pain

If muscle strain is the cause of your pain, using a heat pad can help relieve pain. Muscle inflammation and irritation benefit greatly from heat therapy. Be sure to follow appropriate safety measures when using anything hot. Do not use a warm compress on an area that doesn’t have normal sensation, and never apply a hot pack/heat pad directly on the skin.

A warm compress will help the muscle relax and release its tension.

Conversely, using a cold compress or an ice pack on a sore muscle will help reduce inflammation. This is especially beneficial if you are experiencing pain related to carpal tunnel. Relaxing inflamed muscles that surround the median nerve and flexor tendons can relieve wrist and hand pain.

As with a hot pack, never place an ice pack directly on the skin, and don’t use it on an area that doesn’t have normal sensation.

Physiotherapy

Physiotherapy can help relieve many aches and pains that result from childbirth or the responsibilities a mother has after. Physiotherapy can help improve your posture, joint mobility, and overall flexibility. It is also beneficial for hand/wrist injuries, leg injuries, and abdominal pain and tightness. Pain associated with the pelvic floor can also be addressed by one of our experienced pelvic health physiotherapists.

Massage

Many people view massage as a tool for relaxation (like when at the spa). For women that have recently given birth, massage can be effective ways to break down scar tissue, relax sore muscles, and help your body heal and recover.

Relaxation, Meditation, & Yoga

Pain changes you in subtle ways that can be challenging to deal with. Newfound responsibilities as a parent, in addition to discomfort and pain, take their toll mentally as well as physically.

We are strong advocates in caring for your mental health and encourage new mothers to practice effective relaxation techniques. Reducing your stress and anxiety levels can benefit you, your baby, and your family. We recommend:

  • Yoga – Yoga is a powerful and proven relaxation tool that helps you build strength, flexibility, and breathing techniques. Be sure to be mindful of your body when performing yoga, and never take on a method or pose that causes discomfort.
  • Meditation – There are numerous ways to practice meditation. We recommend finding a method that you resonate the best with.

Postpartum Symptoms & Solutions to Get You Through

Now that you’ve put the long months of pregnancy behind you and you’ve given birth, you’re probably breathing a sigh of relief at the thought of waving goodbye to those frustrating pregnancy symptoms. But just as you get used to seeing your feet again, you’re likely to be hit by some postpartum side effects – some of them as weird as the pregnancy symptoms you just left behind.

Your First Six Weeks of Recovery

Your first six weeks after birth are what’s known as a postpartum recovery period – when your body recoups from the monumental task of making and then pushing a baby into the world. Most, if not all, symptoms will be temporary, gradually easing up within a week. Some symptoms (like backaches, sore nipples and possibly pain in the perineum) continue for weeks, while others (like leaky breasts or your achy back) may not get better until your baby is older.

The important thing to remember: While you’re focusing your care and attention on your new baby, remember that it’s essential to care for your own health. If you’re not well in mind and body, it’s that much harder to care for the little person you’ve brought into the world.

Common Postpartum Symptoms and Solutions

Your postpartum symptoms will depend on the type of delivery you had (easy or difficult, vaginal or cesarean) and other individual factors, such as the shape you were in when you were pregnant and whether this is your first baby. Below are 15 of the most common symptoms that you may experience as well as solutions for dealing with them.

Bleeding from your vagina

  • Solution: Be prepared with a pile of pads (not tampons) to absorb the flow, which may continue on and off for up to six weeks.

Abdominal cramps as your uterus contracts

  • Solution: Your uterus can take up to six weeks to shrink back to its normal size as well; in the meantime, try taking acetaminophen (Tylenol) for relief.

Perineal discomfort, pain or numbness

  • Solution: Keep the perineal area clean. Try using chilled witch hazel pads or a cold pack; take a warm sitz bath; use a local anesthetic spray, cream, ointment or pad; lie on your side when you sleep; wear loose clothing; and take acetaminophen. Kegel exercises can also help get the circulation going and speed the healing process.

