Postpartum bleeding: What is too much and how do I handle it?

Postpartum bleeding (lochia) is normal. Here are some reasons why you may be bleeding after delivery, what to do about it and when to call your healthcare provider.

how-much-bleeding-is-normal-postpartum

Postpartum bleeding (also called lochia) isn't any woman's favorite postpartum symptom, but it's very much a normal part of postpartum recovery.

During pregnancy, your body went through many changes to grow this baby. Now that the baby is here, your body needs to heal. Your body's natural healing process after birth will involve some vaginal bleeding or spotting—how much postpartum bleeding you experience will depend on your individual body and your birth experience. It's also normal for postpartum bleeding to be especially heavy or noticeable in the days right after birth.

But just because it's "normal" doesn't mean we automatically know what to do about it! So let's explore postpartum bleeding—why it happens, and what to do about it.

Here are some reasons why you may be bleeding postpartum, what to do about it, and when to call your health care provider.

Why am I bleeding postpartum?

Postpartum bleeding is called lochia and happens whether you have a vaginal or Cesarean birth. Bleeding may last up to six weeks after labor and delivery.

The bleeding and discharge occur for a few reasons. The blood remaining in your uterus from birth and remnants of the pregnancy need to be expelled after the baby is born. Your uterus is also healing the site where your placenta was attached. It's much like a wound that needs time to get better.

If you are at all concerned about how much you are bleeding, let your team know right away. This warrants a 2 am call to your midwife or doctor.

How much postpartum bleeding is normal

Lochia changes as time passes.

For the first three to five days, postpartum bleeding will feel (and look) like a moderately to heavy period. The blood will be red or dark red with a moderate flow (called lochia rubra). You may see a few small pieces of the amniotic sac, vernix (the white waxy substance that covered your baby in the womb) or lanugo (your baby's downy body hair) in those first days.

You may also have some blood clots, which can be normal. Blood clots form when blood is stagnant, or not moving. So, if you sleep for a period of time and then stand up, you may see or feel a clot or two come out. You may also have a gush of blood when you stand up because the blood has been pooling in your vagina while you were lying down.

By the end of the first week, the lochia rubra will transition into lochia serosa, which consists of a lighter flow and lighter color. It's usually light red or brownish-red instead of deep red. Lochia serosa lasts about two weeks, though this can vary—for some women this type of postpartum bleeding will last for just 10 days, while others may experience it for up to four weeks.

After lochia serosa comes lochia alba. This is more like vaginal discharge than bleeding. It is yellowish-white in color and may last until around week six postpartum.

Will I have postpartum bleeding after a Cesarean section?

Many women are surprised to learn that they will still have vaginal bleeding after a Cesarean section, even if they did not experience any contractions. The blood comes from your uterus, which is healing where the placenta detached, recovering from surgery and healing from all those months of pregnancy.

So, your postpartum bleeding after a Cesarean birth will be much like the bleeding after a vaginal birth.

Can I use a tampon for postpartum bleeding?

For the first months of postpartum, either pads or disposable or washable absorbent underwear are the best ways to manage postpartum bleeding. Tampons are not recommended. If you had a vaginal birth, your vagina is sensitive and healing, and tampons will impact that process. With either type of delivery, tampons can increase the risk of toxic shock syndrome.

When should I call my doctor or midwife about postpartum bleeding?

It is possible to bleed too much—this is called a postpartum hemorrhage, and it requires immediate medical treatment. While most postpartum hemorrhages happen right after birth, they can happen days or even weeks later, so it is important to pay close attention to how much you are bleeding.

Signs of too much postpartum bleeding include:

  • A sudden increase in bleeding or sudden return to bright-red bleeding when it's been brown or pink
  • Filling a pad with blood within one to two hours
  • Multiple blood clots, or one clot that is the size of a golf ball or larger

Other concerning signs to report right away include:

  • Chills
  • Foul-smelling vaginal discharge
  • Blurred vision
  • Dizziness, light-headedness or weakness
  • Fast heartbeat or rapid breathing
  • Clammy skin
  • Confusion
  • Nausea or vomiting
  • Swelling in the vaginal area
  • Fever

Our intention is to never worry you too much, mama, but when it comes to postpartum bleeding, we drop our guard on that a bit. It is essential to be aware of the risk if you have a problem because it's likely that you are going to be the one to identify it first, not your medical team. This is a vital area to practice your self-advocacy.

If you have any concerns, call your provider, go to the emergency room or call 911 right away.

What are some ways to optimize postpartum healing and recovery?

Over the course of six to eight weeks, you will start to feel a lot better—though full recovery from birth takes about a year!

Here are a few tips to help you feel better and heal:

  • Sitz bath: This is a plastic basin that goes on your toilet. It is filled with water and acts like a whirlpool for your bottom. Several times per day for about 20 minutes, sit with your bottom immersed in the sitz bath. Use room temperature or warm water (not hot). You can also mix in two tablespoons of witch hazel and a few drops of lavender essential oil. If you decide to use your bathtub, make sure that it is cleaned and disinfected so your perineum doesn't become infected.
  • Padsicles: Take a regular menstrual pad and line it with witch hazel (either poured from a bottle or presoaked towelettes). You can then add a tablespoon of aloe vera and a few drops of lavender essential oils if that's your preference. Place the pad in your underwear, or if you don't need it right away, wrap it up and put it in the freezer until you do.
  • Pee frequently. When your bladder is full, it can push the uterus off to one side, which impacts the uterus's ability to heal and shrink. Stay hydrated and empty your bladder about every two hours while awake to prevent this from happening.
  • Rinse, don't wipe. When you go to the bathroom, avoid wiping yourself clean when you can. We love products like the Frida Peri Bottle to rinse away urine and blood.

Mama, you went through the Herculean tasks of pregnancy and birth, be patient with your body. It will take time for you to get used to the changes your body goes through after delivery.

By giving yourself a chance to adjust, you are allowing your body to heal properly. If you still don't feel comfortable after some time, whether physically or emotionally, reach out to your doctor for advice on how to navigate it.

Here are some of our favorite products for making your postpartum recovery easier, so you can spend more time cuddling and less time worrying!

'The Motherly Guide to Becoming Mama'

motherly guide to becoming mama

Community inspired and expert-driven, The Motherly Guide to Becoming Mama is the essential guide to pregnancy, birth and the fourth trimester.

$20

C-section recovery briefs

c section recovery underwear

When you're recovering from a Cesarean birth, underwear that doesn't irritate your incision is key. These high-waisted beauties from Belly Bandit are perfect. You deserve to be comfortable, mama.

$35

Peri bottle

Next Nine Months peri bottle

The Next Nine Months peri bottle is a total game-changer. Think of it as a portable bidet. Its angled neck makes cleaning and soothing your sore vaginal area easy and comfortable.

$14

Absorbent maternity underwear

Black maternity underwear with scalloped edges

For environmentally-friendly postpartum support, we love Proof absorbent underwear. The leak-proof and antimicrobial technology will make your life so much easier. Just make sure to change and wash them regularly to keep your nethers as healthy as possible.

$25


A portion of this article has been excerpted from The Motherly Guide to Becoming Mama.

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