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Post-Pregnancy Bleeding: What’s Normal and What’s Not

Jan 13, 2022 | 3 Minute Read

Hey mama, pregnancy was likely a great reprieve from your monthly menstrual cycle, and you may be shocked to learn just how long bleeding post-birth may continue. Nurses know you’re not sleeping right now; baby needs all your time and attention, but may we gently suggest you also need to take care of yourself during this important time of healing following baby’s birth.

Post-pregnancy bleeding occurs in three distinct phases as what experts identify as: Lochia rubra, serosa, and alba. Each of these are three distinct phases of post-pregnancy bleeding. Understanding what is normal versus not will help you adjust during the post-pregnancy stage, and know when to seek care from your own healthcare provider if something is just not quite right.

Postpartum Bleeding: What is Normal?

Following childbirth, you will have vaginal bleeding and discharge. This is known as lochia. This is how your body gets rid of the extra blood and tissue in your uterus that helped your baby grow during pregnancy.

Following a vaginal birth, it’s normal to lose about half a quart (500 milliliters) of blood. Following a cesarean surgery, losing about 1 quart (1,000 milliliters) of blood is normal.

What is Lochia?

Lochia is considered vaginal bleeding after birth of a baby that includes bloody fluid made up of blood, placental tissue, sloughed off endometrial lining, and mucus. Post-pregnancy bleeding typically lasts 3 to 6 weeks following the birth of your child as your uterus heals and returns to its normal shape and size.

Post-pregnancy bleeding is normal and is how your body expels the extra blood and tissue in your uterus that helped your baby grow. Most of the blood in lochia comes from the area where the placenta detached itself from the uterine wall during the birth of your child. This area leaves a wound that needs to heal—the endometrial lining that built up during pregnancy sloughs off post-pregnancy and contributes to lochia.

Phases of Lochia

Lochia Rubra: This is the first phase of post-pregnancy bleeding. It lasts 3-4 days following the birth of your child/children. The color is bright or dark red. It’s normal to see clots in your lochia during this phase. Normal size clots are smaller than a quarter or a small plum. You may have some pelvic cramping as your uterus contracts to return to its usual size.

Lochia Serosa: This is the second phase of post-pregnancy bleeding and typically lasts two weeks post-childbirth, during days 4-10 postpartum. You should notice your blood flow is lighter. The color of the blood flow is also changing from a light red to a watery pink or pinkish brown. You may still be blood clots during this phase, but they should be small in size and getting smaller as time goes on.

Lochia Alba: This is the third phase of post-pregnancy bleeding and typically lasts 2-6 weeks following childbirth. The color of the discharge changes from pink to a light brown to a yellowish-white color. However, you may still see an occasional spotting of blood. During this phase of post-pregnancy bleeding, primarily white blood cells leave the body after helping to heal your uterus after birth.

Type of Lochia

Color

Duration

Rubra

 

Bright or dark red

3-4 days

Serosa

 

Pinkish-brown

4-10 days

Alba

 

Whitish-yellow

10-28 days


When will my period restart?

If you are not breastfeeding, your first real period after pregnancy and birth may start again within 6 to 8 weeks of giving birth. If you are breastfeeding, it may take longer for your periods to resume. For some women, they may not see a period again until they stop nursing their baby.

When Bleeding Becomes a Health Problem

Bleeding is typically heavy for the first few days after childbirth. However, if you experience heavier post-pregnancy bleeding after this timeframe, please contact your healthcare provider. Additionally, if you pass clots larger than a quarter or small plum, please contact your healthcare provider.

What is Postpartum Hemorrhage?

Postpartum hemorrhage is a serious condition when a woman or birthing person has heavy bleeding after giving birth. It is rare but does occur. It typically happens within one day of childbirth but can happen up to 12 weeks after delivering a baby.

Seek help immediately with your pregnancy care provider if you see any of the following signs of postpartum hemorrhage:
  • Bright red blood beyond the third day after birth
  • Blood clots bigger than a quarter
  • Bleeding that saturates more than one sanitary pad an hour and doesn’t slow down or stop
  • Blurred vision
  • Chills
  • Clammy skin
  • Dizziness
  • Fast heartbeat
  • Lightheadedness or faint feeling
  • Pale skin
  • Pain and swelling around your vagina or perineum (area between the vagina and rectum)
  • Nausea
  • Weakness

If you have any of the signs and symptoms of postpartum hemorrhage, please call your healthcare provider or 911 immediately. The Center for Disease Control and Prevention has additional information on Urgent Maternal Warning Signs at this link:
https://www.cdc.gov/hearher/maternal-warning-signs/index.html

Managing Postpartum Bleeding

There are products, including organic products, to help manage post-pregnancy bleedings. Typically, you will first use a hospital-grade sanitary pad and eventually transition to a regular pad. Postpartum underwear is an excellent option to provide the ultimate in protection during post-pregnancy bleeding.

Protective products that help with bleeding include: This is no time to wear a tampon and experts advise avoid using tampons and menstrual cups for managing post-pregnancy bleeding as they can lead to infections during this time. It may be safe to use these two products after your six-week check-up with your healthcare provider. When selecting a product, pick what is most comfortable for you, and remember you may need a variety of pads as you transition through the three phases of post-pregnancy bleeding.

Shawana S. Moore, DNP, MSN, CRNP, WHNP-BC

Shawana S. Moore, DNP, CRNP, WHNP-BC, is a Philadelphia-based, board-certified women’s health nurse practitioner and the director of the Women’s Health-Gender Related Nurse Practitioner Program at Thomas Jefferson University.

The information contained on this article should not be used as a substitute for the medical care and advice of your health care professional.