Postpartum Bleeding: What You Should Know
Vaginal bleeding, or lochia, occurs as the uterus sheds blood, tissue, cells, and lining from pregnancy after the baby is born. Getting rid of what the body no longer needs isn’t always comfortable, but it’s critical. “Oftentimes during pregnancy, the focus is on the actual delivery, and then skips right ahead to focus on the baby and breastfeeding, so the bleeding part of the postpartum process gets less attention,” says obstetrician and gynecologist Kelsey Kossl. “But lochia happens to everybody after they have a baby—it’s a normal part of the healing process.”
What Is Happening
“For the first few days after delivery, the lochia contains a significant amount of blood so it will appear dark red” says Kossl. “It’s normal to pass clots during those first few days- sometimes as large as a plum. Women may notice passage of clots in the morning or after being sedentary.” After the first few days, the consistency will become more watery, and the color will shift to more pinkish and brown. This phase usually lasts for about the first two weeks. Then lochia will shift again, to a creamier or a pale-colored discharge with some intermittent spotting in between. Lochia can last for about 6-8 weeks” If you had a C-section, you may experience less bleeding after the first 24 hours, and lochia may follow a different timeline, but the color transition will remain the same.
“Postpartum bleeding is not like a woman’s normal period,” says Kossl. “It can be very sporadic—heavy one day, light another day—and more persistent than a normal period.” It’s also natural for postpartum blood to smell stale or musty, but foul-smelling lochia could signal an infection, especially if accompanied by pain. If you think yours falls out of the realm of normal, contact your obstetrician.
What To Do About It
“Stock up on a combination of heavy pads, which will be helpful in the beginning, as well as thinner liners for the long haul, since you may have persistent lochia for up to six weeks,” explains Kossl. (You cannot use tampons during this time, but that’s not a big deal because you almost certainly won’t want to.) Ask for a stash of disposable underwear before you leave the hospital [LINK TO WHAT TO STEAL STORY]—they’re comfortable and will save your own underwear from unpredictable spotting. Kossl also recommends the peri bottle, particularly for women healing from a laceration or hemorrhoids. “It’s a good way to keep the area clean without having to wipe as often.”
Choose a postnatal multivitamin with iron. “Between blood loss during delivery and the potential for prolonged bleeding afterward, there’s a potential risk for becoming a little bit anemic,” says Kossl. “Iron helps your body replenish its blood stores.”
Breastfeeding and Bleeding
Bleeding may increase after feeding or pumping. “The hormones released during breastfeeding cause the uterus to cramp, and that can be a good thing,” says Kossl. “The cramping ultimately expels more of the tissue and blood that is meant to come out of the uterus.” Bleeding can also increase following physical activity. If you are breastfeeding, you may not have a period for several months- it depends on how often a woman breastfeeds as well as other individual variables. If you aren’t breastfeeding, you will likely start having periods again within 6-12 weeks. The first menstrual period may be heavier or longer than usual, may have passage of clots, and subsequent menstrual periods may not be predictably timed as your body resets.
Women who start birth control immediately after childbirth may experience breakthrough bleeding or spotting even after lochia becomes creamier and lighter colored, as the birth control method begins to impact the uterine lining. “There’s a slightly higher risk of developing blood clots in the postpartum period, and we think estrogen has some contribution to blood clots,” explains Kossl. “So obstetricians avoid methods of birth control that contain estrogen for the first four to six weeks after childbirth.” There are many great methods of birth control available though, ranging from oral progesterone-only pills to longer acting progesterone and hormone-free implants. In addition to reviewing your family planning goals, “If a woman was bothered by painful or heavy periods before pregnancy, this is a good time to review those symptoms, as some forms of birth control can treat abnormal bleeding and pain.”
BOX: When to Call a Doctor
“The benefit of talking through the details with your provider is that they know the exact details of your delivery,” Kossl says. “Never feel bad about calling just to review your symptoms with your healthcare provider.”
Postpartum hemorrhaging usually occurs at the time of delivery or within 24 hours, but in rare cases—only 1% of women—a delayed postpartum hemorrhage can occur. If you experience any of the symptoms above, call your doctor immediately.
- Bleeding that saturates one maxi pad or more in less than an hour
- Persistent passage of clots larger than a plum
- Malodorous or foul-smelling lochia, especially if accompanied by pain