Supporting you to become the parent you want to be
Site search

NCT Information Sheet: Blood loss after birth

NCT Information Sheet: Blood loss after birth

Blood loss after birth

Women vary in how they recover from pregnancy and labour, so it is difficult to tell you precisely how your body will recover. However, this sheet draws on recent surveys to provide you with information about what is normal for the amount and colour of your blood loss for the first six weeks after the birth (this is usually about the time when you make an appointment at your GP’s surgery for your postnatal check). Information is also included about the return of your periods and where your vaginal loss might be a cause for concern in the weeks after the birth.If you are concerned about the colour or amount of your loss at any time after the birth, you can contact your midwife, health visitor or GP. There is more information on the most common problems later in the sheet.

About blood loss after birth

It is normal for women who have given birth to lose some blood from their womb (uterus) until its lining is renewed. This blood loss, or lochia to give it its medical name, can last from anything between two and six weeks and usually varies in colour over that time. It tends to go from bright red to brownish pink to pale pink but will be different for each woman. Vaginal blood loss has a very slight smell – a sort of irony (metallic), heavy smell. It is not a ‘bad’ or offensive smell, but in the first two or three days after the birth you may notice this. It is quite normal. Some women continue to have a small loss for several weeks; the colour tends to stay the same for them – either a browny-red or pinky-red and it should only be a light stain on a pad. If you have a loss that is brighter red again, it could be your periods re-starting but if you are worried, contact your GP or health visitor.

Factors which may affect blood loss after birth

Breastfeeding

 If you are breastfeeding, the increased hormones act on your womb and make it contract and you might feel these contractions as afterpains. The contractions might also be painless and then the only sign of this might be a slight increase in the amount of your blood loss or a return to a red colour of your loss during or just after a feed.

Going to the loo

If you have stinging, or difficulty, passing urine or you become constipated and have to strain or push to have any success, this might affect the colour or amount of your blood loss at that time and make it slightly heavier or a more red colour. You might also pass small blood clots (the size of your little fingernail) or experience pain or cramp in your pelvis if you are constipated or if you have problems passing urine or where you might have a urine infection.

Exercising

As you begin to do more, especially in the first two weeks after the birth – such as doing the shopping, pushing the buggy or just going up and down stairs more often – you might have a heavier loss. Although it may be heavier in amount, the colour should still be the same – either a browny or pinky red, rather than a bright red colour.

Which kind of third stage you had

Although there is a lack of robust research on this question, anecdotal reports from some women and midwives indicate that there may be a difference in your blood loss after birth depending on whether your third stage of labour was physiological (natural) or active (managed). The most common suggestion is that blood loss after birth clears up more quickly after a physiological third stage than an active one, where it can continue at a low level for some weeks. However, a number of factors are involved and in the absence of further research it may be premature to draw firm conclusions about this issue.

Worried you may have a problem?

The information in the following paragraphs and the table describes what is a normal amount or colour of blood loss as you would see it on a standard absorbent sanitary pad. If this is your first baby and you have previously used tampons, seeing the blood loss stain in this way might be more of a worry as you may not know what to expect. Some problems may suggest that your body is not recovering in a straightforward way and the most common of these are described below. If you feel that you have any of these problems, contact your midwife, GP or health visitor and get advice. Everything may turn out to be normal, but if you are worried it is better to contact a health professional earlier rather than later. There are a number of different reasons why your body may be prevented from recovering straightforwardly and a range of possible factors that might cause this. Sometimes, for example, a small piece of the placenta can get left inside the womb – a situation which might mean you will need to be admitted to hospital for treatment, something which can come as a bit of a shock in the first few weeks after the birth.

You have passed blood clots

 For the first two to three days after the birth, some women pass clots which can be quite large (the size of a small orange) or several smaller ones (less than 10p size) and have no further problems. Some women also pass some very small clots (the size of your little fingernail or less) once or twice in the first 10 days and again this does not lead to any further problems. However, if you pass any large clots after the first few days (as big as a small orange) or you continue to pass clots or have a much heavier blood loss than you had before, then it is important to contact a midwife or your GP straightaway. If you are concerned about your loss and you are at home, keep any heavily stained pads or any clots you may have passed and show them to your midwife or GP.