Pain or numbness around C-section incision

  • Solution: Take prescribed pain relievers as directed. If pain continues for weeks, try over-the-counter pain relief medications and discuss dosages with your doctor. Also avoid heavy lifting for the first few weeks after surgery.

Difficulty urinating

  • Solution: You might find it difficult to pee for the first couple days after birth – so drink plenty of fluids and go for a stroll. Pour some warm water over your perineal area, take a sitz bath, or apply an ice pack to your perineal area to induce urgency. You can also simply try turning on a water faucet while you’re trying to urinate.

Constipation

  • Solution: Your first post-birth BM can be a bit slow-coming, so in the meantime don’t try to force things. Drink fluids and eat fiber-rich foods like whole grains, fresh fruits and veggies. Go for walks and do Kegel exercises, avoid straining and use stool softeners. Finally, give chewing gum a try, since it can help stimulate digestive reflexes.

Hemorrhoids

  • Solution: All of that pushing during labor can result in hemorrhoids – so take sitz baths or try using topical anesthetics, witch hazel pads, suppositories or hot or cold compresses.

Fatigue

  • Solution: Share the load with your partner, family, friends or even hired help. Don’t get too caught up in keeping your home immaculate, returning emails or writing thank you cards. For now, just focus on the most important stuff. If you need something from the store or you’re too tired to cook a meal, get it all delivered. Sleep when your baby sleeps. And don’t forget to eat regularly!

Overall achiness, especially if you did a lot of pushing

  • Solution: Take acetaminophen and ease sore muscles with hot baths, showers or a heating pad. If you’ve never had a massage before, there’s never been a better time to book one.

Bloodshot (or puffy) eyes

  • Solution: Apply cold compresses to your eyes for 10 minutes a few times a day.

Night sweats

  • Solution: Cover your pillow with an absorbent towel and drink plenty of fluids to help compensate for the water you’re losing.

Breast discomfort

  • Solution: Wet a washcloth with warm water and place it on your areolas, or lean into a bowl of warm water. You can also gently massage your breasts or use ice packs. And make sure you’re wearing a well-fitting nursing bra.

Sore or cracked nipples from breastfeeding

  • Solution: Make sure your breasts are positioned the right way, and vary your nursing positions. Expose your nipples to air briefly after breastfeeding, keep them dry, and protect them from any undergarments or fabrics that may irritate them. Let your breast milk dry on your nipples to help heal them, try applying ultra-purified medical grade lanolin to your nipples (avoid petroleum-based products) or wet regular tea bags with cool water and place them on your nipples. Taking acetaminophen before nursing may also help ease soreness.

An achy back

  • Solution: Try focusing on bending from your knees when you lift your baby, and use a footrest to elevate your feet when breastfeeding or sitting.

Leaking breasts

  • Solution: Invest in nursing pads and opt for dark patterned tops that will help hide any wet spots.

Postpartum depression

  • Solution: The first weeks postpartum come with their own set of emotions: Bringing a baby into the world and learning to care for her are no small feats – and many women experience jitters, mood swings and even depression. Postpartum depression is common, affecting up to one in seven women. It typically starts two to three days after giving birth, though it can begin later. The good news is that it often gets better within a couple of weeks on its own. Until then, take care of yourself. Allow friends or your partner to make a meal or to clean up your kitchen so you can focus on resting and bonding with your baby. And if symptoms persists for longer than a couple of weeks, talk to your doctor. Many moms have been there before, and with help they got past their depression to truly enjoy parenting. It’s crucial to your future and your family’s that you speak up.

What I Wish I Knew Before I Gave Birth

Your Postpartum Checkup

Up until now, new moms would have one postpartum checkup with their doctor around six weeks after giving birth. But the American College of Obstetricians and Gynecologists (ACOG) changed its recommendations in 2018 in light of the growing call for better postpartum care and follow-up in the U.S. Now the guidelines suggest that women see their OB/GYNs within three weeks of giving birth, with regular check-ins as needed up until that point and after. They also suggest scheduling a comprehensive visit with your doctor within the first 12 weeks postpartum.

