Bleeding after labor

What's Normal, What's Not, Causes, Treatment

Written by Paige Fowler

What's Normal

Your blood will be bright red, and you may see some clots for the first few days after you give birth. They shouldn’t be bigger than a quarter. You’ll have to wear a hospital-grade pad at first. But you should be able to go back to a regular pad later.

You might bleed a little more when you bring your baby home. This may be because you’re moving around a lot. If this happens, try to stay off your feet and rest a little.

It’s also normal to sometimes feel a gush of blood when you stand. This is because of the way your vagina is shaped. The blood collects in a cup-like area while you’re sitting or lying down. When you stand, it comes out.

After about 10 days, you should see less blood. You may have light bleeding or spotting for up to 6 weeks after delivery. You can only use sanitary pads during this time. Tampons could lead to an infection.

When to Call Your Doctor

Heavy bleeding after giving birth is called postpartum hemorrhage. It affects up to 5% of women who give birth. It’s most likely to happen the first 24 hours after delivery. But it can happen anytime within the first 12 weeks after your baby is born.

Postpartum hemorrhage is serious. It can cause a big drop in your blood pressure. If the pressure gets too low, your organs won’t get enough blood. This is shock, and it can cause death. That’s why it’s important to get medical help right away.

Tell your doctor or call 911 if you have any of these symptoms or signs:

Bright red bleeding beyond the third day after birth
Blood clots bigger than a plum
Bleeding that soaks more than one sanitary pad an hour and doesn’t slow down or stop
Blurred vision
Chills
Clammy skin
Rapid heartbeat
Dizziness
Weakness
Nausea
Faint feeling

What Causes It?

Certain things can raise your chance of postpartum hemorrhage. You’re at higher risk if you’ve had it before. For unknown reasons, Asian and Hispanic women are more likely to have it.

The most common cause of postpartum hemorrhage is something called uterine atony. Normally, the uterus squeezes after delivery to stop bleeding where the placenta was. The placenta is an organ that grows in your uterus during pregnancy and nourishes your baby. With uterine atony, the uterus doesn’t contract as well as it should. This can cause heavy bleeding after you give birth.

You may be more likely to have this if you:

Give birth to more than one child at a time (twins, for example)
Have a baby bigger than 8 pounds 13 ounces
Are in labor for a long time
Have given birth several times before

Other conditions can raise your risk for postpartum hemorrhage. These include:

Uterine rupture -- when the uterus tears during labor
Cesarean section -- your risk for postpartum hemorrhage is higher compared with a vaginal delivery
Tears in the vagina or cervix during delivery
General anesthesia -- this may be used if you have a Cesarean section
Oxytocin (Pitocin) -- a medicine that makes you go into labor
Preeclampsia -- high blood pressure and protein in your urine that develops during pregnancy
Obesity
Issues that affect the placenta

How It's Treated

There are many different treatments for postpartum hemorrhage. The cause of your bleeding will help your doctor decide what may be best for you.

They could:

Give you medicine to help your uterus contract
Massage your uterus
Remove pieces of the placenta still in your uterus
Perform a laparotomy -- surgery to open your abdomen to find out the cause of bleeding and stop it
Give you a blood transfusion -- blood is given to you through a tube that goes in a vein to help replace blood you've lost
Perform a hysterectomy -- surgical removal of the uterus
Give you a shot of a special medicine to stop the bleeding
Have a radiologist do what's called a uterine artery embolization, which limits blood flow to your uterus
Use something called a Bakri balloon that's inflated inside your uterus and adds pressure to help slow the bleeding

Bleeding after birth: 10 things you need to know | Life as a parent articles & support

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
Anaemia
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
Episiotomy
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.

(RCOG, 2016)

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).

Symptoms include:

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

Further information

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700.

You might find attending one of our Early Days groups helpful as they give you the opportunity to explore different approaches to important parenting issues with a qualified group leader and other new parents in your area.

Make friends with other parents-to-be and new parents in your local area for support and friendship by seeing what NCT activities are happening nearby.

Complications after childbirth - causes and consequences

Increased discharge
Retention of part of the placenta in the uterine cavity
Changes in the blood coagulation system
Disorder of uterine muscle contraction
Inflammatory process in the vagina or uterus
Vaginal candidiasis (thrush)
Postpartum endometritis
Laktostasis and mastitis
Postpartum pyelonephritis
Venous thrombosis
Discomfort in the area of postoperative sutures
Urinary incontinence, feces, uterine prolapse
Hemorrhoids

After giving birth, a woman often thinks that all worries and anxieties are behind her. But, alas, sometimes the first, happiest days or weeks of the life together of mother and baby can be overshadowed by various complications. In what cases are postpartum changes normal, and when should you see a doctor? nine0031

