Before and during your pregnancy, your uterus (womb) built up a thick lining that cushioned and nourished your baby when it was just an embryo. This lining will need to shed from your body much like a regular monthly period. Also, the placenta that has given your baby oxygen and nutrients throughout the pregnancy was attached to the lining of your uterus, and once the baby is delivered, will separate from your uterus. This separation will also cause some bleeding. Like most pregnant women, you may be wondering how much bleeding you should expect, and how long it will last. Each woman's body is different and there are a multitude of factors that can affect the amount and length of bleeding in the postpartum period. In this post we will cover the most common sequence of events related to post birth bleeding. 

Bleeding Immediately After Birth

How much bleeding you have immediately after birth can vary considerably from one woman to the next, and will depend on the type of delivery you have. You can expect to have more bleeding with delivery during a cesarean section than you will with a vaginal delivery. A good estimate is between 500 and 1000 milliliters of blood loss. To give you a good visual for comparison, 500 milliliters is equivalent to one-half cup and 1000 milliliters is equivalent to 1 cup. Your healthcare team will be at your side during this phase of birth, and though it may seem weird, they will be closely measuring your blood loss. In years past, it was common for the healthcare team to estimate the amount of blood lost at delivery, but now we know better. Studies have shown that providers often underestimate the amount of blood lost at delivery, which can delay recognition of postpartum hemorrhage, and contribute to maternal mortality. Postpartum hemorrhage is basically heavy bleeding at delivery or in the immediate postpartum period. It is widely accepted that blood loss over 500-1000 milliliters is considered a hemorrhage. To ensure that your blod loss is closely monitored, your healthcare team should be using graduated drapes to capture blood loss at delivery and weighing any underpads and peri-pads to capture every milliliter of loss possible. We will cover postpartum hemorrhage in more depth in a later post. 

Bleeding During the First 24 Hours After Delivery

Vaginal bleeding during the first 24-72 hours will be bright red and like a heavy period. This bleeding is called Lochia Rubra, and is mostly made up of the part of the lining of the uterus that formed the maternal side of your placenta, and blood. I would advise that you wear disposable mesh panties during this time, as leaking around your peri-pad is common. Quite frankly, you will feel as if you and the baby are wearing diapers! If you are delivering your baby in the hospital setting, these mesh panties will most likely be provided to you by the facility. However, if you are delivering in a birth center or the home setting, you will most likely need to provide these for yourself. There are many different options available for purchase through Amazon. I highly recommend you invest in these as they will save your regular panties over the first 24-72 hours post birth. It is common to experience a sudden gush of blood or clots from your vagina when you stand after lying down for a period of time. This occurs because as you lay, you continue to bleed, but instead of exiting, the blood pools in the vaginal vault, sometimes forming clots. When you stand the blood exits all at once, which can cause a gush. This often gives women the perception of a sudden increase in bleeding. Do not be alarmed by this increase unless it continues to flow. You can help to reduce the amount of bleeding that you have during this time, by using the restroom often, nursing your baby frequently, and massaging your uterus at intervals through the day.

What to Expect After the First 72 Hours

After the first 72 hours, your bleeding will change from bright red, to dark red, to pink, and finally a creamy white or tan. The length of time it takes for all of this to occur is different for each woman. You should also notice that the amount of discharge is decreasing from the heavy flow you experienced in the first few days to a scant discharge by around days 10-14 post delivery. 

Lochia Serosa is the phase that begins around day 4. You will notice the flow decreasing and the color changing to a dark red, then eventually, a serous pink color. This bleeding is made up of more of the uterine lining we talked about above, white blood cells, red blod cells, and body fluids. Word of warning, you may start to notice that this discharge has an odor that isn't very pleasant. It is important to change your peri-pads often, and remove your bathroom waste basket often to avoid an increase in odor. It is also important that you maintain good personal hygiene because the odor can become worse when this discharge mixes with sweat. Unfortunately, as your fluids shift postpartum, sweating is quite common, so shower daily if possible. It is important to note that while this odor is distinct, it should not be foul. Foul odor is an indication of possible infection and should be reported to your provider of care. This is especially true if it is accompanied by a temperature of 100.4 or greater, and /or an increase in pain or cramping, or tenderness to your lower abdomen or pelvic area with touch. This phase of vaginal discharge will last until around day 8-14, after which the discharge will change to Lochia Alba. This phase of postpartum discharge is characterized by a creamy white, yellow, or tan discahrge. This is mostly made up of more of the uterine lining, and white blood cells.  This phase will last approx 2-4 more weeks, but can last up to 8 weeks postpartum. It is not uncommon for discharge during this time to still have a pink hue. For the most part, after the bright red bleeding stopped, you should not see a return to bright red bleeding. Hoewever, around day 10 postpartum, some women will experience a short burst of increased bleeding that will last a short amount of time. This is caused by the sloughing off of the cells at the site where the placenta was adhered to the uterus. Do not be alarmed, but monitor this bleeding, and if you are saturating a peri-pad end to end within an hour, seek medical care. 

When Should I Expect My Period to Return? 

If you have had a vaginal delivery with no complications, you can expect to see your provider for follow-up sometime around 4-6 weeks after birth. If you have had a cesarean section, you will see your provider sometime between 1-2 weeks after birth, and again around 4-6 weeks out. Most women will not have had a return in their period by this time, especially if you are exclusively breastfeeding. As a matter of fact, if you are exclusively breastfeeding, you may not have a period until around 6 months after birth. If you are formula feeding, your period will return sooner, usually around 2-3 months. It is important to note that just because you are not having a period, doesn't mean you can't get pregnant! You will very likely return to a fertile state before your period returns, so it is very important that you discuss your plans for birth control with your provider after birth, before you resume sexual interocurse. We will review postpartum cpntraception and resuming sexual intercourse in another post, as these are both huge topics that deserve their own spotlight!   

I hope this post has helped to prepare you for what to expect in relation to vaginal bleeding after the birth of your baby. This post, could never cover all the specifics of postpartum bleeding, so if you have specific questions, you should always talk to your provider.