ACOG also says in its latest guidelines that doctors should be informing new moms of their risks up-front and insurance should cover postpartum care.

During your postpartum visits, your doctor will check your:

  • Blood pressure
  • Weight
  • Vagina, cervix and uterus
  • Breasts
  • Site of episiotomy or perineal laceration, if you had either
  • Cesarean incision, if you had one
  • Hemorrhoids or varicose veins
  • Emotional health

This is a good opportunity to talk to your practitioner about any questions or concerns you may have, including when you can start having sex again, what birth control options are available, what you can do to start losing some of the pregnancy weight you gained, and where to get help breastfeeding. It can be helpful to jot down a list of the things you’d like to discuss before you go, so you’re prepared and don’t forget anything in the moment. And don’t be afraid to speak up: Your doctor has been there, heard it all before and is there to help you – but only if you tell her what’s on your mind!

How to Manage Pain After Pregnancy

Pregnancy pain can transition into a host of new pains after labor, most of which will go away in the next few weeks and months. Preparing for the possibility of epidural pain, breastfeeding pain, and pain related to tears or incisions will help you be prepared for life after delivery.

“Those first few weeks post-partum feel like an eternity,” says obstetrician-gynecologist Amanda Calhoun, MD, MPH, assistant director of women’s health for Kaiser Permanente Northern California in Richmond. “However, after three months almost every woman feels much better.”

If you’re worried about how you will manage pain after childbirth, stock up on water and take a deep breath: Dr. Calhoun recommends hydration and patience as the keys to surviving post-pregnancy pains. After you’ve given birth, it’s also appropriate to take ibuprofen for temporary relief from aches and pains. Read on for other tips to ease post-childbirth pain.

Abdominal Pain After Childbirth

In the immediate aftermath, you may be most aware of pain below your waist:

  • Uterine contractions. Your uterus has to return to its normal size after delivery. Breastfeeding encourages this process and may seem to trigger the pain. These contractions can be very painful, especially for second and third deliveries.
  • Incisions. If you gave birth by cesarian (C-section), you will likely have incision pain for a few days in addition to the pain of uterine contractions. You will probably need narcotic pain remedies for a day or two, after which ibuprofen can help manage pain. Unlike other types of post-labor pain, incision pain may be with you for several months as you heal, although it is most acute in the days immediately following delivery. Call your doctor right away if the C-section incision becomes red, hot to the touch, bleeds, or oozes pus.
  • Vaginal or perineum pain. Tears or incisions in this area can remain painful for a week to 10 days as you heal. “Sitting in a sitz bath or low shower water, coupled with a Motrin, will help,” says Calhoun, adding that you should call your doctor if you have a fever or any pus or blood in the area. A sitz bath simply means taking a bath for 20 to 30 minutes to submerge your buttocks and hips in warm water.
  • Vaginal dryness. Women who are breastfeeding are especially vulnerable to severe vaginal dryness after giving birth. Your doctor can provide you with an estrogen cream to ease the dryness.

Breastfeeding Pain

Breastfeeding is usually not painful, says Calhoun. However, some women may experience pain, which can be remedied fairly easily:

  • Breastfeeding pain during feeding. You want your baby to open his mouth wide and take in not just the tip of your nipple, but all or most of the areola, the darker skin around the nipple. This sucking position is called the latch. A bad latch is a common cause of pain. Infants and new mothers often need to learn and practice a correct latch to help manage pain. A lactation consultant or maternity nurse may be able to help you.
  • Engorgement. Breasts may be painful when your milk first comes in and at other times when they are very full. This is called being engorged. You can lessen the pain by relieving your breasts of milk, either through a feeding, using a breast pump, or hand expressing. A warm-water shower may also help.
  • Bacterial infection. If one or both of your breasts are red, sore, and hot to the touch, you may have a bacterial infection called mastitis. See your doctor for a prescription antibiotic to manage this infection. You do not need to stop breastfeeding your baby if you have mastitis.
  • Yeast infection. A painful, burning sensation in and around your nipples could be due to a yeast infection. Contact your doctor for help in treating a yeast infection and managing the pain.

