The joys of motherhood are many, but nothing quite compares to the feeling of your baby lying on your chest after an arduous labor and birth. After this point, you will begin to heal from pregnancy and birth and that starts with the normal process of postpartum bleeding.
Whether you’ve had a vaginal birth or a cesarean section, you will experience postpartum bleeding. This blood is referred to as lochia. Lochia is discharged from your uterus and consists of a mix of blood, mucous, and uterine tissue (2). There are 3 types of lochia: rubra, serosa, and alba.
Lochia Rubra is bright red blood that starts immediately after the birth of the placenta and lasts for about 3-4 days (2). Some clots are present.
Lochia Serosa is pinkish blood and can last from day 5 to week 2 (2). Clots should be very small or absent.
Lochia Alba is a yellow-white discharge and can last from week 2 and up to week 6 (2). No clots are present. It may have very light pink or brown spotting.
The length of postpartum bleeding varies from person to person. Some women may find that they stop bleeding around two weeks postpartum and others may bleed up until week six postpartum (2).
What should you expect in the first hours after birth?
After you birth your baby and the placenta, the normal process of bleeding begins. As your body works to release the placenta, there is a big rush of the hormone oxytocin which assures your uterus will start contracting to control bleeding from the placental site. The lining of the uterus is also shed, and any other fluids will be excreted as lochia. Lochia flow at this time is typically moderate to heavy and should begin to taper within 24 hours (2).
In the first few hours, you can expect that your postpartum nurse or midwife will assess your uterus and bleeding frequently. They will massage the top of your uterus to check that it is contracted and firm and to ensure your bleeding is controlled. This massage is also referred to as a fundal massage. You can place your hands on the fundus of your uterus and press down to encourage this process. In doing so, it is normal to feel a rush of blood. Immediately after birth, you can expect your uterus to be at the same level as your belly button and it should feel like a firm and round contracted muscle. Eventually it will return to its normal size, about that of your fist.
What is the difference between menstrual discharge and postpartum discharge?
The difference between your regular menstrual discharge and postpartum discharge is that postpartum discharge can be heavier and last longer than your monthly period.
Along with postpartum bleeding, you will also experience some cramping or “afterpains”. Your uterus wants to return to its normal size and continues doing so through these "afterpains" contractions. These cramps may feel like your usual period cramps. Women who have had multiple pregnancies may experience this more intensely as the uterus contracts to control bleeding and return to its pre-pregnancy state (3).
A breastfeeding mother may notice an increase in cramping while breastfeeding, especially in the first 2 to 3 days following childbirth (1). This is because breastfeeding stimulates the release of the hormone oxytocin which encourages the uterus to return to its original size, about that of your fist. This is good - your baby breastfeeding is helping you heal.
What should lochia smell like?
Lochia should smell like your regular menstrual blood. If your postpartum discharge smells foul, is green-tinged, or you have a fever then you may have an infection (2). In this case, it is best to see your healthcare provider immediately.
How do you know if you’re bleeding too much?
The heaviness of postpartum bleeding is going to be the most in the first 3 days after birth. However, you should not soak a pad within 1 hour or pass clots the size of an egg or bigger. This could indicate a postpartum hemorrhage.
If you have heavy bleeding or discharge (lochia rubra) for over a week, then this may mean that your uterus is not effectively contracting due to a portion of retained placenta or infection (2).
Please seek immediate medical attention at your local emergency department if you are soaking a pad in 1 hour, passing large clots, discharging lochia rubra for over 1 week, have foul-smelling lochia, or have a fever.
Remember, that postpartum bleeding is a short yet important phase of healing. Take this time to rest and to enjoy your sweet baby, and before you know it you will be ready to tackle the next stage of motherhood head on.
References
1. Breastfeeding. (n.d.). Stanford Medicine Children’s Health. https://www.stanfordchildrens.org/en/topic/default?id=breastfeeding-85-P00990
2. Chauhan G, Tadi P. Physiology, Postpartum Changes. [Updated 2022 Nov 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK555904/
3. Lcce, C. T. (2020, December 4). All About "After Pains" - Cramping After Giving Birth. Lamaze International. https://www.lamaze.org/Giving-Birth-with-Confidence/GBWC-Post/all-about-after-pains-cramping-after-giving-birth-1
Manal Sarhan is a postpartum registered nurse and freelance health writer based in Canada. She is passionate about discussing topics related to pregnancy and perinatal care. Manal also has a passion for teaching and loves to share health knowledge through her writing. To get in touch, visit her website at www.sarhanhealthwriting.com.
