Postpartum Bleeding: What To Expect After Giving Birth
Bleeding After Delivery
It's natural for most women to bleed for 4–6 weeks after delivery. This postpartum bleeding is known as lochia. It's normal to bleed heavily and pass grape-sized clots for the first 4 days. Over the next few weeks, usually, the blood turns brownish-pink and finally white and no clots are passed. But it's not normal to bleed unusually heavily (soaking a maxi-pad in an hour) or pass multiple golf ball-sized clots at any point in the bleeding period – not even the first 4 days.
Postpartum bleeding or bleeding after giving birth – whether a vaginal or a C-section delivery – is normal. Referred to as “flow” or “lochia,” the period-like bleeding from the vagina is experienced by every woman after having a baby. Unless the bleeding is extremely heavy or prolonged, there is no need to worry. Do note that this is not your first period after childbirth.
Women’s bodies are, in fact, designed to increase overall blood volume (by about 50%) during pregnancy to nourish the baby. Bleeding after delivery is how this extra blood is lost, and it does not depend on the process of birthing – vaginal or cesarean.
Bleeding Up To 6 Weeks After Delivery Is Normal
When you are pregnant, the placenta (a cushion-like mass of blood vessels between the uterus and fetus) supplies oxygen and nutrients to the fetus and removes fetal excreta. When you give birth, this placenta is detached from your uterus, leaving open-ended blood vessels in an extended uterus, thereby resulting in vaginal bleeding. It takes up to 6 weeks for your uterus to contract and close up these blood vessels. Till then, you will experience vaginal bleeding. Some bleeding may also be due to an episiotomy you might have had during vaginal birth. Overall, the bleeding should end within 4–6 weeks.1
A Heavy Flow In The First 4 Days Is Normal
Postpartum blood or lochia contains blood, patches of uterine lining, mucus, and white blood cells. Gradually, the blood content of lochia decreases and it is then mostly composed of mucus, cholesterol, fat, and white blood cells. This is why the color changes from bright red to brownish pink and, finally, white.
The first week after delivery, especially the first 4 days, will be marked by heavy bleeding, which is very similar to the bleeding you experience on the first 2 days of your period. This blood is usually bright red with a few clots. This is known as lochia rubra. You may also experience intense cramps like during period. This is due to the contraction of the uterus. Your cramps may worsen if you’re nursing as oxytocin produced during breastfeeding stimulates uterine contractions. This, however, will help you heal sooner.
For The Next 2 Weeks, A Light But Steady Brownish-Pink Flow Is Normal
Over the next 6–14 days, you will notice that the blood has turned brownish-pink and that there has been a significant reduction in the flow. Blood clots are also fewer and far between, if at all. You may notice slightly increased flow after breastfeeding or after any physical activity. This is known as lochia serosa.
A Yellowish-White Discharge For The Next Few Weeks Is Normal
By the end of the third week, the flow would have reduced to spotting that leaves only about a 3–5 cm stain on your sanitary pad. This phase lasts for about a month, after which the blood turns yellowish-white and almost resembles the usual vaginal discharge. This is known as the lochia alba and it can last for a couple of weeks.
Unusually Heavy Bleeding Even Within Week 1 Of Delivery Isn’t Normal
Although you might experience heavy bleeding during the first week after delivery, if you’re soaking up an entire maxi-pad within an hour, it could be a cause for concern. Your pad should last at least for 3 hours, even if it’s your first week. Here are some ways to determine whether your bleeding’s abnormal.
Risk Factors Of Postpartum Hemorrhage
- A history of postpartum hemorrhage2 or having given many births previously
- A C-section delivery3 or a vacuum-assisted vaginal delivery
- Prolonged labor
- Infection during pregnancy
- Asian or Hispanic background4
- You soak an entire maxi-pad in an hour.
- Your bleeding is heavy even 4 days after childbirth.
- Your blood isn’t fading in color and is become increasing fresher or red, even after a week postpartum.
- The blood has a foul smell or greenish color. Lochia typically smells like menstrual blood. A foul odor that indicates an infection will be stronger and fishier.
- You’re experiencing intense abdominal pain.
- You feel dizzy and unusually tired.
- Your heartbeat is irregular.
- You are feverish.
If you’re bleeding excessively, you might have a postpartum hemorrhage (PPH). PPH may occur in 2 phases:
- Primary PPH occurs within 24 hours of delivery.
- Secondary PPH occurs between 24 hours and 6 weeks postpartum.5
Since about 1–5 in every 100 women experience postpartum hemorrhage,6 to prevent death, it’s important to take precautions if you have any of the risk factors. Foul smell and greenish color in the lochial discharge also indicates an infection.
