Everything You Wanted To Know: Postpartum Bleeding

Welcome to our new summer blog series! This summer we will be looking at all those details you want to know about, but are too afraid to ask! We know that pregnancy and parenting are full of moments where you wonder what on earth is happening. Whether it is the changes to your body, postpartum recovery, or all the delightful (and sometimes gross) things that your baby does, we have the answers that will help you to feel confident and comfortable with all the new experiences coming your way! The first taboo topic we are looking at is postpartum bleeding.

Postpartum Bleeding

Do you have questions about what exactly goes on with your body after giving birth? You aren’t alone! Postpartum bleeding is not something we talk about all that much but it is something you definitely need to know about.

The first thing to know is that the initial bleeding after birth is called lochia.

Lochia

Lochia is the initial bleeding that lasts for 4-6 weeks and is a normal part of childbirth. During pregnancy, the placenta is attached to the uterine wall. Following the birth of your baby, the placenta will detach from the uterus and be expelled. This leaves an open wound on the inside of the uterus. A nurse, doctor, or midwife will probably press on or massage your uterus to help it contract down; this helps to reduce the size of the wound and limits bleeding.

There are three kinds of lochia. Lochia rubra is the bright red, heavy bleeding that characterizes the first 3-5 days. It is common to have large-sized clots and the bleeding will be bright red. The colour should first darken to a deep red, then turn brown or pink. If bright red bleeding returns or persists past the fifth day, please contact your medical care provider.

Lochia serosa is the second stage of lochia and is generally brown or pink in colour. This discharge contains some red blood cells, but far fewer than Lochia rubra. This stage usually lasts 10-14 days postpartum. If it persists past that point, it can indicate a problem and should be addressed by your medical care provider.

Lochia alba is usually very light pink, white, or yellow in colour and contains very few red blood cells. This stage can last several weeks and is the body shedding the remaining fat, epithelial cells, and microorganisms that your body produced during pregnancy.

The real question about lochia is how do you manage it!?

Because lochia is caused in part by an open wound, nothing internal should be used. That means no tampons or menstrual cups as both reusable and single-use menstrual products can introduce bacteria to the vagina, and therefore the uterus. For the first 3-7 days, we recommend using some form of adult diapers.

We know it seems strange to head to the local store and grab a bag of Depends, but they are perfectly suited for postpartum bleeding! With no worries about things slipping out of place or leaks caused by getting stuck under a cluster feeding newborn, they are the most convenient way of managing. Generally, after 6 weeks it is okay to use tampons or internal-use products, but ask your care provider at your 6-week follow-up if you are still bleeding.

While many people believe the myth that caesareans “clean out” the uterine cavity and reduce postpartum bleeding, the truth is that those who give birth by caesarean will bleed as much as anyone else. This is another reason why adult diapers are so helpful. The soft and stretchy waistband does not irritate the healing incision.

It came back!

For some women, their lochia can stop or fade and then return, often between week 5 and 8 and it can occur even after a week or more of nothing. While it is possible this is the return of your menstrual cycle, it is unlikely for most women. As your hormones start to shift, it can cause spotting or breakthrough bleeding. It is also not unusual for people to feel stronger and more active around this time and to overdo it, causing renewed bleeding.It is a good sign to take it easy for a few days.

Contact your medical care provider immediately if you are soaking a pad or tampon in less than an hour, if you have a fever or chills, or if you suddenly begin bleeding bright red blood again.

Menstruation

No one wants their period to come back, but it will eventually come back. When your period returns is decided by a few factors, primarily if you are breast/chest feeding, how much you are breast/chest feeding, and your personal hormonal makeup. While is it possible for your cycle to return as early as six weeks postpartum, even those who are not breastfeeding will usually not experience a period until closer to 12 weeks postpartum. And remember, you ovulate two weeks before your period!

The First Period

The first period is usually much heavier and potentially more uncomfortable than you might be used to. Even those people who had a light or “easy” period before pregnancy generally find that the first cycle after birth is heavy and uncomfortable. The first few periods might also be unpredictable and irregular. All of this is normal as your body sheds the lining built up over a longer period of time and your hormone levels start to settle.

Lactation-Induced Ovulation Prevention

The old wives tale that breastfeeding prevented pregnancy is not completely true. Officially called lactation-induced amenorrhea, this method of birth control is not particularly reliable, particularly after any supplement nutrition has been added to the infants routine, including pacifers and solids.

Physiologically, the act of a baby suckling at the breast reduces certain hormone levels. Specifically, the luteinizing hormone surge that results in ovulation is suppressed. However, in order for this to be effective, one must be exclusively breastfeeding with no supplemental or artificial nipple. However, even exclusive breastfeeding and room-sharing will not be enough to prevent the return of their cycle for everyone. And because you cannot tell if you have ovulated until two weeks later when your period arrives, this is considered an unreliable form of birth control.

How do I know what is normal?

It is normal to worry about what your body is doing, especially if this is your first baby! The good news is that most new parents will recover fairly easily. However, there are a few problems that can crop up that should be addressed quickly.

• if, at any point postpartum, you begin bleeding heavily and soak through a tampon or pad in less than an hour. This can indicate a late postpartum hemorrhage.
• a fever higher than 100.4F, severe chills, or any other indication of infection
• if the discharge has a foul odor or the colour changes to green
• itching, burning, or difficulty urinating after the first 24 hours (it is not uncommon to have some difficulty urinating immediately after giving birth, particularly if you had an epidural or catheter during labour)
• a return to bright red blood once it has faded
• passing clots larger than a plum, not associated with prolonged lying down or breastfeeding

Postpartum bleeding certainly isn’t the most fun part of having a baby, but it isn’t scary and it is manageable.

Remember to check in every week to see what questions we are answering! Next week we are going to talk about caesarean birth and what, exactly, happens during a caesarean birth! And don’t forget to e-mail us if you have any questions you want to know the answers to, but are too afraid to ask! There are no silly questions and no judgment here.