Author: Dr. Joel M. Bernstien, M.D.
After childbirth, your body begins the healing and recovery process. Part of this is the natural postpartum bleeding, medically referred to as lochia. At Kamm Mckenzie OBGYN, we get several calls and messages regarding bleeding patterns postpartum, so we thought we would take a minute to elaborate on what is considered “normal” bleeding postpartum.
What is postpartum bleeding?
As you can imagine, there are significant changes to your uterus to support pregnancy. The uterine size is enormous compared to its non-pregnant baseline. The lining is thick to support your baby. And the uterus has a much larger vascular supply to manage the needs of growth and fetal/placental development. After delivery, whether vaginal or cesarean, the uterus begins its process of returning to its non-pregnant state. It sheds the thickened lining, along with blood and tissue, and slowly starts to shrink in size.
What pattern of bleeding can I expect?
Bleeding patterns after delivery vary from person to person and can be different from one individual’s delivery to another (i.e., you may bleed a little more after your third delivery than your first). Typically, once out of the immediate post-delivery window, your bleeding will start to improve. However, it will continue to be heavier than a menstrual cycle at first and then taper down as time goes by. It is typical to see increases when standing after being in bed for a while, while being more active, or while nursing/pumping. Lochia can be of varying colors (bright red, dark red, brown, yellowish) and mixed with mucus and a little tissue. For most women, bleeding will subside by the time they return for their six-week postpartum check-up, but some women stop sooner and some bleed longer.
An important event that can startle patients is a sudden increase in bleeding that can occur one to two weekspost-delivery. You feel like you are in a groove and your lochia is decreasing, then you may have a day or two of bright red heavier bleeding again. This is VERY common and is due to the placental site scab coming off (the medical term is placental site involution).
Can I use tampons?
No, for the first six weeks postpartum, you should avoid introducing anything into the vagina. Thus, we recommend pads. For the first few days, it may be most comfortable to wear large overnight type pads and then slowly decrease the thickness as the bleeding tapers.
How much bleeding is too much?
We typically tell patients that once they are home, if they are fully saturating a super absorbent pad every hour for 3 straight hours or more, we should hear from you. If you
are passing clots larger than a lemon, please call or message us. Remember, intermittently passing smaller clots is normal. Any postpartum fever >101 would warrant contacting our office.
When will my period return?
Timing of return of menstruation is variable, from as early as six weeks to as long as several months. Usually women who are nursing have a longer delay to menstruation. A friendly reminder: your first period after giving birth may be way heavier than your baseline normal! It should, however, slowly revert to what you are used to.