Back and Shoulder Pain

Back pain is common during pregnancy. You may find that you still have back pain after delivery, although for different reasons, including the strain of labor and delivery or using an awkward posture while holding or breastfeeding your baby.

Calhoun recommends changing your posture, taking warm baths, and building in lots of time for healing after delivering the baby.

Headaches

You may experience more frequent or more severe headaches after delivery. This can be due to changing hormones, stress, and sleeplessness. However, Calhoun adds that dehydration often plays a leading role in headaches.

“Most new mothers do not realize how dehydrated they are,” she says. Dehydration is especially likely if you are breastfeeding. Try to keep a full bottle of water close by to sip throughout the day. If drinking water doesn’t help ease a headache, it’s fine to take over-the-counter pain medications, but if they don’t work, you should contact your doctor.

Joint Pain

You may also experience pain in joints throughout your body, including your hands, wrists, feet, and ankles. These pains may be due to the position you were in during delivery and recovery. Your joints may also still be affected by the chemical changes during pregnancy that caused them to loosen.

“All of the muscular and joint aches really do go away,” assures Calhoun. Applying warmth and taking an over-the-counter pain medication can help in the interim.

Carpal tunnel syndrome, pain in your wrists due to compression of nerves as they travel through the wrist to the hand, can take longer to go away. Try wrist braces if carpal tunnel pain is a problem for you, but visit a doctor if the pain doesn’t resolve in a few months.

Leg Pain

Women who gave birth by C-section or had a long labor induction may have leg pain because of the large amount of fluids they were administered intravenously. The swelling will subside and the pain will ease as the fluids go down. As you’re watching this happen, be alert for signs of blood clots, such as redness and tenderness to the touch, especially in the backs of the legs. These signs warrant an immediate call to your doctor.

Ladies, let’s take a few minutes to talk about pain. There is enough emphasis about the pain experienced during labour, but I want to focus specifically on the aches and pains that women feel after giving birth to their little bundle. While many women expect there will be some ups and downs during the first year after a new baby arrives, most do not anticipate that headaches and constant, nagging stiffness and pain will be part of the package. It’s not exactly part of that loving image of cuddling with baby and gazing at their innocent sleeping face as time stands still … and your upper back feels like it’s being stabbed and you think your hips might actually fall off.

The reality is, pregnancy-related musculoskeletal pain affects women’s lives dramatically. Low back pain is the most common cause of sick leave from work after having a baby and it is estimated that anywhere from 30-95% of women experience back pain during the first year after giving birth (depending on who you ask). This is no surprise! Giving birth is an extreme sport and the demands placed on the body are intense. A recent study showed that after giving birth, many women even experienced injuries similar to athletic injuries, such as broken bones, stress fractures, muscle tears, and severe strains1. This is because of the new, persistent, and extreme demands that you are putting on your body during a time of particular vulnerability. Your ligaments and connective tissue are still not back to their pre-pregnancy strength and now you are walking around carrying 10-30 pounds of extra (sometime wiggly) “baggage” 24 hours a day. Some of these injuries can take over 8 months to fully heal.

We see this often – everyday new moms present to our office suffering from headaches, aching stiffness in the upper back and between the shoulder blades, and nagging or sharp pain across the low back or hips. Sometimes they have tenderness or even tingling in their wrists and hands. To top it all off, they’re running on a few hours of sleep and can’t remember the last time they ate a proper meal.

