After you’ve given birth, you can expect to experience a myriad of mental and physical changes from bleeding to mood changes. But what exactly do these changes involve? How do you know if they are normal and how do you know when to call your doctor? Dr. Dara Maker, a family physician at Women’s College Hospital in Toronto, advises women to pay attention to the signs—and the warning signs:

Bleeding

What’s normal: It’s normal to have some bleeding, similar to a period, that may last up to three weeks postpartum. The lining of the uterus is shedding, so it’s normal to experience a heavier flow early on, but it should lighten over the next few weeks.

What’s not normal: Contact your doctor if you are soaking through a pad every hour, if you are passing clots greater than the size of a loonie or if you have foul smelling discharge or a fever. It may be an infection or retained placenta.

Vaginal Soreness

What’s normal: Many women have an episiotomy, or small tears, during delivery, so it’s common for the area to be sore and uncomfortable for up to a few weeks. Keep the area clean and use a squirt bottle filled with water after urination or a bowel movement. Some women use an ice pack, especially 24 to 72 hours after delivery, to help bring down the swelling. You can sit on a donut pillow and use stool softener to ease the pain.

What’s not normal: If you’ve taken Tylenol or Advil and you still have substantial pain, or if the pain gets worse, talk to your doctor.

Hemorrhoids

What’s normal: It is very common for women to develop hemorrhoids during pregnancy or during the delivery. Basically, intraabdominal pressure forces veins to swell and stretch around the anal area. You can treat the symptoms of pain, itching and discomfort by taking a warm sitz bath (a shallow bath with warm water) for 10 minutes. Also be sure to drink lots of water and eat a high fibre diet to avoid straining. You can also apply witch hazel, which is soothing, or use an over-thecounter product containing hydrocortisone and zinc oxide.

What’s not normal: For many women, the hemorrhoids will eventually go away, but others will have them long term. Consult with your doctor if you’re bleeding or in a lot of pain. Surgery is a last resort option.

Breast Pain 

What’s normal: After delivery, your breasts will fill with milk and become engorged. Often, it is difficult for newborns to help relieve the engorgement because they can’t yet suck hard enough to empty the breasts. Some babies also have problems latching, which can cause moms to have bleeding or cracked nipples. Both conditions are painful. For engorgement, use Tylenol or Advil. You can also use cool cloths or even cool cabbage leaves to relieve the pain. Try expressing milk by hand or pump and you should see an improvement fairly quickly. If you have cracked or sore nipples, see a lactation consultant or go to a breastfeeding clinic to make sure you are breastfeeding properly. Otherwise, the pain will worsen.

What’s not normal: Call your doctor if your breast is sore, hard and red or if you have a fever. It could be an infection called mastitis and you might need antibiotics.

Mood Changes

What’s normal: 40 to 80 percent of women will develop the baby blues. This is normal. It usually starts during the first postpartum week and can last for two weeks. Rely on the support of your friends and family to get through it.

What’s not normal: Up to 10 percent of women may develop postpartum depression, which can appear anytime within 12 months of delivery. If you have substantial sadness, anxiety or are having trouble caring for your baby or getting things done, see your doctor. Anxiety can be common, but if it interferes with eating and sleeping and you are agitated all the time, take it as a warning sign. It can be treated with a range of therapies including individual therapy, group therapy or medication. Women who have had it before are more likely to get it again.

C-section Scar

What’s normal: Follow your doctor’s direction upon discharge to care for your c-section scar. Once the staples come out, you will likely get steri-strip bandages, which you should leave on for as long as your doctor advises. When you remove them, keep the area clean by gently cleaning with soap and water.

What’s not normal: If your scar is red, oozing or smelling, contact your doctor. You could have a postpartum wound infection that can affect up to10 percent of women and can be treated with antibiotics.

Your body will experience a lot of changes postpartum; many of these are normal, but if you aren’t sure, contact your doctor for advice. Many women will put their own wellbeing on the back burner, but it is important that you look after yourself as much as your baby during this time. After all, you can take better care of your baby if you are well, too.

Dr. Dara Maker has two boys and is a family physician at Women’s College Hospital in Toronto. Originally published in December 2013.