menstruation pain or stomach ache on bedCoping with ‘After Pains’

What are after pains?

‘After pains’ are contractions of the uterus (womb) following your baby’s birth; they are perfectly normal and there is no reason to feel concerned. In fact, after pains are a positive sign; initially immediately after birth these contractions ensure the small blood vessels that once lead to you placenta (afterbirth) are sealed to prevent an excessive amount of blood being lost from your womb (postpartum haemorrhage). Secondly, they indicate that your body is returning to its pre-pregnant state; this involves your uterus contracting down to its non-pregnant size and returning to its usual position tucked away inside your pelvis. This whole process is called ‘involution’ and takes around four to six weeks to complete.

It is usual to be more aware of these uterine contractions in the first few days following your baby’s birth. They can also be more noticeable if you have chosen to breastfeed. This is because breastfeeding encourages the release of a hormone called ‘oxytocin’; this hormone helps your breast milk to be ‘let down’ (flow) and also stimulates your uterus to contract. You will probably notice that your postnatal bleeding (‘lochia’) also increases slightly during and shortly after breastfeeding.

After pains can be quite uncomfortable and some women can find them painful – this is often the case if women have already had a baby. However, other women don’t even notice them, especially following the birth of their first baby; this isn’t abnormal and it just shows how individual we all are. Some women report that their after pains become more severe the more babies they have; however, there is no research evidence to prove that this is the case.


Pain relief

If you are finding after pains uncomfortable or painful, you can take pain relieving drugs, such as Paracetamol every four to six hours with a maximum of eight tablets in a 24 hour period. If you are not breastfeeding, Ibuprofen tablets can also be effective, as they contain anti-inflammatory properties. Once your baby settles into a breastfeeding routine, it can be helpful to take pain relief around 20 minutes before you start feeding, as this can help to take the edge off any uterine contractions. Comfort measures like gently rubbing/massaging the top of your uterus (fundus), or applying a ‘wheatie’ or hot water bottle to your abdomen can also be helpful. However, these shouldn’t be too hot.

However, if you have any concerns or are finding after pains particularly painful, speak to your midwife or GP who will be able to advise you and can organise stronger pain relief. They can also feel your abdomen (called palpation) to check that your uterus is involuting as it should be. Having gone through labour and birth, it can sometimes be disheartening to have painful cramps post birth, but try to remember that your body is going through a perfectly normal and necessary process.

Waite J (2002). Report on Rangiora hospital after pains audit: feedback on a midwifery led initiative.Midwifery News [New Zealand College of Midwives] (24)March:28.