Postpartum Bleeding

Something most women don’t realize is how much you bleed after you have a baby. Everyone does. Even if you have a c-section, you will likely bleed for a few weeks. Most women will bleed up to 6 weeks after birth, some very little and some a lot. In this post I’ll walk you through what to expect with your bleeding, what isn’t normal, and when to call your doctor if something isn’t right after you leave the hospital.

Why Are you Bleeding? 

  • When the placenta is delivered, there are blood vessels inside the uterus that are now open which causes the bleeding.
  • After delivery, your uterus should keep contracting for a few days which closes these blood vessels and decreases bleeding.
    • To keep your uterus contracting after delivery, your nurse will palpate and massage your uterus frequently. They may also give you a medicine called Piton (Oxytocin) which stimulates your uterus to contract.
  • If you have an episiotomy or tear after birth, you may bleed from these stitches and may be more and longer.
  • When your uterus does not contract well after delivery, the blood vessels remain open and can lead to massive blood loss, referred to as postpartum hemorrhage.

 

Normal Bleeding: 

  • Bleeding after you have a baby is called lochia. It changes color and consistency through the first week after the baby is born and should decrease to scant spotting by the time you go home from the hospital.
    • Day of birth: Moderate sometimes heavy bright red blood. Your nurse will monitor the amount for you. At Sinai, we weigh pads to make sure our moms aren’t bleeding too much for the first 24 hours.
      • You should be going through a pad every few hours. More than a pad an hour is a little heavier than normal and you should let your nurse know.
    • Further stages:
      • Rubra: This is the first stage of bleeding. It’s bright red and contains mostly blood. This will last 3-5 days.
      • Serosa: Thin, yellow and brown discharge containing exudate and mucous. This will last from Day 5-10.
      • Alba: Yellow and white discharge from day 10 on. Usually will subside by 2 weeks after birth.
    • Some spotting of blood is normal for up to 6 weeks after delivery.

 

 

How Bleeding is Managed: 

  • In the hospital, you will be given pads, mesh underwear, ice packs, pads on the pad, etc.
  • At first, use heavy duty or large pads. The hospital will give you a few when you are sent home.
  • As the bleeding tapers off, you can switch to mini pads or panty liners.
  • As mentioned, if your bleeding is heavier than normal after delivery or in postpartum, the nurses and doctors will massage your uterus to stimulate contraction, give you Piton to stimulate contraction, and possibly give you fluids or blood if bleeding is especially heavy.
    • If bleeding is extensive, DON’T PANIC. Let your nurse know ASAP if it is leaking out quickly and you are saturated a pad or more an hour.
    • In the US now, it is very rare for a mother to die in labor or postpartum (For example, at Sinai Hospital we have had only 4 maternal deaths in the past 25 years). Your nurses and doctors know how to handle bleeding. Let them know if you are concerned.

 

Severe Bleeding at Home: 

  • Sometimes, bleeding can increase once you get home. By the time you are discharged, you will still be in the Rubra phase, however it will be MUCH lighter than your first day or two.
  • If your bleeding starts to increase and you are having to change your pad every hour because you are saturating them quickly, this is not normal.
  • Passage of clots is also normal, however, anything large than a golf ball is not normal.
    • If either of these occurs more than once, call your doctor.
    • If the bleeding is extensive, go to the hospital ER.
    • If you feel light headed, loose consciousness, or feel faint, call 911.
  • If your bleeding is extensive, make sure you are drinking lots of water and resting.

 

Other Tips: 

  • When to expect your period again:
    • Nursing moms: Up to 6 months before your period returns to normal.
    • Non-nursing moms: 1-3 months when your period returns to normal.
  • Postpartum Doula:
    • These are incredibly useful tools! These are volunteers, nurses, techs, etc. who work with a home care agency and will help you at home during your postpartum period. They can help you monitor your bleeding and get you any help that you may need at any point.
  • Pain control!
    • Contractions are painful and most moms don’t realize you will keep cramping after the baby is born. You’ll be given pain meds in the hospital like tylenol, motrin, and oxycodone around the clock but other things can help too! Especially if you have an episiotomy or laceration things like Sitz baths, numbing spray or Tuks pads can help.
      • Tylenol and motrin will help the most with cramping pain.

 

If you ever have any questions about this please let me know!

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