Giving birth 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 birth. All new mums experience heavy bleeding after birth. But when is it too much? When should you worry and when is it no big deal?
Here’s the deal. Heavy bleeding after birth is your body’s way of flushing out tissue and blood from your uterus that supported your pregnancy but is no longer needed. The blood and fluid shed after birth 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 labour.
Lochia is made up of a number of things:
- 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
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 into a yellowish-whitish discharge with occasional spotting. This can last up to 12 weeks postpartum but will likely go away within 3 to 6 weeks.
You may even soak through a normal menstrual pad every few hours. This is normal in the first few days after birth. It may be a good idea to use absorbent pants such as ALWAYS DISCREET underpants instead of a pad that needs to be changed so often.
However, soaking through a menstrual pad in an hour or less is a sign of excessive bleeding after birth and you should consult your doctor. Another sign of excessive postpartum bleeding is passing blood clots larger than a plum. Keep an eye out.
Excessive bleeding after birth can be a sign of postpartum haemorrhage, a very serious condition. The highest risk period for postpartum haemorrhage is within 24 hours of giving birth. This type of severe postnatal blood loss is known as primary postpartum haemorrhage, and it affects 5 out of every 100 women who give birth. However, although much more rare, postpartum haemorrhage can occur anywhere within 12 weeks of birth. This is called secondary postpartum haemorrhage.
The most common cause of postpartum haemorrhage is something called uterine atony. Typically, after labour, your uterus contracts to stop 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 labour for primary postpartum haemorrhage.
Before labour, the risk factors include:
- Previous postpartum haemorrhage
- Obesity
- Giving birth to multiples (twins, etc.)
- Placenta previa (a low-sitting placenta)
- Placental abruption (when the placenta pulls away too early)
- Pre-eclampsia or high blood pressure
- Anaemia
During labour, the risk factors include:
- Caesarean section birth
- Induced labour
- Retained placenta
- Episiotomy
- Uterine rupture
- Forceps or vacuum-assisted vaginal delivery birth
- Labour that lasted for 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% of women develop excessive bleeding after birth, 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 A&E if you are experiencing symptoms of shock. These include:
- 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
- Feeling faint
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 haemorrhage can include blood transfusion, an injection of medication designed to stop the bleeding, hysterectomy or removal of the uterus, or surgery to identify the source of the bleeding and stop it, called a laparotomy.
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 heavy bleeding after birth. They include:
- Having another person massage your uterus
- Breastfeeding
- Urinating 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.