Vaginal Bleeding After Birth: When to Call a Doctor

If you have a vaginal delivery or Cesarean section, you’ll have vaginal bleeding and discharge after birth. This is known as lochia. It’s how your body gets rid of the extra blood and tissue in your uterus that helped your baby grow.

Bleeding is heaviest the first few days after your baby is born. But if heavy bleeding continues after that, you may need to call your doctor.

What's Normal

Your blood will be bright red, and you may see some clots for the first few days after you give birth. They shouldn’t be bigger than a quarter. You’ll have to wear a hospital-grade pad at first. But you should be able to go back to a regular pad later.

You might bleed a little more when you bring your baby home. This may be because you’re moving around a lot. If this happens, try to stay off your feet and rest a little.

It’s also normal to sometimes feel a gush of blood when you stand. This is because of the way your vagina is shaped. The blood collects in a cup-like area while you’re sitting or lying down. When you stand, it comes out.

After about 10 days, you should see less blood. You may have light bleeding or spotting for up to 6 weeks after delivery. You can only use sanitary pads during this time. Tampons could lead to an infection.

When to Call Your Doctor

Heavy bleeding after giving birth is called postpartum hemorrhage. It affects up to 5% of women who give birth. It’s most likely to happen the first 24 hours after delivery. But it can happen anytime within the first 12 weeks after your baby is born.

Postpartum hemorrhage is serious. It can cause a big drop in your blood pressure. If the pressure gets too low, your organs won’t get enough blood. This is shock, and it can cause death. That’s why it’s important to get medical help right away.

Tell your doctor or call 911 if you have any of these symptoms or signs:

  • 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
  • Faint feeling

Continued

What Causes It?

Certain things can raise your chance of postpartum hemorrhage. You’re at higher risk if you’ve had it before. For unknown reasons, Asian and Hispanic women are more likely to have it.

The most common cause of postpartum hemorrhage is something called uterine atony. Normally, the uterus squeezes after delivery to stop bleeding where the placenta was. The placenta is an organ that grows in your uterus during pregnancy and nourishes your baby. With uterine atony, the uterus doesn’t contract as well as it should. This can cause heavy bleeding after you give birth.

You may be more likely to have this if you:

  • Give birth to more than one child at a time (twins, for example)
  • Have a baby bigger than 8 pounds 13 ounces
  • Are in labor for a long time
  • Have given birth several times before

Other conditions can raise your risk for postpartum hemorrhage. These include:

  • Uterine rupture -- when the uterus tears during labor
  • Cesarean section -- your risk for postpartum hemorrhage is higher compared with a vaginal delivery
  • Tears in the vagina or cervix during delivery
  • General anesthesia -- this may be used if you have a Cesarean section
  • Oxytocin (Pitocin) -- a medicine that makes you go into labor
  • Preeclampsia -- high blood pressure and protein in your urine that develops during pregnancy
  • Obesity
  • Issues that affect the placenta

How It's Treated

There are many different treatments for postpartum hemorrhage. The cause of your bleeding will help your doctor decide what may be best for you.

She could:

  • Give you medicine to help your uterus contract
  • Massage your uterus
  • Remove pieces of the placenta still in your uterus
  • Perform a laparotomy -- surgery to open your abdomen to find out the cause of bleeding and stop it
  • Give you a blood transfusion -- blood is given to you through a tube that goes in a vein to help replace blood you've lost
  • Perform a hysterectomy -- surgical removal of the uterus
  • Give you a shot of a special medicine to stop the bleeding
  • Have a radiologist do what's called a uterine artery embolization, which limits blood flow to your uterus
  • Use something called a Bakri balloon that's inflated inside your uterus and adds pressure to help slow the bleeding
WebMD Medical Reference Reviewed by Traci C. Johnson, MD on December 11, 2017

Sources

SOURCES:

American Academy of Family Physicians: "Recovering from Delivery (Postpartum Recovery)."

March of Dimes: "Your Body After Baby: The First 6 Weeks," "Postpartum Hemorrhage," "Placental Accreta, Increta, and Percreta."

Mayo Clinic: "Postpartum Bleeding: How Much is Too Much?" "Placenta: How It Works, What’s Normal," "Blood Transfusion."

Cleveland Clinic: "Physical Changes After Delivery."

Children’s Hospital of Philadelphia: "Postpartum Hemorrhage."

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