You think your blood loss is too heavy

From about a week after the birth, your blood loss should generally be getting less although the amount may be variable for several days initially. If the loss gets heavier than it had been at first and continues as a heavy or moderate loss for longer than a week, you should tell your midwife or GP. Again it is helpful to keep your sanitary pads to show the midwife or GP.

You think your blood loss is smelly

You are aware that the loss smells even if you have just changed a pad or it is not long since your last bath or shower. The loss might also have changed in colour from what has become normal for you. One of the reasons for this might be an infection; this could be in the uterus, or in and around the vagina if you had any tears or cuts, and so you should let your midwife or GP know as soon as possible.

You have pain in your lower stomach or pelvis

If you have pains which you do not think are afterpains or caused by constipation, this could be an infection in the womb or possibly a urinary infection – you should contact your midwife or GP as soon as possible if you think this might be the reason.

You feel shivery and unwell, have abdominal pains and a loss that is different – heavier or much less, or smelly

This is a combination of the other problems above; you may have an infection in the womb and you should contact your GP straightaway.

Table:

The first day after the birth

Normal ranges of colour of vaginal blood loss: A fresh red or browny red blood loss

Normal ranges for the amount of vaginal blood loss: Quite a heavy loss, soaking a maternity pad every few hours. You may pass one or two quite large clots (the size of a small orange) or a number of smaller ones (about the size of a grape). This is not unusual – but it is a good idea to show them to your midwife 

Days 2-6 after the birth

Normal ranges of colour of vaginal blood loss: The loss should go a darker red or a browny or pinky red.

Normal ranges for the amount of vaginal blood loss: You might still pass a few clots but these should be small (less than the size of a grape). At first a moderate amount which makes a 3-5inch (7-12cm) stain on the pad. The loss should then get less towards day 6 (a 2 inch/5cm stain) 

Day 7-10 after the birth

Normal ranges of colour of vaginal blood loss: Staying the same colour or getting a lighter shade of the browny or pinky-red.

Normal ranges for the amount of vaginal blood loss: If you are breastfeeding, you might have a small fresh loss at the end of a feed. For most of the time, less than a three inch stain (7cm) on the pad, and not soaked at any time. Getting less generally although still variable. Your loss might be heavier with activity 

Days 11-14 after the birth

Normal ranges of colour of vaginal blood loss: Staying the same colour or getting lighter. If you are beginning to be more active, the colour might be more pinky-red than before.

Normal ranges for the amount of vaginal blood loss: The amount will still be lessening and you may have some pads which are hardly stained; again, increased activity might increase the amount 

3rd and 4th weeks after the birth

Normal ranges of colour of vaginal blood loss: If loss still present, a browny-pinky colour or paler, possibly a creamy white colour sometimes.

Normal ranges for the amount of vaginal blood loss: Continuing to get less with longer periods of very little or no loss at all. If the loss stopped by the 2nd or 3rd week and then you have a red loss again, this might be your first period if you are not breastfeeding 

At about 6 weeks after the birth

Normal ranges of colour of vaginal blood loss: Continuing along the same colour pattern as before, more likely to be a small or occasional loss of browny or pinky-red or a creamy yellow colour.

Normal ranges for the amount of vaginal blood loss: You may still have a blood loss, either all the time or some days only. If you are concerned, ask for advice when you have postnatal check at 6 weeks 

Further information

Further healthcare information related to this topic can be found by visiting the MIDIRS website for consumers at www.choicesforbirth.org, or the MIDIRS website for healthcare professionals at www.infochoice.org. Alternatively call 0800 581009 or email sales@midirs.org 

Acknowledgments

The information in this sheet is the result of a research project called The BliPP Study (Blood Loss in the Postnatal Period) which was undertaken by researchers from the University of Portsmouth and the National Perinatal Epidemiology Unit, Oxford. This project was funded by a grant from the South & West NHS Executive Research and Development Committee. The NCT would like to thank Dr. Sally Marchant PhD, RM, RN, Dip Ed. for the use of the information in the sheet.

If you would like further copies of this information sheet (Code 1717), click here; other sheets in the series can be obtained from NCT Shop at www.nctshop.co.uk or on 0845 8100 100