Labor ends after the third stage of labor, that is, after the birth of the placenta. Following this, the uterus immediately significantly decreases in size, becomes spherical, its cavity is filled with blood clots; the bottom of the uterus at this moment is located approximately in the middle between the womb and the navel. The early postpartum period lasts for 2 hours and during this time the woman is in the maternity ward. Then comes the late postpartum period. This period lasts 6-8 weeks. During this time, there is a reverse development (involution) of all organs and systems that have undergone changes due to pregnancy and childbirth. The exception is the mammary glands, whose function reaches its peak precisely in the postpartum period. The most pronounced involutional changes occur in the genital organs, especially in the uterus. The rate of involutional changes is most pronounced in the first 8-12 days. The uterus and cervix are significantly reduced in size. After the birth of the placenta, a large wound surface remains in the uterus, which takes about 4-6 weeks to heal. During this period, the placental site in the uterus bleeds, spotting - lochia - in the first days is bloody in nature, gradually their color changes from red to reddish-brown, brownish, by the 4th week the discharge almost stops and soon disappear completely. In women who have undergone a cesarean section, everything happens more slowly, because, due to the presence of a suture on the uterus, it contracts worse. Their total amount of spotting during the postpartum period is 500-1500 ml. nine0031

What complications can occur after childbirth

You should consult a gynecologist in the following cases:

Increased amount of discharge

discharge does not stop for a long time, large blood clots appeared. When bleeding occurs, you need to contact an obstetrician-gynecologist, preferably at the maternity hospital where the birth took place. If the bleeding is very heavy (several pads are required within an hour), you do not need to go to the hospital yourself, you need to call an ambulance. nine0031

Retention of part of the placenta in the uterine cavity

The most common cause of late postpartum hemorrhage (that is, those that occur later than 2 hours after birth) is the retention of a part of the placenta in the uterine cavity. The diagnosis in this case is confirmed by ultrasound. To remove the remnants of the placenta, curettage of the walls of the uterus is performed under general intravenous anesthesia with mandatory subsequent antibiotic therapy to prevent infectious complications. nine0031

Changes in the blood coagulation system

In rare cases, the causes of bleeding may be changes in the blood coagulation system of a hereditary or acquired nature, blood diseases. In these cases, complex drug therapy is required.

Violation of contraction of the muscles of the uterus

Development of bleeding associated with impaired contraction of the muscles of the uterus is possible. This is the so-called hypotonic bleeding. In the subsequent period, the hypotonic state of the uterus can be caused by its overstretching due to polyhydramnios, multiple pregnancies, large fetuses, and underdevelopment of the uterus. A decrease in the contractility of the uterus is also caused by changes in its very wall (fibroids, the consequences of inflammatory processes, frequent abortions). These bleeding most often occur in the first hours after childbirth and require active treatment with medications, and in severe cases, surgery. nine0053 A sharp, unexpected cessation of spotting should also alert the woman and requires urgent medical attention. In this case, the outflow of blood from the uterus may be disturbed, that is, lochia accumulate in the cavity and the so-called lochiometer develops. Blood clots are a good breeding ground for bacteria, so if the lochiometer is not treated in time, bacteria enter the uterine cavity and endometritis develops - inflammation of the uterine mucosa. After a caesarean section, a lochiometer occurs more often than after a vaginal birth. Treatment consists in prescribing drugs that reduce the uterus, while using antispasmodics to relax the cervix and restore the outflow of lochia. In some cases, it is necessary to resort to vacuum aspiration of the contents of the uterus under general intravenous anesthesia and mandatory follow-up antibiotic therapy. nine0031

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Ultrasound of the pelvic organs

Inflammatory process in the vagina or uterus

The discharge has acquired an unpleasant odor. This may indicate the development of an inflammatory process in the vagina or in the uterus. In the postpartum period, there was a significant increase in the composition of most groups of bacteria, including bacteroids, Escherichia coli, streptococci, staphylococci. Potentially, all of these species can be the cause of postpartum infectious diseases. A common problem for women after childbirth is the development of bacterial vaginosis. Bacterial vaginosis is a pathology of the vaginal ecosystem caused by the increased growth of predominantly anaerobic bacteria (that is, those that grow in an oxygen-free environment) that actively proliferate in the postpartum period in the woman's vagina and can be pathogens in postpartum endometritis or suppuration of the sutures of the vagina and cervix. Diagnosis of bacterial vaginosis is based on measuring the acidity of the vagina and detecting in a smear on the flora specific for this disease "key cells" (these are cells of the vaginal mucosa covered with anaerobic bacteria). Treatment of bacterial vaginosis in the postpartum period is carried out with local preparations. nine0031

Vaginal candidiasis (thrush)

The appearance of curdled discharge, itching, burning in the genital area, redness indicates the development of vaginal candidiasis (thrush). The risk of this complication increases with antibiotics. Diagnosis is based on the detection of a large number of yeast-like fungi in a smear on the flora. For treatment, local preparations are used in the form of vaginal suppositories or tablets.

