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How to Tell if Postpartum Bleeding Is Normal.
After you give birth, you can expect a heavy discharge of blood, tissue, and bacteria known as “lochia.”
This blood loss is completely natural, and should be on par with a heavy period.
You can be certain that your postpartum bleeding is normal by understanding what to expect, knowing when you should contact a doctor, and recognizing the symptoms of a postpartum hemorrhage (a rare but serious condition).
Understanding What to Expect
Expect to bleed heavily for three to 10 days.
For roughly the first week after you give birth, you will experience a heavy, bright red flow of blood.
During this time, you may also pass several small to medium-sized blood clots.
During this first stage of postpartum bleeding, you will probably saturate a menstrual pad about every three hours.
You may also pass one or two large clots (the size of a quarter), and several more small clots (the size of a grape).
If you have given birth by Caesarean section, you can expect your bleeding to be a bit heavier.
You should begin to notice a slight change in the color of your lochia after two to four days postpartum.
Pay attention to the color of your discharge.
For those first three to 10 days, your lochia will be a deep, bright red (growing a bit lighter after about four days).
After three to 10 days, this should change from red to pink. After another few days, lochia will change to brown, and finally to a yellowish-white.
Anticipate continued bleeding.
Although you should only bleed heavily for around three to 10 days after giving birth, you will continue to have a light to medium flow for several weeks (up to six).
Your bleeding should be slowly tapering off, and becoming lighter in color during this time.
If you are breastfeeding, you may notice a slight increase in bleeding and cramping when you nurse (or immediately after).
Nursing causes the uterus to contract slightly, so this is perfectly normal.
If you have begun taking hormonal birth control, you may continue spotting after six weeks.
Discuss this with your healthcare provider.
Learn about what's happening in your body.
It may ease some of your fears to understand what is happening inside your postpartum body.
After you give birth, the placenta separates from your uterus, and the blood vessels where it was attached are left open, bleeding into your uterus.
After the placenta is delivered, your uterus continues to contract, releasing this blood, as well as any leftover tissue, fluid, and bacteria.
As the uterus contracts it also closes off the bleeding vessels.
In short, during your first six weeks postpartum, your uterus is cleansing itself and restoring normal conditions.
During pregnancy, the amount of blood in your body rises by about 50%, so your body is well-prepared for this postpartum blood loss.
If you experienced a tear during birth or had an episiotomy, you may bleed from this site as well.
Knowing When to Contact a Doctor
Watch for large clots.
Although some small to medium sized clots are normal and expected, contact a healthcare provider if you are passing blood clots larger than a golf ball.
Track your usage of menstrual pads.
One way to keep track of how much you are bleeding is to pay attention to how often you change your pad.
Contact your doctor if you are soaking through one pad (or more) per hour, for three or more consecutive hours.
The use of tampons is discouraged during this time, as using they can introduce bacteria into the vagina.
Your bleeding should be heaviest during the first few days and then begin tapering off.
Contact a doctor if your bleeding does not seem to be tapering off.
Notice the color of your blood
During the first few days after you have given birth, your blood should be very bright red.
After around four days, it should lighten in color.
Speak to your doctor if your blood is still bright red more than four days after delivery.
Pay attention to unusual odors.
If your blood has a foul, rotten odor this could be a sign of postpartum infection.
(Lochia should smell like typical menstrual blood.) Contact your healthcare provider if your blood has a foul odor.
Postpartum infection is usually also associated with severe pain and a fever over 100.4°F (38°C).
Recognizing Postpartum Hemorrhage
Understand that this condition is rare.
Postpartum hemorrhage (PPH) is a rare, but serious condition that affects only 4 – 6% of women after giving birth.
Although PPH is very rare, it remains the number one cause of postpartum death.
As such, it is important for you to recognize the risk factors that make PPH more likely, as well as the symptoms of PPH.
Learn about medical conditions that increase risk.
You are more likely to experience PPH if you have been diagnosed with any medical conditions that affect the uterus, conditions that affect the placenta, or conditions that affect the way your blood clots.
Conditions that affect the uterus include: uterine atony, uterine inversion, and uterine rupture.
Conditions that affect the placenta include: placental abruption, placenta accrete/increta/percreta, and placenta previa.
Conditions that effect the way your blood clots include: von Willebrand disease, disseminated intravascular coagulation (DIC), and you are taking anticoagulants (warfarin, enoxaparin, etc.).
Learn about other risk factors.
A variety of other factors can place you at a heightened risk for PPH.
Keep in mind, none of these conditions indicate that you will experience PPH (again, this condition is rare); they only signal that your risk is slightly increased.
You may be at an increased risk if you experience:
- Long labor (lasting more than 12 hours)
- Emergency c-section
- Pre-eclampsia or high blood pressure
- PPH in a previous delivery
- Uterine infections (endometritis)
Recognize the signs.
PPH is most likely to occur within one day of giving birth; however, it is possible for PPH to occur up to two weeks postpartum.
It is crucial for PPH to be treated immediately, so contact your health care provider if you experience any symptoms.
- Heavy bleeding from the vagina that does not slow down or stop
- Drop in blood pressure or symptoms of shock (blurry vision, chills, clammy skin, very rapid heartbeat, feelings of confusion, extreme dizziness or fainting)
- Pale skin
- Swelling and pain around the vagina and/or perineum