What are afterpains
Afterpains are contractions of the uterus after birth. The uterus reduces in size in the days and weeks after delivery, returning towards its pre-pregnancy state. This involution can feel like period pain or like short, recurring labour-like pains.
Afterpains are not just pain. They are also part of the process that helps stop bleeding in the uterus and can be related to postnatal bleeding (lochia), because the area where the placenta was attached continues to contract.
Why afterpains occur
After birth the uterus is considerably enlarged and well supplied with blood. Rhythmic contractions help firm the tissue, compress blood vessels and support the involution process. That is the biological reason for afterpains.
Why breastfeeding can make afterpains worse
Breastfeeding triggers natural signals that cause the uterus to contract more. Many people therefore notice noticeably stronger cramps when attaching the baby or during the let-down reflex. This is a common, typical link. NHS: Your body after birth — involution and cramp-like pains
Who tends to feel stronger afterpains
- People who have given birth before often report stronger afterpains than at the first birth
- Those who are breastfeeding may notice afterpains more frequently around feeding times
- 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 diminishing. During breastfeeding they can briefly flare up and then subside again. If the overall course is towards less pain, this is more consistent with normal afterpains.
Afterpains and postnatal bleeding
Some people notice that the lochia becomes briefly heavier or looks a little redder during or immediately after breastfeeding. This can be related to the uterus working harder in that phase. NHS: Lochia and changes with breastfeeding
What helps for afterpain relief
The aim is not to eliminate all pain, but to reduce it to a level that allows you to sleep, breastfeed, eat and move around. 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 pad
- Changing position instead of staying still, short walks around the home if it feels comfortable
- Emptying the bladder regularly, as a full lower abdomen can increase pressure
- Calm breathing during pain peaks, similar to coping with period cramps
Ibuprofen, paracetamol and breastfeeding
Many people need pain relief in the first days, and this is common in the postnatal period. For those who are breastfeeding, ibuprofen and paracetamol are commonly first-line options because only small amounts pass into breast milk and they are widely used in practice. ACOG: Postpartum pain management
If you have specific questions about dosing, existing conditions, stomach issues, asthma, bleeding disorders or other medications, an individual assessment is important. The LactMed database describes ibuprofen as a preferred option during breastfeeding because the amounts in breast milk are very low. LactMed: Ibuprofen during breastfeeding
When afterpains no longer look normal
The key 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 pain becomes more intense, is constant or is accompanied by other warning signs, this is less consistent with normal afterpains.
Warning signs you should have checked promptly
- Fever, chills or a marked feeling of being unwell
- Foul-smelling lochia or increasing tenderness of the uterus to touch
- Pain that gets stronger day by day instead of lessening
- Heavy bleeding, large clots or a sudden increase in bleeding after earlier improvement
- A one-sided, stabbing pain that does not come and go in waves
- Severe pain when passing urine, blood in the urine or difficulty emptying the bladder
Think about bleeding and lower abdominal pain together
Sometimes the main issue is not the cramp but a combination of increasing bleeding, bad odour and lower abdominal pain. This can indicate an infection or other causes and should be medically assessed. The RCOG also provides information on warning signs for increasing bleeding in the postnatal period. RCOG: Heavy bleeding after birth — warning signs
Common confusions
Afterpains are not the only cause of lower abdominal pain after birth. Especially in the first weeks many conditions can feel similar. It helps to sort symptoms roughly by pattern.
Digestion and pelvic floor
Constipation, trapped wind and an irritated pelvic floor can cause pressure and cramps that feel like uterine pain. If the pain is more associated with eating, bowel movements or wind, that can be a clue.
Urinary tract
Irritation, infection or problems fully emptying the bladder can cause lower abdominal pain and should be taken seriously, particularly if there is burning, frequent urge to pass urine or fever.
Birth injuries
Pain from a perineal tear or stitches is usually located at the vaginal opening or perineum and gets worse when sitting, standing up or going to the toilet, whereas afterpains are described more as deep lower abdominal cramps. Both can occur at the same time.
Practical plan for daily life in the postnatal period
Many people cope better if they do not have to 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 lying down for a longer time
- Take pain relief not only when the pain is at its worst, but as advised for your situation
- Choose a feeding position that eases pressure on the lower abdomen and back
- If you are unsure, note the course: when, how severe, which accompanying symptoms
If you feel you cannot sleep because of the pain, cannot breastfeed or are anxious about each next wave, that is a good reason to seek help. It is not about enduring but about ensuring a safe recovery.
Conclusion
Afterpains are a common sign that the uterus is working and involuting after birth. They are often strongest in the first days and can be more noticeable during breastfeeding. If the overall course improves, this is more consistent with normal afterpains. If pain increases or warning signs such as fever, foul odour or heavier bleeding appear, seek medical assessment promptly.