This is a day in the life of a Mom with “Postpartum Pain Syndrome”. It’s a combination of a predictable pattern of symptoms caused by repetitive activities and sustained postural stress during a time when you are most susceptible to injury. Breastfeeding for hours a day, hunching forward to change an infinite number of diapers, dragging around that heavy, awkward bucket known as “the car seat”, and carrying baby on your hip (let’s be real here… it’s always the same hip!). Eventually (quite quickly actually) this routine will take a serious toll on your body. When these activities are preformed over and over, it can create tiny micro-tears in the muscles and ligaments supporting the spine and pelvis. This initiates a cycle of inflammation, pain, and instability. Due to the repetitive nature of these postures, your body is under constant physical stress and never gets a chance to heal. The cycle is perpetuated by increased stress and a lack of sleep, which heightens inflammation and makes your nervous system “raw”.

Symptoms of Postpartum Pain Syndrome

  • Pain and tension across the shoulders, near the bra-line or between the shoulder blades
  • Neck stiffness, jaw pain, and/or headaches
  • Tingling in the arms or hands and wrist pain
  • Low back pain and hip pain
  • Weakening (and possibly separation) of the abdominal and pelvic floor muscles

Too often women suffering from these symptoms are misdiagnosed with fibromyalgia or arthritis, sometimes they are even put on long term pain medication. Possibly even worse, they are most often just ignored! This type of pain, aggravated by a lack of sleep, emotional stress, and adapting to a new family dynamic, can be a huge contributor to postpartum depression. It’s a slippery slope and it’s easy to get overwhelmed when physically you are not feeling your best. It isn’t just about pain and discomfort and complaining. You can not be your best self or the best mom you can be when you are in pain or drained. Taking care of yourself is not selfish; it’s one of the best things you can do for your baby.

So what can you do?!

1. Understand that you are not alone.

Many women struggle with the dramatic physical changes that are associated with bringing a brand new person into this world. Being a Mom is hard work! It is normal to feel this way and you will get through it. There are plenty of new Mom groups and support spaces if you ever are feeling like you need someone to connect with in your community.

2. Invest in the care you need.

Your body deserves a little love! A skilled practitioner, such as a chiropractor, massage therapist, acupuncturist, or naturopath can help you address the specific physical challenges associated with motherhood and get you functioning, moving, and feeling better. Find what type of care (or combination of care) works best for you and stick with it, even when you start to feel good again. Make sure you find someone who is familiar with the intricacies of working with the post-natal population.

3. Make home-care a priority.

I repeat: taking time to look after yourself does not make you selfish. Make time in your day to stretch, eat well (and often), and stay active. Try a Mom and Baby yoga class, go for a swim, or try a new hike. Get your family involved and create a habit of being healthy together. At AltaVie, we can help create a home-care plan with customized exercise rehab that accomplishes your goals and fits your lifestyle.

4. Pay attention to your posture.

Take some time to think about your body position. For many “Mommy” postures, such as breastfeeding or sleeping, there is usually an alternative that is just a little bit easier for your back. Just being aware of sitting up straight and keeping your shoulders relaxed is a great first step. Use pillows. Check in with yourself. Try a variety of positions. Make sure you are taking full breaths (and not breathing shallow).

5. Drink up! … Water that is 😉

Water affects every organ and cell within your body. Dehydration is a huge contributor to headaches and chronic pain. It has been estimated that over 75% of North Americans are dehydrated.

It’s easy to invest the world in your baby and prioritize their safety, health, and happiness above all else. It’s good too! But it is not good to let yourself suffer. I can’t emphasize enough the impact it will have on your entire family if YOU are happy and healthy. A thriving, pain-free, well-fed mom will guide and raise an exceptional family. What’s best for baby is mom at her best. So take a deep breath, check in with your posture, and take care of you!

