After your baby is born, one event you might not look forward to is the return of your menstrual periods. Resumption of menstrual cycles depends on changes in hormones that occur after your baby is born, so the fact that you had a cesarean section (C-section) instead of a vaginal delivery won't affect when your periods return. But having a cesarean may cause your first periods to appear heavier. And whether you deliver vaginally or by C-section, your first few periods will often differ in various ways, including length or amount, from your usual periods.
When Menstruation Returns
After both cesarean and vaginal delivery, your levels of certain hormones will drop, including estrogen, progesterone and human chorionic gonadotropin (hCG). But one hormone -- prolactin -- is needed to produce breast milk, so it decreases only if you don't breastfeed. High levels of prolactin also prevent ovulation. Since periods usually return about 2 weeks after ovulation resumes, breastfeeding usually delays the resumption of periods.
With bottle-feeding, periods generally return 5 to 12 weeks after delivery, according to Dr. Pahl at Baby Centre. If you breastfeed exclusively, the persistently high prolactin levels delay ovulation, although ovulation usually resumes by about 6 months in most women, according to the textbook "Maternal-Child Nursing." But the effects of breastfeeding only apply if you are exclusively breastfeeding. In fact, if your baby sleeps through the night, the nighttime break in breastfeeding may cause your periods to return as early as 3 months, notes Dr. Pahl.
Whether you deliver vaginally or by C-section, you will experience a bloody vaginal discharge called lochia for 4 to 6 weeks after delivery. This becomes lighter in color and less copious over time and should not be confused with a period. Lochia tends to be less after a C-section than after a vaginal delivery, according to the Cleveland Clinic. Some women who have had a cesarean delivery may note heavier periods at first because of the incision made in their uterus.
When your periods resume after any delivery -- whether vaginal or C-section -- they are likely to differ initially in length, color, regularity, odor or amount from your periods before pregnancy. Over time, they will usually return to normal.
If you don’t ovulate, you can’t become pregnant. Because of this, if you are exclusively breastfeeding, you have a small -- less than 1 in 100 -- chance of getting pregnant, according to the Association of Reproductive Health Professionals. But breastfeeding is not a foolproof method of birth control, so once your doctor says its okay to resume sex, use contraceptives if you aren't ready for another baby.
Although your initial periods can differ from your usual periods, they will usually return to normal after a few months. In some women, they remain changed -- sometimes worse, sometimes better -- according to the Cleveland Clinic, but check with your doctor if they are not back to normal in a few months to make sure there is no underlying problem.
Reviewed and revised by Mary D. Daley, M.D.