Many women who plan to breastfeed are unprepared for the afterbirth pain that accompanies nursing in the first few days after birth. Afterbirth pain can vary from mild to severe in different women and can even vary from birth to birth for the same woman.
It's comforting to know that afterbirth pain is both temporary and important. When the baby nurses, it stimulates the mother's body to produce a hormone called oxytocin. Producing oxytocin is the body's way of stimulating uterine contractions. (Before birth, doctors often use a synthetic version of this hormone to stimulate or speed labor contractions.)
After birth, oxytocin released by the body serves the significant role of shrinking the uterus back to pre-pregnancy size through contractions. Aggressive shrinking of the uterus also closes off the open blood vessels where the placenta separated from the uterine wall, reducing the chance of post-birth hemorrhage.
Breastfeeding the baby is the body's natural way to signal the body that it's time to begin this process. This is one of the reasons it's important to bring the baby to the breast to nurse as close as possible after birth. Each time the baby nurses, oxytocin is released and for the first several hours or days after birth, the mother may feel pain from the uterine contractions. Pain usually subsides after the first few minutes of the nursing session, or at least reduces over the course of the feeding.
It's helpful for a nursing mother to expect some afterbirth pain. First, it's important to realize that this is completely normal and is actually a helpful function of nursing. It certainly does not signal any sort of breastfeeding problem. It's also helpful to recognize afterbirth pain, especially if severe, as something temporary that just needs to be worked through. Judicious use of ibuprophen or acetaminophen while breastfeeding is allowed by most doctors, so you can check with your post-partum nurses, obstetrician and/or your baby's pediatrician if the pain is difficult to bear.
I had fairly severe afterbirth pain with my first daughter, controlled by ibuprophen in the hospital. With my second daughter, born at home, I was determined to avoid pain medication, suffering through 3 days of debilitating cramps the first few minutes each time I nursed. I remember kicking my bedframe and trying not to double over on the baby as she fed. Finally my midwife convinced me to stop being a martyr and take a dose of acetaminophen. I was so glad that I finally did, as could finally find some enjoyment in nursing my newborn daughter.
I share this because it's important that nursing moms in pain need to know that there is a purpose, that it will subside, and that if severity of afterbirth cramps are interfering with a positive experience breastfeeding, there are options to discuss with your health care team. It's also worth noting that not breastfeeding will not avoid afterbirth pain.
Some women, nursing or not, feel no afterbirth pain – this can also be completely normal. Either way, your post-partum team will check the progress of the shrinking of the uterus, may perform abdominal massage to help and may teach you to do one or both of these things to ensure a healthy and safe recovery. Remember that timely and frequent breastfeeding is not the cause of afterbirth pain, but may help to avoid hemorrhage or related post-partum interventions.