Afterpains: postpartum cramps as your womb shrinks back

Afterpains are the postpartum cramps you feel low in your tummy as your womb contracts back to its pre-pregnancy size. KKH describes them as a mild ache that is most intense in the first few days after delivery and can last from a few days up to four to six weeks. They feel like period pain and often flare while you breastfeed.

Why your womb cramps after the birth

Right after delivery your womb is still big and heavy. Cleveland Clinic says it weighs about 1,000 grams just after the birth, with its top level with your belly button, and sinks back into your pelvis by 10 to 14 days. KKH's obstetrics team says it takes about 6 weeks to return to its original size and place. The squeezing that shrinks it is what you feel as afterpains.

Afterpains and bleeding tend to go together. The NHS says your lochia may turn redder and heavier when you breastfeed, because feeding makes the womb contract, and you may feel period-like cramps at the same time.

Why postpartum cramps get worse when you breastfeed

When your baby suckles, or when you pump, your body releases the hormone oxytocin, Cleveland Clinic explains, and the womb contracts. KKH says breastfeeding mothers feel the womb tighten while the baby is at the breast. Cleveland Clinic describes strong cramping that lasts about five minutes and then eases off.

There is a payoff. Cleveland Clinic says the womb shrinks faster if you breastfeed. ACOG adds that afterpains are more common in the first few days of breastfeeding and in women who have given birth before, so a second or third baby can bring stronger cramps than the first.

What eases afterpains

Most mothers here go home with pain relief. KKH says anti-inflammatory painkillers (NSAIDs) are commonly prescribed after childbirth to reduce pain and lochia flow, and asks you to take them as your doctor prescribed. If you are breastfeeding, the NHS says to check with a pharmacist or doctor before buying any over-the-counter painkiller.

Simple comfort measures help too. ACOG says a heating pad on your tummy relieves the cramping. Cleveland Clinic suggests the breathing and relaxation you practised for labour, lying on your front with a pillow under your lower belly, and walking.

If your family suggests herbs or tonics during confinement, KKH asks you to consult a doctor before taking any traditional or complementary medicine.

When tummy pain after birth is not afterpains

Afterpains are worst in the first few days and then fade. Pain that behaves differently needs checking. The NHS lists a high temperature with a sore, tender tummy as a possible sign of infection, and sudden or very heavy bleeding with feeling faint or a racing heart as a sign of haemorrhage. Cleveland Clinic adds excessive cramping or pelvic pain to its list of reasons to call a doctor.

In Singapore, KKH's Urgent O&G Centre is a 24-hour walk-in centre that sees post-pregnancy problems. For significant tummy pain or heavy bleeding, KKH says to go there or to your nearest emergency department straight away. Families for Life gives the same advice for worsening tummy pain or fever: see your obstetrician or go back to hospital as soon as possible. Cramps that linger are worth raising at your 6-week postnatal review.

Frequently asked questions

How long do afterpains last?

KKH says they are most intense in the first few days after the birth and may last from a few days up to four to six weeks. Cleveland Clinic says most women only notice them for a few days.

Why are afterpains worse with my second baby?

ACOG and Cleveland Clinic both say afterpains tend to be more painful if you have given birth before. Ask the ward for pain relief if the cramps stop you resting.

Is it normal to get cramps while breastfeeding?

Yes, in the early days. KKH says breastfeeding mothers feel the womb contracting when the baby suckles, and the NHS describes painful period-like cramps during feeds.

Can I use a heat pack for postpartum cramps?

ACOG says applying a heating pad to your abdomen helps relieve afterpains. If you also need medicine, take what your doctor prescribed.

Related terms

• Lochia: The bleeding and discharge after birth, red at first and paler over three to eight weeks.
• Confinement (Zuo Yue Zi): The traditional rest period after birth, 30 to 44 days depending on community, with food rules and extra help at home.
• 6-Week Postnatal Review: Your own check-up with a doctor four to six weeks after birth, covering healing, mood, feeding and contraception.
• C-section (Caesarean Section): An operation to deliver your baby through a cut in your tummy and womb, planned ahead or done in labour.
• Let-down Reflex: The reflex that makes your stored milk flow when your baby sucks. Some mums feel a tingle, others feel nothing.

See every term in the glossary