Postpartum Bleeding
Lochia and Hemorrhage After Childbirth

Postpartum Bleeding

Contents

• What Is Postpartum Bleeding?
• How Much Bleeding Is Too Much?
• Postpartum Bleeding After 6 Weeks
• Abnormal Bleeding: Postpartum Hemorrhage
• When Periods Return

After childbirth the lining of the uterus is shed over 3 to 6 weeks in the form of vaginal bleeding called lochia. It will start out as a heavy flow, typically within a few hours of birth, which is bright red in color and may contain small clots (about the size of a grape). Gradually the color will change to pink, then brown and finally a creamy yellow as it subsides. One sign that you are overexerting yourself (by exercising too much for example) is a sudden increase in flow. Breastfeeding on the other hand can reduce flow by encouraging uterine contractions. Don't be alarmed if you find you suddenly gush blood when you stand up.

The vagina is shaped like a cup and while you are lying down the blood pools in the cupped area. When you stand up, it may feel like the blood is pouring out. Lochia is a completely normal part of the postpartum period. Every woman who delivers a child, either vaginally or by cesarean section will experience it. It is the way your body expels excess placenta tissue, blood and mucus which is no longer needed. It is similar to a menstrual period but much heavier and may initially be scary. For the first few days you will need to wear a hospital grade pad but as bleeding slows down you will be able to switch to a commercial pad.

Tips For Coping With Lochia

1. Rest as much as you can and avoid excessive walking or standing as this increases blood flow.
2. Use heavy maxi pads to soak up the blood.
3. Avoid tampons for at least 6 weeks postpartum because they can introduce bacteria and infections into the uterus.
4. Avoid penetrative sexual intercourse until blood flow has at least turned pink and any pain has subsided. See our article postpartum sex for more details.

How Much Bleeding Is Too Much?

Lochia is usually heaviest in the hours after delivery. Try not to panic if bleeding seems to worsen when you go home. Simply being up about can increase bleeding. If you soak a pad completely within an hour, go to bed and rest. Typically lochia is not considered a postpartum complication and it will cease when your body has dispelled all the material it needs to. If the bleeding continues at the same rate for several hours however, or if you pass clots larger than the size of golf balls, call your doctor or return to hospital. Other signs that require medical attention are:
• If the blood remains bright red in color for more than 7 days after birth.
• There is a foul smelling discharge.
• You have a fever or chills.

Postpartum Bleeding After 6 Weeks

Usually lochia turns pale pink or brown by the second week after delivery. Don’t be alarmed however if you find bright red bleeding reappears from time to time throughout the first 6 to 8 weeks. Exercise or increased activity can cause red bleeding and a heavier flow to reappear. If bleeding and cramps increase, lie down for a few hours. If it does not slow down when you are off your feet, it is time to call your doctor.

Related Articles
Postpartum checkup: At week 6, what to expect.
Postpartum exercises: Tips and advice on a suitable program.

Abnormal Bleeding: Postpartum Hemorrhage

Postpartum hemorrhaging is a severe type of bleeding after childbirth. If you lose more than 1,000 ml of blood after a c-section or more than 500 ml after a vaginal birth, you are classified as hemorrhaging. Between 1 and 10 percent of all pregnancies in the U.S. result in hemorrhages. It usually begins within 24 hours of childbirth (early postpartum hemorrhage), but it can occur any time within 6 weeks (delayed postpartum hemorrhage). After childbirth the most common cause is failure of the uterus to contract as it should, leading to uncontrolled bleeding from the site where the placenta was attached. Occasionally it can result from unrepaired tears to the vagina or cervix. Delayed hemorrhaging can occur as the result of placenta fragments sticking to the uterus; or due to infection. Both types of hemorrhaging are dangerous and can (rarely) lead to the death of the mother.

Signs Of Postpartum Hemorrhaging
• Bleeding soaks a maxi pad every hour for several hours in a row.
• Bleeding remains bright red in color for more than 7 days after birth.
• Passing large clots of blood - the size of a golf ball or lemon.
• Pain or swelling in the tummy after the first few days of delivery.
• Loss of blood may cause faintness, breathlessness, dizziness or a racing pulse.

Treatment


After delivery the midwife will examine the dispelled placenta to make sure that it is intact and that no part is left inside you. She will probably also give you a drug called Syntocinon (oxytocin) and massage your tummy to encourage uterine contraction to minimize bleeding. Breastfeeding (if you plan to) as soon as possible will also encourage natural contraction. If bleeding does not stop you will need a procedure called dilation and curettage (D&C) to investigate the uterus and remove any bits of placenta which were not dispelled. In rare cases a blood transfusion is necessary. If the uterus is damaged a hysterectomy may be necessary.

Risks
Your risk of developing postpartum hemorrhage is higher in the following instances:
• Twins or multiple birth.
• Polyhydramnios (excessive amniotic fluid).
• Placenta previa.
• Induced labor.
• Giving birth to a large baby.
• Uterine fibroids that prevent symmetrical contraction.
• The mother is weakened due to anemia in pregnancy, preeclampsia or fatigue.
• The mother has taken herbs or drugs that interfere with blood clotting such as ibuprofen, aspirin, large doses of vitamin E or ginkgo biloba.

When Periods Return

If you are not breastfeeding your first period may come within 4 to 8 weeks of delivery - but it can take up to 12 weeks. If you are nursing, your period may come a few weeks later, although many mothers who breastfeed don’t have a period until the baby is weaned or beginning to nurse less. When you get your first period it may be different to previous flows. It can be heavier or last longer than normal. Or it may stop and start and have clots in it, there may also be spotting between bleeds. If you need to change a pad more than every hour, lie down until it subsides. It if doesn't subside within a few hours, call your doctor.

For more postnatal advice, see the following:

• Losing weight after childbirth: Diet and nutrition advice.
• Hair loss after pregnancy: Losing clumps of hair?
• Postpartum emotions: What it is 'normal' to feel.
• Postpartum baby care: Tips for coping with baby's home coming.
• Baby car seats: How to choose one, prices and types.

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