What to know about postpartum bleeding - Ruth Health

What to know about postpartum bleeding

Fast facts:

  • Postpartum bleeding, or lochia, is part of the physical recovery from childbirth.
  • It typically begins immediately after delivery and may last for up to six weeks.
  • There are three stages of lochia as the flow gradually decreases over time.
  • Use pads, and change frequently to prevent infection, as tampons can introduce bacteria into your uterus and genital tract. 
  • See a doctor or other healthcare professional if large clots form or if you soak through a pad in an hour or less.

Early postpartum is filled with many physical changes. As your uterus sheds the blood and tissue required to sustain a healthy pregnancy, you’ll experience postpartum bleeding, or lochia

This typically begins immediately after childbirth and may last for up to six weeks after delivery. The flow should gradually decrease over time.

Here’s what to expect and how to manage postpartum bleeding.

What are the stages of bleeding after birth?

Lochia is a type of vaginal bleeding similar to a menstrual period. However, the flow is heavier and lasts longer than a typical menstrual cycle. It first develops immediately after delivery and typically tapers off over four to six weeks.

There are three stages as the lochia transitions from heavy bleeding to more mucus than blood.

  • Lochia ruba (red) occurs for about one to two weeks after giving birth.
  • Lochia serosa (pinkish-brown) may last an additional 1-2 weeks after delivery.
  • Lochia alba (yellowish) may last an additional 1-4 weeks

Lochia is usually heaviest for the first 10-14 days. Some birthing people may experience slightly shorter or longer postpartum bleeding.

Those who delivered by c section may not have as much bleeding after birth. However, you will likely still experience postpartum bleeding for several weeks. It will progress in three stages, just like lochia after a vaginal delivery.

How do I manage bleeding after delivery?

First and foremost, expect to use pads for the majority of your postpartum bleeding. Tampons and menstrual cups can introduce bacteria into your uterus and genital tract while your cervix is still closing. 

Wear a pad until a trusted healthcare professional gives you clearance to insert anything intravaginally. 

Initially, you may experience heavy bleeding that requires a thick, extra-absorbent pad. If you are giving birth in a hospital, ask a nurse or other staff member if you can take home some hospital pads.

Once the bleeding decreases, you can use regular menstrual pads. Change pads often as a precaution against infection. 

How frequently you need to change your pad depends on the heaviness of your flow. Many women need to change them every one to two hours during the first days of postpartum bleeding. This will gradually decrease in the following days.

Be sure to take it as easy as possible during this time. Diving into activities too quickly can slow down postpartum recovery and increase bleeding. Ask friends and family for help and look for opportunities to slow down and recharge. Every minute of rest counts!

What causes bleeding later after giving birth?

Lochia should naturally taper off, but several factors can temporarily increase bleeding. 

This includes the following:

  • Exercise or other physical activity
  • Straining when urinating or during bowel movements
  • Breastfeeding, as the hormone oxytocin stimulates uterine contractions, which may intensify bleeding

If the flow increases enough to soak through a hospital pad in less than an hour or does not decrease after a few days, contact your doctor or another healthcare professional.

You should also seek treatment if large clots (bigger than a quarter) form. This may indicate that the uterus is not naturally contracting to its pre-pregnancy size.

Is it normal for postpartum bleeding to stop and start again?

It isn’t uncommon to have postpartum bleeding stop and resume due to the factors mentioned above. It can also happen when some parts of the uterine lining take more time to heal than others.

Contact your provider if you experience several days of heavy, bright red bleeding after the lochia has tapered off, or if large clots form.

If bleeding resumes several weeks after stopping, your menstrual cycle may have started again. If this is the case, evaluate your birth control options. You can ovulate as early as two weeks postpartum and may be fertile even if you haven't experienced all the phases of postpartum bleeding.

What are the signs of a postpartum infection?

While uncommon, postpartum bacteria infections can develop when bacteria enter the reproductive tract, a vaginal tear, or c section incision.

Some amount of bleeding is part of your body’s natural postpartum recovery, but excessive bleeding may be a sign of an infection.

A postpartum hemorrhage is another rare but serious complication to be mindful of. This is excessive blood loss in the days or weeks after giving birth. The bleeding may occur from the placenta’s detachment from the uterus or vaginal or cervical tears.

See a doctor or other healthcare professional if you soak through a menstrual pad in an hour or less.

Here are additional signs of a postpartum infection or hemorrhage to watch for.

  • Blood clots
  • A fever or other flu-like symptoms including chills, nausea, headache, or loss of appetite
  • Intense abdominal or pelvic pain
  • Redness, swelling, or discharge near a c section incision or perineal tear
  • Foul-smelling discharge

We’re here for you during postpartum

Postpartum isn’t a few months following childbirth — it’s an ongoing health journey. And we’re with you through it all.

Ruth Health provides expert, evidence-based maternal advice so that you can make the best decisions for you.

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