How long does the postpartum period last and when does it end?
According to the organisational standard of perinatal care, the postpartum period (połóg) begins after the birth and lasts six weeks. During this time the changes caused by pregnancy and birth reverse. pacjent.gov.pl describes it the same way, and the WHO sets the postnatal period at six weeks, or 42 days.
In conversations and guides you will often see “6-8 weeks”. That is because recovery does not end on a single day: the abdominal muscles, pelvic floor or scar may need more time, and wellbeing and strength come back at a different pace for every woman. Formally, though, the postpartum period ends six weeks after the birth.
Throughout this time you are entitled to home care from your POZ midwife (the primary care midwife funded by the public health fund, NFZ). She makes at least four home visits (wizyty patronażowe), and the first should take place within 48 hours (excluding weekends and public holidays) of the birth being reported. During the visits the midwife checks, among other things, how your uterus is contracting, your bleeding, how the perineum or wound is healing, your breasts and how you are feeling.
How do postpartum bleeding and the uterus change week by week?
Lochia (odchody połogowe) is the discharge from the birth canal through which the uterus cleans itself after the birth. At first it is bloody and heaviest, then it turns brownish or pinkish, and towards the end it is light, yellowish or whitish and scant. Meanwhile the uterus contracts, which you may feel as pain in the lower abdomen, often stronger while breastfeeding. The pace of change is individual, so the table below shows a typical course, not a rigid schedule.
| Postpartum week | What happens | What to watch for |
|---|---|---|
| Week 1 | Bloody and heaviest lochia, uterine contractions, the perineum or wound is at its most painful. Your milk usually comes in between days 3 and 5, and baby blues often appear around day 3. | The amount of blood and the size of clots, your temperature, passing urine, wound healing. The first visit from the POZ midwife usually happens this week. |
| Weeks 2-3 | Lochia gets lighter, brownish or pinkish, and there is less of it. Pain in the perineum or wound eases noticeably and feeding settles down. | Mood: baby blues should pass after about 10 days. Watch for a return of heavy, bright red bleeding, foul-smelling lochia, or a painful breast with a fever. |
| Weeks 4-6 | Lochia is scant and light or has already stopped. The uterus has almost fully contracted, and you have more energy for walks and everyday tasks. | In week 4 the POZ midwife assesses your risk of postnatal depression. Tell her about leaking urine, pain when sitting or lasting sadness. |
| Weeks 6-8 and later | The postpartum period formally ends, but the abdominal muscles, pelvic floor and scar may need a few more weeks or months. | A check-up with the obstetrician after the postpartum period, a conversation about contraception and a gradual return to activity. |
How is the postpartum period after a caesarean different from after a vaginal birth?
The postpartum period after a caesarean section also lasts six weeks, and the uterus contracts and cleans itself in a similar way, so you will have lochia too. The difference is that the abdominal wound from the operation has to heal. The first days usually need more help with getting up, lifting the baby and finding a comfortable feeding position.
After a vaginal birth, the perineum needs the most attention, especially after a cut (episiotomy) or a tear. Hygiene after every trip to the toilet helps, as does avoiding standing or sitting in one position for a long time. Perineal pain should ease day by day, not get worse.
In both cases the POZ midwife checks healing during the home visits and removes stitches from the perineum or abdomen if needed. The WHO recommends returning to activity gradually after the birth, and after a caesarean especially in consultation with a midwife or doctor. Ask at one of the visits about caring for the scar once the wound has healed.
When do periods come back after giving birth?
When your period returns depends mainly on feeding. If you are exclusively breastfeeding and your baby is under 6 months old, your period usually has not come back yet. It often appears only when there are fewer feeds, for example after starting solids or after weaning. If you are not breastfeeding or are combination feeding, your period usually comes back sooner.
Important: fertility can return before you see your first period. According to the NHS, you can get pregnant as early as 3 weeks after the birth, even if you are breastfeeding and have not had a period yet. Breastfeeding alone is therefore not reliable contraception, unless you are deliberately using the lactational amenorrhoea method and meet all of its conditions.
If you are not planning another pregnancy, talk to a midwife or doctor about contraception while you are still in the postpartum period. Education on the return of fertility and family planning methods is part of the POZ midwife's visits.
When should I see a gynaecologist after birth, and when can I go back to sex and exercise?
The perinatal care standard says the POZ midwife tells you about the need to see an obstetrician after the postpartum period ends, that is six weeks after the birth. The doctor then checks how you have healed, and it is a good moment to talk about contraception. The midwife also reminds you about a dentist visit within 6 weeks of the baby's birth.
No regulation sets a date for resuming sex. Many women wait until the lochia has stopped and the perineum or wound has healed, and some wait until the check-up. Be guided by whether you feel any pain and whether you feel ready, and remember contraception if you are not planning a pregnancy.
You can usually start walking early. The WHO recommends starting with a small amount of movement and gradually increasing it, eventually to at least 150 minutes of activity a week, or about 20-25 minutes of walking a day. If you notice leaking urine or a feeling of heaviness in the perineum, ask your midwife about pelvic floor exercises.
Baby blues or postnatal depression: how can I tell the difference?
Baby blues, a spell of low mood after the birth, usually appears around the third day after giving birth. You may be tearful and irritable, have trouble sleeping and feel that you are not coping. According to pacjent.gov.pl, 25 to 85 per cent of women experience it, and the low mood usually passes after about 10 days, especially when you have support and can rest.
If for more than 10 days you are constantly tired and low, nothing gives you joy or you keep fearing that you are a bad mother, it may be postnatal depression. It can appear within the first couple of weeks after the birth, or even in the second half of the baby's first year. It is an illness that can be treated, not a sign of weakness.
Tell your midwife, your POZ doctor (GP) or a psychiatrist, for whom you do not need a referral. Round-the-clock psychological support is available on 116 123 and 800 70 2222. The POZ midwife assesses your risk of depression in week 4 after the birth, but you do not have to wait for that visit.
Which postpartum symptoms need urgent medical help?
Some symptoms may signal a haemorrhage, an infection, a blood clot or another complication. Do not wait for the midwife's visit with them and do not look for advice online:
- fever or chills,
- bleeding that suddenly gets heavier, very heavy bleeding or large clots,
- foul-smelling lochia or worsening pain in the lower abdomen,
- pain, swelling, redness or warmth in one calf,
- shortness of breath or chest pain,
- a severe headache, especially with vision problems,
- a red, hot and painful breast with a fever,
- a perineal or caesarean wound that is oozing pus, coming apart or getting more and more painful,
- thoughts of harming yourself or your baby, hallucinations or a sense of losing control over yourself.
With shortness of breath, chest pain, very heavy bleeding or thoughts of harming yourself or your baby, call 112. In other situations, contact a doctor urgently or go to hospital. Let your midwife know afterwards so she can adjust your further care.