Postpartum endometritis

Purulent discharge, lower abdominal pain, fever. These symptoms may indicate the development of a serious complication - postpartum endometritis (inflammation of the inner lining of the uterus). Most often, endometritis occurs in patients after cesarean section, manual examination of the postpartum uterus, manual separation of the placenta and removal of the placenta (if independent separation of the placenta is difficult due to a violation of the contractile function of the uterus), with a long anhydrous interval (more than 12 hours from the moment of amniotic fluid outflow to the birth of a baby), in women admitted to childbirth with inflammatory diseases of the genital tract (for example, against the background of sexually transmitted infections), in patients with a large number of abortions in the past. The classic form of endometritis occurs on days 1-5. Body temperature rises to 38-39degrees, heart rate increases to 80-100 beats per minute. They note depression of the general condition, chills, dryness and hyperemia of the skin, soreness of the body of the uterus, purulent discharge with a smell. The erased form appears on the 5-7th day, develops sluggishly. The temperature does not exceed 38 degrees, there is no chill. Endometritis after caesarean section always proceeds in a severe form.

An ultrasound examination of the uterus and a complete blood count, which reveal signs of inflammation, help the doctor make a diagnosis. Treatment of endometritis should be started as early as possible. It is carried out in a hospital. Assign bed rest, with acute endometritis cold on the lower abdomen. Postpartum endomeritis is necessarily treated with antibiotics, along with them, agents that reduce the uterus are used. Currently, in many clinics and maternity hospitals, the uterine cavity is washed with cooled solutions of antiseptics. In severe cases, an intravenous infusion of saline solutions is required to improve blood circulation, relieve symptoms of intoxication. nine0031

In case of untimely treatment, there is a very high risk of spreading the inflammatory process to the entire uterus, small pelvis, the development of sepsis (the appearance of infectious agents in the blood), up to the death of the patient.

Laktostasis and mastitis

In the postpartum period, there may be pain in the mammary glands, a feeling of fullness, an increase in body temperature. When these symptoms appear, you should definitely consult a doctor - an obstetrician-gynecologist in a antenatal clinic or a surgeon. nine0031

Possible causes of pain in the mammary glands and the accompanying fever are lactostasis and mastitis.

Laktostasis (stagnation of milk in the gland), due to blockage of the excretory ducts. Most often, this condition develops when the baby is not properly attached to the chest, violation of the feeding regimen. Laktostasis often affects primiparous women. With the stagnation of milk, the mammary gland increases in volume, its dense enlarged lobules are determined. Body temperature can rise to 38-40 degrees. There is no redness of the skin and swelling of the gland tissue, which usually appear with inflammation. After decanting the mammary gland with lactostasis, the pain disappears, painless lobules with clear contours are small in size, and the body temperature decreases. If lactostasis is not eliminated within 3-4 days, mastitis (inflammation of the mammary gland) occurs, since when milk stagnates, the number of microbial cells in the milk ducts increases dramatically, milk is a good breeding ground for various bacteria, which contributes to the rapid progression of inflammation. With the development of mastitis, the body temperature constantly remains high, accompanied by chills. Symptoms of intoxication appear (general weakness, fatigue, headache). The patient is disturbed first by a feeling of heaviness, and then by pain in the mammary gland, which is accompanied by stagnation of milk. The mammary gland increases in volume, areas of redness are noted on the skin. Pumping milk is painful and does not bring relief, after pumping, dense painful areas remain, and a high body temperature persists. In severe cases, pus impurities can be determined in milk. nine0031

To eliminate lactostasis, pumping, local anti-inflammatory ointments, and physiotherapy are used. Mastitis is treated with antibiotics. In some cases, lactation suppression and surgical treatment are required.

Postpartum pyelonephritis

Fever, pain in the back or side, painful urination. These symptoms may indicate the development of postpartum pyelonephritis, that is, inflammation of the kidneys. Critical periods for the development of postpartum pyelonephritis, doctors consider 4-6 and 12-14 days of the postpartum period. The development of the disease is associated with infection in the urinary tract from the genital tract. Most often, the disease develops in puerperas, in the urine of which a small amount of bacteria was found during pregnancy. An ultrasound examination of the kidneys and bladder and a urine test help the doctor make the diagnosis. nine0031

Treatment of pyelonephritis is mandatory with antibiotics.