Last Updated on November 7, 2019



Pregnancy exposes you to a variety of information about your own body, allowing you to come to terms with the changes that have taken place in the entire period. However, there are a bunch of other changes that occur after delivery of the child as well. Many mothers experience pain in their hips, even after surgery, and discover that the weird wobbly feeling in the knees persists, even after the baby is out of their womb. Joint pain after giving birth is yet another persistent and acute pain that can make one feel old all of a sudden.



What Causes Post Delivery Joint Pain?

These are some reasons why mothers face joint pain after delivery.

  • The primary reason most mothers face acute joint pain post delivery is the weight gain that occurs during pregnancy. The baby’s weight keeps increasing throughout the pregnancy and the body tries its best to carry this weight around. The pain is a result of the body coming to terms with the completion of delivery.
  • Certain mothers are more susceptible to joint pain post pregnancy due to problems such as chronic pain and arthritis. This further adds to joint pain.
  • If you have previously suffered injuries to the joint and tailbone, these can turn into extreme joint pain after delivery of the baby.
  • There are hormones secreted during pregnancy and delivery that are important for the safety of the mother and baby. These hormones cause the body ligaments to relax, allowing the mother to carry the baby’s weight around and undertake a successful delivery. Once the delivery is complete, the ligaments require some time to return to their original position. This, consequentially, results in joint pain.
  • If a woman does not exercise regularly during pregnancy or if she faces issues related to health or injuries that prevent her from exercising, the risk of experiencing joint pain after delivery is quite high.

How Long Does it Take to Recover From Joint Pain After Childbirth?

As with any kind of recovery, the recovery duration highly depends upon the health of a person. On a general level, joint related pains last for a bunch of weeks or so. In certain extreme cases, they have been known to last for four to six months as well. If a mother has had a good pregnancy along with a healthy delivery and can return to a proper eating habit and dietary recommendations, paired with a proper exercise structure, her chances of recovering from the pain are higher. With better care post delivery and addressing previous conditions of injuries and health, this time duration can be further reduced.




While nursing the baby, care needs to be taken to maintain a proper breastfeeding posture, not lifting the baby from a very low position, holding the baby comfortably, and holding the baby for shorter periods of time. Not taking care of these can aggravate joint pains and cause sacroiliac joint pain after pregnancy.

Home Remedies

There is no specific postpartum joint pain treatment process, as such. However, certain measures and remedies can help reduce pain.





  • Do light exercises on a regular basis. These do not have to be formal exercises, since the key is to keep your body active. This is elementary in controlling joint pain. Exercises that do not put pressure on the joints should be preferred, such as swimming. In any case, it is best to have a consultation with an expert before adhering to any exercise schedule.
  • One can resort to the classic hot and cold technique to take care of the pain. Making use of hot water bags, going for a hot water bath in a tub, and using ice packs to alleviate the pain in the joints can bring gradual relief. Do not use hot bags or ice packs directly on naked skin. Wrap them in a towel and then apply it to the affected area.
  • Nothing beats a fantastic body massage. Massage your joints yourself or hire an expert who can give you a great massage. You may use certain oils or ointments that are known to reduce joint pain.
  • There have been cases where certain women have found great relief from joint pain by resorting to techniques of acupuncture. These may be done right at home if you are well-versed with them. Else, it is always recommended to take your doctor’s or an expert’s advice.

All the pains and aches that occur after delivery are a part of the natural process that happen throughout pregnancy. The body has undergone a huge change in nine months, with extreme conditions throughout pregnancy. Once you give it good time to recover and balance relaxation and activity in the right manner, the pain will start subsiding and bring you relief. In case the pain worsens or you start observing changes in your body that you haven’t seen before, get in touch with your doctor to rule out any postpartum complications or get pain relief treatments.

Also Read: Postpartum Back Pain




PMC

DISCUSSION

Pregnancy-related pelvic pain is one of the common symptoms during the peripartum period. It is usually caused by change in the center of gravity, secondary to weight gain, pregnancy-related hormonal changes, and joint laxity. The intensity of pain can range from mild to severe. In most cases, the pain disappears soon after delivery and signs of joint infection such as heating sensation, swelling, and tenderness are usually not observed .

