Which condition could increase the severity of afterpains?

• A. Bottle-feeding
• B. Diabetes
• C. Multiple gestation
• D. Primiparity

Answer: (C)

Afterpains come from the uterus contracting after birth to shrink back to its normal size and stop bleeding. The more the uterus has to work to involute, the stronger and more painful the contractions can be. In a pregnancy with multiple gestation, the uterus is significantly stretched by more than one fetus, so it must contract harder and longer to return to its normal size. That increased muscular work leads to more intense cramping and pain in the postpartum period.

Breastfeeding would actually tend to worsen afterpains because it triggers more oxytocin release and stronger contractions; bottle-feeding reduces that stimulation and can lessen the cramping. Diabetes doesn’t inherently make these involution contractions more painful, and primiparity (being a first pregnancy) is usually associated with less uterine distension than a pregnancy with multiples. So the condition that would most increase the severity of afterpains is carrying more than one fetus.