Venous thrombosis

Pain in the legs, swelling, redness on the legs along the vein, increased pain when walking - these are symptoms of a serious pathology - venous thrombosis (formation of blood clots in the veins) and require an urgent visit to a surgeon or phlebologist. The most dangerous periods for the occurrence of thrombosis are considered 5-6 days after childbirth or cesarean section, less often thrombosis occurs 2-3 weeks after childbirth. The causes of thrombosis are changes in the blood coagulation system that occur during pregnancy and after childbirth. Physiologically, in the postpartum period, the activation of the coagulation system occurs. As the body tries to stop bleeding. At the same time, the tone of the vessels of the small pelvis and lower extremities is reduced, the veins have not yet had time to adapt to work in new conditions. These conditions trigger the mechanisms of thrombus formation. An important role in the development of postpartum venous thrombosis is also played by the hormonal background, which changes dramatically after the end of pregnancy. nine0031

The risk of developing venous thrombosis is especially high in women with various pathologies of the blood coagulation system, which are detected even before pregnancy or during childbearing. There is a high probability of thromboembolic complications and in the presence of diseases of the cardiovascular system, overweight. The risk of thrombosis also increases in women in the age group after 40 years, in the presence of varicose veins of the lower extremities. The risk of thrombus formation is increased in women who have undergone a caesarean section. An ultrasound examination of the veins, with Dopplerography, that is, an assessment of blood flow in the vessels, helps the doctor in making a diagnosis. For the treatment of venous thrombosis, medications are used, wearing compression stockings. nine0031

A severe complication of venous thrombosis is the detachment of part of the thrombus and its movement along the vascular bed. In this case, blood clots, entering the vessels of the lung or brain, cause strokes (impaired cerebral circulation) or pulmonary embolism (blockage of the pulmonary arteries by a thrombus). This serious complication appears as a sharp cough, shortness of breath, pain in the chest, hemoptysis may begin - the appearance of blood streaks in the sputum when coughing. In severe cases, the work of the heart is disrupted and death can occur. nine0031

Unpleasant sensations in the area of postoperative sutures

Discomfort in the area of postoperative sutures after caesarean section or in the area of sutures on the perineum. Normally, after suturing vaginal tears, there may be slight pain for 1-2 days, but they quickly pass. Pain in the postoperative wound after cesarean section may be disturbing for 2 weeks, gradually decreasing. Feeling of heaviness, fullness, pain in the area of the postoperative wound may indicate the accumulation of hematoma (blood) in the area of the sutures. This usually happens in the first three days after childbirth and requires surgical treatment - removal of accumulated blood. Pain, burning, bleeding of the sutures, the appearance of discharge with an unpleasant odor, swelling in the area of the sutures, an increase in body temperature indicates the attachment of an infection and suppuration of the sutures. In these cases, you should also consult a doctor to treat the wound and decide on a further method of treatment. nine0031

Urinary incontinence, feces, uterine prolapse

Violation of the physiological functions of the pelvic organs of varying degrees (bladder, rectum), which may appear as in the postpartum period - urinary incontinence, feces, uterine prolapse. The problem of genital prolapse occurs when the pelvic floor muscles have lost the ability to contract so much that individual organs or their parts do not fall into the projection of the supporting apparatus. The most common cause of pelvic organ prolapse is trauma to the pelvic floor muscles during childbirth. nine0031

Hemorrhoids

Quite often, after childbirth, women are worried about the appearance of hemorrhoids - varicose veins of the rectum. The predisposing factor in this case is a significant increase in intra-abdominal pressure during pregnancy and during childbirth. In the case of hemorrhoids, formations appear in the anus, which can be painless, but most often - painful, bleeding and itchy. The appearance of intense pain in the anus, bloody discharge from the rectum are a reason to consult a doctor - a proctologist. Most often, uncomplicated forms of hemorrhoids are treated with local medications - creams and suppositories, in case of complications (nodule pinching, bleeding), surgical treatment is required. nine0031

In any case, if you experience any symptoms that cause concern, it is advisable to consult a doctor, because any complication is best prevented or treated at the very initial stage.

Blödningar efter förlossningen – postpartum haemorrhage

Blödningar efter förlossningen - ryska

There is always bleeding from the vagina after childbirth. Bleeding wound surface in the uterus. A wound occurs when the placenta separates from the walls of the uterus. In case of complications associated with postpartum discharge, it may be necessary to seek medical attention. nine0031

Du kan läsa texten på svenska här.

The blood that flows after childbirth is called postpartum discharge.

Bleeding after childbirth

The first few days after childbirth, bleeding resembles heavy menstruation.

Bleeding may increase during physical activity,

or if you lie still and then stand up. In the latter case, blood may come out in clots.

There will be less and less blood

Bleeding decreases over time. After a while, the blood turns brown, and then becomes light brown.

Bleeding stops after about six to eight weeks.

What can you do yourself?

When bleeding, follow these guidelines:

Shower instead of bath.
Do not use hygiene products that are inserted into the vagina, such as tampons or a menstrual cup. nine0004
Use a condom when having vaginal intercourse.