Afterpains are cramps that come as the womb (uterus) tightens back down after birth. They feel like period pain, often strong, and they are usually worst in the first two to three days. They are frequently stronger while feeding a baby, and stronger after a second or later birth. This page explains what is usual so you can tell it apart from pain that needs checking, and it is not a substitute for your midwife or doctor.

Why the cramping happens

During pregnancy the womb grows enormously. Afterwards it contracts down towards its usual size, and contracting is what you feel.

The tightening also closes the blood vessels where the placenta was attached. That is why cramping and bleeding are linked: cramps often come with a small gush.

Why feeding makes it stronger

Feeding a baby releases the hormone that makes the womb tighten. So the cramps often arrive within a minute or two of the baby latching, peak, and then fade.

This surprises people, and it can make early feeds harder than expected. It usually eases within the first week. Read breastfeeding in the first two weeks for the wider picture of what those days are like.

Why they are worse after a second baby

A womb that has stretched before tends to contract in stronger waves rather than a steady tightening. Many people describe first-baby afterpains as mild and second-baby afterpains as genuinely painful.

If nobody warned you, that is a gap in what people are told, not a sign that something is wrong.

How long they last

Cramping is usually strongest for two to three days and has mostly settled by the end of the first week. Mild twinges can carry on a little longer, especially during feeds.

Cramps that are getting worse after the first week, rather than better, are not following that pattern and need advice.

What tends to help

• Emptying your bladder often. A full bladder makes cramping worse.
• Lying on your front with a pillow under your hips, if that is comfortable.
• Warmth on the lower tummy, if it is safe to use where you are and not on a caesarean wound without asking.
• Slow breathing through the wave, as it does pass.
• Pain relief. Ask your midwife, doctor or pharmacist what is suitable for you and while feeding. This page names no medicines and no doses.

NICE's postnatal guidance expects pain after birth to be asked about and managed at postnatal contacts, so raise it rather than saving it for the six-week check.

When tummy pain is not afterpains

Afterpains come in waves, are strongest early, ease over days, and are linked to feeding. Pain that behaves differently deserves attention:

• Constant pain that does not come in waves.
• Pain that is increasing day by day.
• Pain with a fever, shivering, or feeling unwell.
• Pain with offensive-smelling bleeding.
• Severe pain, or pain in one spot rather than across the lower tummy.
• Pain with heavy bleeding, faintness or breathlessness.

Infection in the womb can cause tummy pain with fever and a bad smell, and WHO's postnatal guidance treats fever after birth as a reason to be assessed. See postpartum warning signs.

Pain around a caesarean wound is a different question, and increasing wound pain always needs checking.

What is worth writing down

Note when the cramps come, how long they last, whether feeding sets them off, and whether they are easing day by day. Note bleeding alongside them.

Femio can hold that record so a pattern is visible. Femio does not assess pain and cannot tell you what is causing it — that judgement belongs to a clinician who can examine you. See bleeding after birth and the first six weeks for what else is happening at the same time.

When to see a doctor

Contact your midwife, maternity unit or doctor for pain that is getting worse after the first few days, pain with a fever or offensive-smelling bleeding, pain that is constant rather than in waves, or pain that is not controlled by whatever relief you were advised to use. Seek urgent care for severe or sudden tummy pain.

Pain that stops you feeding, sleeping or moving is worth a call by itself.

Seek care now: Contact local emergency services or go to the nearest emergency department for severe or sudden tummy pain, tummy pain with heavy bleeding, or pain with fainting, breathlessness, a racing heart or a high fever.

Frequently asked questions

Are afterpains normal?

Yes. Cramping as the womb tightens back down is expected in the first days after birth.

Why do they start when I feed?

Feeding releases a hormone that makes the womb contract, so cramps often begin as the baby latches and fade afterwards.

Are they worse with each baby?

Often, yes. A womb that has been stretched before tends to contract in stronger waves.

How long should they last?

Usually a few days, easing through the first week. Pain that is increasing after that needs advice.

Can afterpains be as strong as labour pains?

Some people describe strong ones that way. Strong is possible; severe, constant, or worsening pain still needs checking.