If You Are Breastfeeding, Fresh Bleeding After 4 Weeks Is Not Normal
Postpartum bleeding usually stops in about 4–6 weeks and the uterus regains its pre-pregnancy state. You may start ovulating again if you are not breastfeeding (prolactin, the milk-producing hormone, inhibits ovulation) and may get your period in about 5 weeks after childbirth. In some, it may start as light spotting and turn darker over the next few days.
Do note that exerting yourself physically within 6 weeks after delivery can also bring about a fresh spurt of bleeding. In which case, you need to take it easy and rest yourself well.
However, if you are breastfeeding and you notice fresh, period-like blood after 4 weeks, it is not normal. If you are breastfeeding your baby, it could take you 6–8 months to get your first period after childbirth.7 In such a scenario, it’s important to seek your doctor’s help.
Passing Multiple Large Clots At Any Time Is Not Normal
It’s common to pass multiple grape-sized clots throughout the day for the first 2 days after childbirth. Blood clots are usually dark red or maroon in color and have a jelly-like appearance. If you pass 1 or 2 clots, which are the size of a small orange, you might want to consult your doctor about it, although it’s not usually serious during the first couple of days.
Don’t panic if you pass grape-sized clots when you stand after sitting or lying down for a long time. Some blood might have collected and coalesced in your vagina. It is absolutely normal.
By the end of the second week, the clots are smaller than a grape and few and far between. By the end of the third or fourth week, there should, ideally, be no more passage of clots.
Passing clots bigger than a grape or passing clots frequently after the first week is not normal. You should have a word with your doctor. And if at any point during the bleeding period, you pass multiple large clots, it’s best to approach your doctor to rule out any other critical conditions.
Don’t Use Tampons For 6 Weeks Postpartum
Up to 6 weeks post-delivery, experts advise against using tampons or menstrual cups. This is because you still have a wound where your placenta met your uterus wall. Also, there might be a few cuts in and around your vagina. To soothe the wounds and let them heal, it’s important that you don’t use tampons. Moreover, tampon usage may encourage uterine and vaginal infections.8
For the first week, use heavy-duty sanitary pads (like the ones you get at the hospital). As your flow tapers off, switch to regular mini pads and finally panty liners. Maintain proper hygiene with regular vaginal washes (you may use warm water) and timely pad changes.
Don’t Exercise Heavily For 6 Weeks After Delivery
Sometimes, heavy exercising may trigger a fresh spurt of vaginal bleeding or bright red spotting, even after your initial heavy flow had tapered to mild spotting.
You can perform light stretches and take short walks. However, it’s wise to avoid high-impact exercises, such as jogging, dancing, or lifting weights when you’re still bleeding. Your uterus needs time to heal and contract.
So, for about 6 weeks post delivery, don’t perform intense exercises or indulge in strenuous activities like swimming.9
Breastfeed Your Baby To Heal Faster
Breastfeeding your little one not only benefits him or her but yourself as well. As mentioned before, breastfeeding triggers oxytocin, which stimulates uterine contractions. To heal, you need the uterus to contract and the blood vessels to close up.
Urinate More Frequently
Childbirth reduces the sensitivity of your urinary bladder. So, even though your bladder may be full, you may not feel the urge to urinate – a potential cause for urinary problems. Remember to urinate often to empty your bladder, even when you don’t feel like it, and avoid further complications.
If you experience discomfort during the bleeding period, take warm tub baths or opt for pain relief medication. Seek help if you continue to bleed even after the 6-week mark. If you notice a change in the color of your blood or if it’s accompanied by severe abdominal pain, immediately consult your doctor.
References [ + ]
|1.||↑||Bleeding after birth guide: What to expect. National Childbirth Trust, UK.|
|2.||↑||Nyfløt, Lill Trine, Irene Sandven, Babill Stray-Pedersen, Silje Pettersen, Iqbal Al-Zirqi, Margit Rosenberg, Anne Flem Jacobsen, and Siri Vangen. “Risk factors for severe postpartum hemorrhage: a case-control study.” BMC pregnancy and childbirth 17, no. 1 (2017): 17.|
|3.||↑||Magann, Everett F., Sharon Evans, Maureen Hutchinson, Robyn Collins, Grainger Lanneau, and John C. Morrison. “Postpartum hemorrhage after cesarean delivery: an analysis of risk factors.” Southern medical journal 98, no. 7 (2005): 681-686.|
|4, 6.||↑||Postpartum Hemorrhage. Health Encyclopedia, University of Rochester Medical Center.|
|5.||↑||Labour and Delivery Care Module: 11. Postpartum Haemorrhage. The Open University.|
|7, 9.||↑||Vaginal delivery – discharge. U.S. National Library of Medicine.|
|8.||↑||How soon can I use tampons after giving birth? Choices, National Health Services.|
Disclaimer: The content is purely informative and educational in nature and should not be construed as medical advice. Please use the content only in consultation with an appropriate certified medical or healthcare professional.