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 Choices, 2015). 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 (University Hospital Southampton NHS Foundation Trust, 2015).
2. Bleeding after birth may last for a while
Bleeding typically lasts around for 24 to 36 days (Fletcher et al, 2012). If your lochia lasts longer that six weeks, don’t worry. That’s normal too (Fletcher et al, 2012).
Bleeding will start off heavy and red to browny red. It will become lighter in colour and flow over time (University Hospital Southampton NHS Foundation Trust, 2015).
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. (University Hospital Southampton NHS Foundation Trust, 2015).
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.
4. If you pass a lot of large blood clots or more than a pint of blood in the first 24 hours, seek treatment
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). Five in 100 women will have primary postpartum haemorrhage after they give birth.
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 massage, an injection or 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
- 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 in at more than 4kg (9lbs)
- Having your first baby when you’re over 40 years old
- Having a raised temperature during labour
- Needing a general anaesthetic.
6. Think about postpartum bleeding when you pack your hospital bag
Pack maternity pads rather than sanitary towels as they’ll 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 and produce more (and redder) lochia blood.
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 usually caused by an infection (RCOG, 2016).
- Pain in your pelvis or lower abdomen that are not after-pains (period-type pains as your womb contracts back into shape).
- 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. (University Hospital Southampton NHS Foundation Trust, 2015; RCOG, 2016)
If you have any of these symptoms you should speak to your GP or health visitor (RCOG, 2016).
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. Avoid touching your stitches or any wound dressings. You should also remove your jewellery and watch before washing your hands, and keep your nails short.
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 March 2018
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Fletcher S, Grotegut CA, James AH. (2012) Lochia patterns among normal women: a systematic review. Journal of Women’s Health. 21(12):1290-1294. Available from: https://www.ncbi.nlm.nih.gov/pubmed/23101487 [Accessed 1st October 2017].
NHS Choices. (2015). Your pregnancy and baby guide. Available from: https://www.nhs.uk/conditions/pregnancy-and-baby/you-after-birth/ [Accessed 1st October 2017].
Royal College of Obstetricians and Gynecologists. (2016) Heavy bleeding after birth (postpartum hemorrhage): Information for you. Available from: https://www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pregnancy/pi-heavy-bleeding-after-birth-postpartum-haemorrhage.pdf [Accessed 1st October 2017].
University Hospital Southampton NHS Foundation Trust. (2015). Patient Information Factsheet: Blood loss – what to expect after the birth of your baby. Available from: http://www.uhs.nhs.uk/Media/Controlleddocuments/Patientinformation/Pregnancyandbirth/Blood-loss-what-to-expect-after-the-birth-of-your-baby-patient-information.pdf