What afterpains are
Afterpains are contractions of the uterus after childbirth. In the days and weeks following delivery, the uterus gradually returns toward its pre-pregnancy size. This involution can feel like menstrual cramps or short, recurring labour-like pains.
Afterpains are not only pain. They are also part of stopping the bleeding in the uterus and can be related to lochia because the area where the placenta was continues to contract.
Why afterpains occur
After birth the uterus is considerably enlarged and well perfused. Rhythmic contractions firm up tissue, compress blood vessels and support involution. This is the biological basis for afterpains.
Why breastfeeding can increase afterpains
Breastfeeding triggers hormonal signals that cause the uterus to contract further. Many people therefore notice stronger cramps when attaching the baby or during the milk ejection reflex. This is a common, typical connection. Health Canada: Your body after birth, recovery and cramp-like pains
Who often feels afterpains more strongly
- People who have given birth before often report stronger afterpains than with their first birth
- Those who are breastfeeding notice afterpains more often in waves around feedings
- A full bladder or constipation can increase pressure in the lower abdomen and make cramps feel worse
How afterpains typically feel
Normal afterpains are wave-like pains in the lower abdomen that come and go. Many describe a pulling sensation centrally behind the pubic bone or a diffuse cramping, sometimes radiating to the back or groin.
There is also a typical pattern: stronger in the first days, then gradually lessening. During breastfeeding they can briefly flare up and then subside. If the overall course trends toward less pain, that is more consistent with normal afterpains.
Afterpains and lochia
Some people notice that lochia becomes temporarily heavier or looks slightly redder during or immediately after breastfeeding. This can be related to the uterus working more actively in that phase. Health Canada: Lochia and changes with breastfeeding
What helps for afterpain relief
The goal is not to eliminate every sensation, but to reduce pain to a level that allows you to sleep, breastfeed, eat and move. Afterpains are often underestimated because they are invisible to others.
Gentle measures that often help
- Heat to the lower abdomen, for example a hot water bottle or a warm cherry-stone pillow
- Change positions rather than lying still; short walks around the home if that feels comfortable
- Empty the bladder regularly, since a full lower abdomen can increase pressure
- Slow, calm breathing during pain peaks, similar to coping with menstrual cramps
Ibuprofen, acetaminophen and breastfeeding
Many people need pain relief in the first days, and this is common in the postpartum period. For those who are breastfeeding, ibuprofen and acetaminophen (paracetamol) are frequently used as first-line options because only small amounts pass into breastmilk and they are widely used in practice. Professional organisations such as the Society of Obstetricians and Gynaecologists of Canada (SOGC) list ibuprofen and acetaminophen as typical first-line medications for postpartum pain in people who are breastfeeding. SOGC: Postpartum pain management
If you have specific questions about dosing, pre-existing conditions, stomach problems, asthma, blood clotting or other medications, an individual assessment is important. In the LactMed database ibuprofen is described as a preferred option during breastfeeding because the amounts in breastmilk are very low. LactMed: ibuprofen during breastfeeding
When afterpains no longer seem normal
The crucial point is not whether you have pain, but whether the overall picture fits involution. Afterpains are usually wave-like, fairly central, often triggered by breastfeeding, and improve over time. If the pain intensifies, is constant, or is accompanied by other warning signs, it is less consistent with normal afterpains.
Warning signs you should have evaluated promptly
- Fever, chills or a marked feeling of illness
- Foul-smelling lochia or increasing tenderness of the uterus to touch
- Pain that becomes stronger day by day instead of lessening
- Heavy bleeding, large blood clots or a sudden return to noticeably heavier bleeding after previous improvement
- One-sided, sharp pain that does not come and go in waves
- Severe pain when passing urine, blood in the urine or difficulty emptying the bladder
Consider bleeding and lower abdominal pain together
Sometimes the main issue is not the cramp but a combination of increasing bleeding, foul smell and lower abdominal pain. This can indicate an infection or other causes and should be medically assessed. Similar warning signs related to increasing postpartum bleeding are also described by the SOGC. SOGC: Heavy bleeding after birth — warning signs
Common confusions
Afterpains are not the only cause of lower abdominal pain after childbirth. Especially in the first weeks many things can feel similar. It helps to roughly sort by pattern.
Digestion and pelvic floor
Constipation, intestinal gas and an irritated pelvic floor can cause pressure and cramps that feel like uterine pain. If the pain is more related to eating, bowel movements or bloating, that can be a clue.
Urinary tract
Irritation, infection or problems emptying the bladder completely can cause lower abdominal pain and should be taken seriously, especially if burning, frequent urge to urinate or fever occur.
Birth injuries
Pain from a perineal tear or sutures is felt more at the vaginal opening or perineum and is worse when sitting, standing or using the toilet, whereas afterpains are described more as deep lower abdominal cramps. Both can occur at the same time.
Practical plan for everyday life in the postpartum period
Many people cope better if they do not reassess every pain anew. A simple, repeatable plan can help, especially on nights with frequent breastfeeding.
- Have heat ready before you lie down
- Drink and empty your bladder before you lie down for a longer period
- Take pain medication before the pain reaches its maximum, according to the recommended schedule
- Choose a breastfeeding position that relieves your lower abdomen and back
- If you are unsure, keep a record of the course: when, how strong, and which accompanying symptoms
If you feel you cannot sleep because of the pain, cannot breastfeed, or are fearful of each next wave, that is a good reason to seek help. It is not about enduring but about ensuring a safe course.
Conclusion
Afterpains are a common sign that the uterus is working and involuting after childbirth. They are often strongest in the first days and can be more noticeable during breastfeeding. If the overall course improves, that is more consistent with normal afterpains. If pain increases or warning signs such as fever, foul smell or heavier bleeding appear, this should be assessed medically in a timely manner.
