Bleeding after birth (lochia)
Following your vaginal or C-section birth you will experience a period of bleeding which is a normal part of the healing and recovery process. Your body is shedding leftover blood cells, tissue and mucus from your uterus, collectively known as lochia. This is similar to a period but can be much heavier, and usually lasts between 2-6 weeks.
It will be quite heavy at first and you may pass clots during the early stages. After about 10 days the bleeding should become lighter until it stops a few weeks later. If you pass lots of large clots, tell your midwife as you may need some treatment.
As the flow gets lighter the colour of your lochia may change from bright red or red/brown to pink and then white/pale.
As the flow will start off quite heavy you are advised to use super-absorbent maternity pads, rather than thin sanitary pads, which you may need to change often. Maternity pads will help you to better assess the amount of blood loss and help your perineum heal with less irritation as they provide some padding. Change the pads or towels regularly, washing your hands before and afterwards. Have a bath or shower every day to help keep the area clean.
You may notice the bleeding is redder and heavier when you breastfeed. This happens because breastfeeding stimulates the release of the hormone oxytocin which makes your womb contract. The flow may also be heavier in the morning when you stand up or when you increase your physical activity, this is due to the shape of your vagina, which causes fluid to pool and collect when you are sitting or lying down and then flow out when you stand up.
Do not use tampons until after your 6-week postnatal check and check that it is ok to use them with your GP, because they could increase your chance of getting an infection. Using internal sanitary products like tampons and menstrual cups before you have fully healed could increase your chance of getting an infection. This is because you will still have a wound where the placenta joined with the wall of your womb, and you may also have tears or cuts in or around your vagina.
A postpartum haemorrhage is when you experience excessive heavy bleeding following birth which can result in dangerously low blood pressure. It is usually caused by a tear/laceration, the uterus not shrinking down, or an issue with the placenta not fully detaching.
In most cases it will occur within 1 day of birth but can occur up to 12 weeks post birth, in which case it is known as a delayed postpartum haemorrhage.
You will be more at risk of experiencing a postpartum haemorrhage if you had a C-section, twin pregnancies or preeclampsia.
It is a serious condition that will need to be treated by a medical practitioner immediately so if you notice excessive bleeding that doesn’t slow down/stop (soaking more than one maternity pad per hour) then contact your medical practitioner immediately.
Cramping & after pains
You may also experience cramps, sometimes called ‘after pains’ within the first few days of delivery. This pain will occur in your lower pelvis as your womb (uterus) ‘contracts’ and shrinks back to its normal size and position.
After pains are caused by an increase in the hormone oxytocin and can vary from mild, period-type pains to something similar to labour contractions. They are less common in women who have had their first baby, tending to increase in frequency and intensity with second and subsequent births.
After pains will be most intense within the first 3 days following birth and will become less frequent and less uncomfortable after a few days, until they disappear within 1-2 weeks.
You may find that the cramps increase during breastfeeding because the baby’s sucking action triggers the release of the hormone oxytocin which causes the uterus to contract. If you would like pain relief, you can discuss this with your midwife or GP.
It's hard to be exact about when your periods will start again, as everyone is different.
If you bottle feed your baby, or combine bottle feeding with breastfeeding, then your first period could start as soon as 5 to 6 weeks after you give birth.
However, if you breastfeed (including at night) without any bottle feeding, your periods may not start again until you start to reduce breastfeeding.
You should not use tampons until you've had your 6-week postnatal check. This is because you will still have a wound where the placenta joined with the wall of your womb and you may also have tears or cuts in or around your vagina.
Using internal sanitary products like tampons and menstrual cups before this wound has healed could increase your risk of infection.
So make sure that you use maternity pads or sanitary towels during this time while your body is still healing.
Red flags - when to seek help
It is vital that you take care of yourself and focus some of your attention on your recovery so that you can spot any warning signs and seek medical advice/treatment when required. Familiarise yourself with the list below and make sure that you tell your midwife, health visitor or GP immediately if you experience any of these symptoms as they could indicate a problem that requires further investigation or immediate treatment.
Excessive bleeding that doesn’t slow down/stop (soaking more than one maternity pad per hour)
Large blood clots size of a golf ball
Bright red bleeding beyond the third day after birth
Foul smelling bleeding or discharge
Headaches or blurred vision
Chills, clammy skin or fever
Feeling dizzy, faint or weak
Pain, swelling or redness in the calf muscle of one leg
How you can support your partner
You can support your partner by ensuring that they are well nourished, well rested, have the supplies that they need and are watchful of their health. Below are some ways that you can be supportive:
Purchase supplies of maternity towels
Prepare iron-rich foods
Prepare foods rich in Vitamin B6, B9 B12
Ensure that they are well hydrated
Create opportunities for them to rest and sleep
As keep an eye out for any red flags listed above and encourage them to seek help when needed.