It may be one of the few things you haven’t discussed with friends. Here’s an honest, clear account of what you can expect with bleeding after birth.
1. Every woman bleeds after they give birth
You will have vaginal bleeding after you’ve given birth (NHS, 2021). This bleeding is known as lochia. The lochia is a combination of mucous, tissue and blood that your womb sheds as it replaces its lining after you’ve given birth (UHS NHS Foundation Trust, 2020).
2. Bleeding after birth may last for a while
Bleeding often lasts for around for four to six weeks, but could last up to 12 weeks after your baby's born (RCOG, 2016). If you’re worried, you can talk to a health professional.
Bleeding will start off heavy and red to browny red. It will become lighter in colour and flow over time (NHS, 2021).
Here’s what you can expect:
- Day 1: Fresh red to brownish-red blood. Heavy flow that probably soaks one maternity pad every few hours, with one or two clots or several smaller ones.
- Day 2 to 6: Darker brown or pinkish red blood. Moderate flow with 7 cm to 12 cm stains on your maternity pads and smaller blood clots.
- Day 7 to 10: Darker brown or pinkish red blood, becoming lighter. Variable but lighter flow, with less than a 7 cm stain on your pads.
- Days 11 to 14: Darker brown or pinkish red blood, becoming lighter. Lighter flow, you may have some sanitary towels that are hardly stained.
- Week 3 to 4: Paler, possibly a creamy white blood loss. Lighter flow.
- Week 5 to 6: Brown, pinkish red, or creamy yellow stains, possibly for several weeks, and possibly only on some days (UHS NHS Foundation Trust, 2020).
3. Don’t keep quiet about clots
They’re common. Discuss any clots with your midwife as she’ll want to keep track of what’s happening. Save your maternity pads to show your midwife if possible. Passing a lot of large clots can flag up something more serious (NHS, 2021).
4. If you pass a lot of large blood clots or more than a pint of blood in the first 24 hours, talk to a health professional immediately
Passing lots of large blood clots or more than a pint of blood in the first 24 hours after birth are symptoms of primary postpartum haemorrhage (RCOG, 2016).
Severe postnatal blood loss can make you feel even more exhausted than is normal after giving birth but it can also be life threatening. Getting quick treatment is essential before it becomes a major haemorrhage.
Treatment normally involves helping your uterus to contract through massaging the belly, an injection to contract the uterus, and a catheter into your bladder. The doctors will check to make sure all of the placenta has come out, and may have to do this under general anaesthetic. You will also have a drip in your arm and blood taken for tests.
5. The risk factors for primary postpartum haemorrhage
Before labour, risk factors are:
- Previous postpartum haemorrhages
- A body mass index (BMI) above 35
- A twin or triplet pregnancy
- Low-lying placenta (placenta previa)
- Placenta coming away early (placental abruption)
- Pre-eclampsia or high blood pressure
- Growths in or around the womb (e.g. fibroids)
- Taking blood-thinning medication
- Blood clotting problems.
During labour, risk factors are:
- Caesarean section birth
- Induced labour
- Retained placenta
- Forceps or vacuum-assisted vaginal delivery (ventouse) birth
- Your labour lasted longer than 12 hours
- Having a baby that weighs more than 4kg (9lbs)
- Having your first baby when you’re over 40 years old
- Having a raised temperature during labour
- Having a general anaesthetic.
6. Think about postpartum bleeding when you pack your hospital bag
Pack maternity pads rather than menstrual pads as they’ll be more absorbant and allow the area between the vagina and anus (perineum) to heal with the least irritation. Describing the number of maternity pads you’re using also gives your midwife a clear picture of how much blood loss you’re experiencing.
7. Lots of things can affect the amount of blood loss
Breastfeeding makes your body release oxytocin. This makes your womb contract so it releases the lochia blood more quickly (but it will be the same amount of blood overall).
Any sort of gentle exercise – even a quick vacuum of the lounge – could also make bleeding heavier. This is especially true in the first two weeks.
Bleeding will tend to be heavier in the morning too. This is because blood pools when you lay down sleeping.
8. It’s important to keep an eye on your blood loss in the weeks after giving birth
It’s possible to get secondary postpartum haemorrhage, which is abnormal or heavy bleeding between 24 hours and 12 weeks after giving birth. It’s often associated with an infection, and sometimes with part of the placenta remaining in the womb (RCOG, 2016).
- Feeling shaky, feverish, and generally ill.
- Having lochia with an offensive smell.
- Heavier than expected bleeding, or bleeding that becomes heavier rather than lighter over time. (UHS NHS Foundation Trust, 2015; RCOG, 2016)
If you have any of these symptoms, you should speak to your GP or health visitor immediately (RCOG, 2016). Treatment for an infection includes antibiotics, so remind the health professional if you are breastfeeding so they can select the most appropriate antibiotic.
Severe pain in the womb in the six weeks after birth could be a sign of a serious infection called sepsis, and should be treated with urgency because it can be life-threatening (RCOG, 2012). Other symptoms of sepsis include a high or low temperature, vomiting, diarrhoea, a rash and offensive discharge (RCOG, 2012). If you are experiencing these symptoms, go straight to the emergency department, say that you have recently given birth, and ask if this could be sepsis.
9. It’s important to reduce your risk of infection
Wash your hands thoroughly before and after using the toilet and changing your maternity pad (NICE, 2021).
10. Always speak to your GP or health visitor if anything doesn’t feel right
In the end, trust your judgement. If you have any worries about your bleeding after you give birth, talk to a health professional. They’re there to help.
This page was last reviewed in November 2021
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NHS. (2021). Your body after birth. Available at: https://www.nhs.uk/pregnancy/labour-and-birth/after-the-birth/your-body/ [Accessed 7th November 2021].
NICE. (2021) Postnatal care [NG194]. Available at: https://www.nice.org.uk/guidance/ng194 [Accessed 7th November 2021].
RCOG. (2012) Bacterial sepsis following pregnancy, Green-top guideline No 64b. Available at: https://www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg6…; (Accessed 8th November 2021)
RCOG. (2016) Heavy bleeding after birth (postpartum hemorrhage): Information for you. Available at: https://www.rcog.org.uk/en/patients/patient-leaflets/heavy-bleeding-aft… [Accessed 7th November 2021].
UHS NHS Foundation Trust. (2020). Patient information factsheet: Blood loss – what to expect after the birth of your baby. Available at: https://www.uhs.nhs.uk/Media/UHS-website-2019/Patientinformation/Pregna… [Accessed 7th November 2021].