What afterpains are
Afterpains are contractions of the uterus after birth. Over the days and weeks following delivery the uterus gradually returns toward its pre-pregnancy size. This involution can feel like period pain or short, recurring labour-like cramps.
Afterpains are not only painful; they also help reduce bleeding in the uterus and can be related to the lochia (postpartum discharge) as the area where the placenta was continues to contract.
Why afterpains occur
After birth the uterus is considerably enlarged and well supplied with blood. Rhythmic contractions firm the tissue, compress blood vessels and support the involution. This is the biological reason behind afterpains.
Why breastfeeding can make afterpains stronger
Breastfeeding triggers natural signals that cause the uterus to contract further. Many people therefore notice noticeably stronger cramps when the baby latches or during a milk ejection reflex. This is a common and typical connection. More information on body changes after birth and cramp-like pains
Who often feels stronger afterpains
- People who have given birth before often report stronger afterpains than with their first birth
- Those who breastfeed tend to notice afterpains more often around feeding sessions
- 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.
A typical pattern is stronger pain in the first days, then a gradual reduction. During breastfeeding these pains can briefly intensify and then subside again. If the overall trend is toward less pain, this more likely fits normal afterpains.
Afterpains and lochia
Some notice that lochia becomes temporarily heavier or looks a bit redder during or immediately after breastfeeding. This can be related to the uterus working more strongly in that phase. More on lochia and changes during breastfeeding
What helps against afterpain
The goal is not to eliminate all pain but to reduce it to a level that allows you to sleep, breastfeed, eat and move. Afterpains are often underestimated because they are not visible to others.
Gentle measures that often help
- Heat on the lower abdomen, for example a hot water bottle or a warm cherry stone cushion
- Changing position instead of lying still, short walks around the house if that feels comfortable
- Emptying the bladder regularly, since a full lower abdomen can increase pressure
- Calm breathing during pain peaks, similar to coping with period cramps
Ibuprofen, paracetamol and breastfeeding
Many need pain relief in the first days, and this is common in the postpartum period. For people who breastfeed, ibuprofen and paracetamol are often first-line choices because only small amounts pass into breastmilk and they are widely used in practice. Guidance on postpartum pain management
If you have specific questions about dose, pre-existing conditions, stomach problems, 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 breastmilk are very low. LactMed: Ibuprofen during breastfeeding
When afterpains no longer seem normal
The key point is not whether you have pain, but whether the overall pattern fits uterine involution. Afterpains are usually wave-like, fairly central, often triggered by breastfeeding, and improve over time. If the pain becomes more intense, is constant, or is accompanied by other warning signs, this is less consistent with normal afterpains.
Warning signs to get checked promptly
- Fever, shivering or a marked feeling of being unwell
- Foul-smelling lochia or increasing tenderness of the uterus to touch
- Pain that becomes stronger day by day instead of improving
- Heavy bleeding, large blood clots or a sudden return to much heavier bleeding after earlier 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 problem is not the cramp itself but a combination of increasing bleeding, foul smell and lower abdominal pain. This can indicate an infection or other causes and should be medically evaluated. Guidance on warning signs for increasing postpartum bleeding is also provided by professional bodies. Information on heavier bleeding after birth and warning signs
Common confusions
Afterpains are not the only cause of lower abdominal pain after birth. Especially in the first weeks many different issues can feel similar. It helps to sort by typical patterns.
Digestion and pelvic floor
Constipation, trapped gas and an irritated pelvic floor can cause pressure and cramps that feel like uterine pain. If the pain is more clearly linked to eating, bowel movements or wind, that is a clue.
Urinary tract
Irritation, infection or problems fully emptying the bladder can cause lower abdominal pain and should be taken seriously, especially if burning, frequent urges or fever occur.
Birth injuries
Pain from a perineal tear or stitches is felt more at the vaginal entrance or perineum and gets worse when sitting, standing up or using the toilet, whereas afterpains are described as deeper lower abdominal cramps. Both can occur at the same time.
Practical plan for everyday life in the postpartum period
Many manage better if they do not have to reassess every pain anew. A simple, repeatable plan can help, especially during nights with frequent breastfeeding.
- Keep heat ready before you lie down
- Drink and empty your bladder before lying down for a longer period
- Take pain relief before the pain reaches its maximum, following the advice you were given
- Choose breastfeeding positions that relieve the lower abdomen and back
- If uncertain, note the course: when, how strong, and which accompanying symptoms
If you feel you cannot sleep, cannot breastfeed because of the pain, or you are anxious about 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 birth. They are often strongest in the first days and may be more noticeable during breastfeeding. If the overall course improves, this more likely fits normal afterpains. If pain increases or warning signs such as fever, bad smell or heavier bleeding occur, seek medical assessment promptly.
