Abdominal pain after giving birth: causes and what to do

What pain is normal after giving birth?

After the birth, the womb has to return to its pre-pregnancy size. To do this, it contracts in waves: these are afterpains. They feel like period pains, sometimes strong. For everything about recovery after birth, see the Childbirth in Paris page.

Afterpains have several features:

• they are often stronger after a second or third baby than after the first;
• they increase during breastfeeding, because sucking releases oxytocin, the hormone that makes the womb contract;
• they ease markedly within a few days;
• they respond to simple painkillers, compatible with breastfeeding, prescribed by your doctor.

Other discomforts are common: perineal pain after a tear or an episiotomy, scar pain after a caesarean, bloating and constipation, or lower back pain.

What causes abnormal abdominal pain after birth?

What is different about pain after a caesarean?

After a caesarean section, pain in the scar and abdominal muscles is expected for a few days, then gradually eases. The French College of Gynaecologists and Obstetricians (CNGOF) recommends managing pain with a combination of painkillers, preferably by mouth.

Some signs should raise concern:

• at the scar: spreading redness, warmth, swelling, fluid or pus leaking, or the wound opening. These may point to a haematoma, an abscess or a collection of lymph fluid (lymphocele);
• in the abdomen: marked bloating, vomiting, being unable to pass wind or stools. These signs suggest a bowel obstruction, which is rare but urgent;
• pain that gets worse instead of better, with fever, may reveal a deep infection.

Could abdominal pain after birth be a blood clot?

The risk of venous thrombosis (a clot in a vein) is higher in the weeks after giving birth, especially after a caesarean. This is why the CNGOF recommends compression stockings from the day of every caesarean and for at least 7 days, combined with anticoagulant injections depending on risk factors.

A thrombosis can affect the legs (calf pain, swollen, warm leg), but also the veins of the pelvis or ovary. It then shows up as pain in the lower abdomen or the side, often on one side, with a fever that persists despite antibiotics. Diagnosis relies on Doppler ultrasound or a CT scan. Treatment combines anticoagulants and, if needed, antibiotics.

Sudden breathlessness or chest pain may signal a pulmonary embolism: in France, call 15 immediately (or your local emergency number).

What tests are done for abdominal pain after birth?

The tests depend on your symptoms and the clinical examination. They may include:

• an examination of the abdomen and scar, and a gynaecological examination;
• a blood test: blood count, inflammation markers, and sometimes β-hCG;
• a urine test (urine culture);
• a vaginal swab;
• a pelvic or abdominal ultrasound;
• sometimes a CT scan, compatible with breastfeeding, if a digestive or vascular complication is suspected.

How is abdominal pain after birth treated?

Treatment depends on the cause:

• afterpains and ordinary pain: painkillers compatible with breastfeeding, gentle warmth on the abdomen, emptying the bladder regularly;
• constipation: fluids, fibre, walking, and a gentle laxative if needed;
• infection (endometritis, urinary infection, wound infection): suitable antibiotics, at home or in hospital depending on severity; for endometritis, a Cochrane review shows that treatments active against penicillin-resistant anaerobic bacteria fail less often;
• retained placenta: removal of the fragments by suction or hysteroscopy;
• abscess, bowel obstruction, ovarian torsion, appendicitis: surgical treatment;
• thrombosis: anticoagulant treatment.

Always mention if you are breastfeeding: most of the treatments needed are compatible, and the choice is adapted.

How can I ease abdominal pain at home after birth?

When the pain is the expected pain of recovery after birth, a few simple measures make you more comfortable:

• take the prescribed painkillers at regular times in the first days, rather than waiting until the pain is strong; paracetamol is the basic treatment while breastfeeding;
• pass urine regularly, even without a strong urge: a full bladder makes afterpains worse and stops the womb shrinking back properly;
• prevent constipation: drink enough, eat fruit, vegetables and wholegrains, and walk a little every day; after a tear or an episiotomy, a gentle laxative may be prescribed to avoid straining;
• use a warm hot-water bottle on the lower abdomen for afterpains, never on a recent caesarean scar;
• during feeds, breathe slowly and take your painkiller half an hour beforehand if the afterpains are strong;
• after a caesarean, get up by rolling onto your side first, and support the scar with your hand or a cushion when you cough or laugh.

Keep track of how your pain changes. Pain from recovery after birth eases day by day. Pain that stays the same or gets worse beyond a few days should be reported to the midwife who visits you at home or to your doctor, even without fever.

When should I seek emergency care for abdominal pain after birth?

Go without delay to your maternity unit's emergency department or to the emergency department if you have:

• severe pain that gets worse or is not relieved by painkillers;
• a fever of 38 °C or more, or chills;
• heavy or foul-smelling bleeding;
• vomiting, a very swollen abdomen, or you cannot pass wind or stools;
• sudden pain on one side;
• a scar that is red, swollen or leaking;
• pain or swelling in one leg.

In France, call 15 (SAMU) or 112 (or your local emergency number) for sudden breathlessness, chest pain, fainting or very heavy bleeding. For other urgent situations, go to the emergency department of the maternity unit where you gave birth (Maternité Sainte-Félicité or Clinique Sainte-Thérèse).

Frequently asked questions

General information article: it does not replace a medical consultation. In an emergency, call 15 or 112 in France, or your local emergency number.