The patient started complaining of pain in the bilateral hip area 12 days after delivery. The pain aggravated gradually, and fever (38.4℃), leukocytosis (14,250/mm3), and increased CRP level (15.2 mg/dL) were detected 17 days after delivery. MR image showed osteomyelitis of bilateral hip joints and femoral heads with an abscess in the surrounding muscle. The physicians explained the need for joint fluid aspiration and biopsy of the hip joints for proper diagnosis and management. However, the patient and her husband strongly refused the invasive procedure, and the physicians had to initiate empirical antibiotic therapy. Cefminox (2nd generation cephalosporin) was immediately administered to the patient and it was changed to cefmenoxime (3rd generation cephalosporin) one week later because of sustained fever. Although fever subsided after the 5-week antibiotic therapy, the patient developed severe leukocytopenia.

According to previous studies, leukocytopenia is not common but it is one of the well-known complications after cephalosporin therapy . We stopped the antibiotic therapy and leukocytopenia was resolved with conservative treatment.

Pandya et al. reported a case of septic arthritis of the hip joint after delivery. They suggested that peripartum colonization of group B Streptococcus (GBS) caused psoas abscess and subsequent septic hip joint. Although we aspirated and analyzed the hip joint fluid, any specific organism was not isolated from the fluid. We assumed that the etiologic bacteria were not isolated because antibiotic therapy was started before the joint fluid culture . However, we confirmed joint and bone infection from the clinical and radiologic evidence, and laboratory results . Because many types of bacteria can cause septic joints during pregnancy, accurate bacterial isolation is very important for effective treatment. For example, Pseudomonas aeruginosa, Staphylococcus aureus, Mycoplasma hominis, and GBS are the most commonly isolated organisms during pregnancy .

Septic arthritis or osteomyelitis usually develops as a result of hematogenous seeding, direct intrusion, extension from adjacent infection, etc., and the hematogenous spread is the most common cause . The MR images obtained immediately after the onset of fever and infection symptoms of the hip joints demonstrated multiple simultaneous infections, such as osteomyelitis, sacroiliitis, and a suspicious abscess. It seems unlikely that this type of multifocal infection can be caused by direct intrusion or extension from adjacent sites Furthermore, the obstetrician could not identify any injury or open wound that might be a possible source of infection after delivery. In the light of statistical data and multifocal infection sites, we assumed that infection in the patient occurred through hematogenous spread from the episiotomy site or detachment site of the placenta . In this case, GBS or Staphylococcus aureus was the highly suspected etiologic pathogen. Although prophylactic antibiotics (aminoglycoside and 3rd generation cephalosporin) were administered before delivery, the infection could not be prevented and it caused severe destruction of the joints. According to many previous studies, prophylaxis with antibiotics was proved to be beneficial for both the mother and the baby. However, it did not guarantee prevention of all types of infection, which means that we should closely observe the mother after childbirth. Pain in the joints such as the hip or pelvis is a very common symptom during the peripartum period. Many physicians tend to ignore the fact that this type of joint pain could be the symptom of a serious infection or illness. This case highlights the importance of paying attention to minor signs and symptoms that could be related to a serious illness.

The patient continued rehabilitative therapy for 12 months after discharge; however, LOM of the hip joints interfered with her daily activities. Every other conservative treatment failed to restore the range of motion and bilateral total hip replacement had to be performed. After the surgery, the hip joint motion was restored and pain was mostly relieved.

To the best of our knowledge, severe infection such as septic arthritis and osteomyelitis after delivery involving both sides is extremely rare. However, this case proved that hip joint pain after delivery could be due to a destructive joint disease rather than a benign musculoskeletal disorder. Therefore, we should consider early invasive and extensive evaluation with high suspicion even when the patients present with only minor or common symptoms.

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