Heavy Bleeding After Birth: What’s Normal and What’s Not?

Welcoming a new bundle of joy to the world can be an awe-inspiring experience. As you’re enjoying your new addition to your family, you may have noticed some less expected changes to your body, such as heavy vaginal bleeding after childbirth. All new moms experience heavy bleeding after birth (also known as lochia). But when is it too much? When should you worry and when is it no big deal?

Use this guide to understand everything you need to know about postpartum bleeding and lochia.

What is Lochia?

Here’s the deal. Heavy bleeding after giving birth is your body’s way of flushing excess tissue and blood from your uterus that supported your pregnancy but are no longer needed. The combination of blood and fluid shed after childbirth is called lochia. It is normal. Some of your lochia will also be comprised of fresh blood from the wound created when your placenta detached from your uterus during labor.

Lochia is made up of a number of things, including:

• Placental tissue that got left behind
• Thickened endometrium no longer needed post-pregnancy
• Blood from the wound site where the placenta detached from the uterine wall
• Cervical mucous

You'll go through a few stages of postpartum bleeding after delivery. Check out this article to learn what to expect during the three stages of postpartum bleeding.

What is Normal Postpartum Bleeding?

In the first 1 to 3 days after birth, your lochia will be bright red and heavy. This is not a sign of excessive postpartum bleeding and is nothing to worry about. After a few days, your lochia will lighten up, becoming watery and pinkish in color. Within a week or so, it will lessen and become a yellowish-whitish discharge with occasional spotting. This can last up to 12 weeks post-partum but will likely go away within 3 to 6 weeks.

You may even soak through a regular menstrual pad every few hours. This is expected in the first few days after birth.

What to Do About Normal Postpartum Bleeding

There are a number of steps you can take to prompt your uterus to contract more rapidly, thereby reducing normal postpartum bleeding, which can include:

• Having a caregiver massage your uterus
• Breastfeeding
• Peeing as often as you can
• Resting and letting your body heal

Your lochia will be heavier the more active you are. So, try to take it easy as much as you can in order to let your body heal.

Products to Manage Postpartum Bleeding: It may be a good idea to use absorbent panties such as Always Discreet underpants instead of a pad that needs to be changed so often. Use this guide to learn how to choose postpartum underwear.

Do not use tampons to manage vaginal bleeding after childbirth. Doctors typically recommend waiting six weeks before inserting anything in the vagina, as it can cause trauma to the very sensitive tissue and could lead to infections. Talk to your doctor about when it is okay to use tampons to manage blood flow.

What is Not Considered "Normal" Postpartum Bleeding?

If you are soaking through a menstrual pad in an hour or less, it may be a sign of abnormal or excessive bleeding after birth and you should call your doctor right away. Another sign of excessive postpartum bleeding is passing blood clots larger than a plum. Keep an eye out and talk to your doctor if you’re concerned.

What Are the Signs of Hemorrhaging After Birth?

Excessive bleeding after childbirth can be a sign of postpartum hemorrhage, a very serious condition. The highest risk period for hemorrhaging after birth is within 24 hours of delivery. This type of severe postnatal blood loss is known as primary postpartum hemorrhage, and it affects 5 out of every 100 women post-child delivery. However, although much more rare, postpartum hemorrhage can occur anywhere within 12 weeks from you giving birth. This is called secondary postpartum hemorrhage.

The most common cause of postpartum hemorrhage is something called uterine atony. Typically, after labor your uterus contracts to stop the bleeding at the site where the placenta was attached during pregnancy. Uterine atony means your uterus doesn’t contract as strongly as it should. Although it is quite rare, there are a number of risk factors both before and during labor for primary postpartum hemorrhage.

Before labor, the risk factors include:

• Previous postpartum hemorrhage
• Obesity
• Giving birth to multiples
• Placenta previa (a low-sitting placenta)
• Placental abruption (when the placenta pulls away too early)
• Pre-eclampsia or high blood pressure
• Anemia

During labor, the risk factors include:

• Caesarean section birth
• Induced labor
• Retained placenta
• Episiotomy
• Uterine rupture
• Forceps or vacuum-assisted vaginal delivery
• Labor that 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

What to Do About Excessive Bleeding After Birth

While only 1 to 5 percent of women develop excessive bleeding after the baby is born, it is important to know what to look out for. If you bleed profusely, your organs will not receive enough blood. This is known as shock, and it can be fatal.

Call an ambulance immediately and head to the emergency room if you are experiencing symptoms of shock. These include

• Bright red bleeding beyond the third day after birth
• Large clots (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

Once you are in the hands of trained medical professionals, it’s good to know what types of treatment might be offered. Treatment options for postpartum hemorrhage can include blood transfusion, an injection of medication designed to stop the bleeding, hysterectomy or removal of the uterus, or a surgery to identify the source of the bleeding and stop it, called a laparotomy.