Bleeding After Delivery: What Is Normal Lochia and When Should You Seek Help?

English version

Vaginal bleeding after childbirth is expected, whether the baby was born vaginally or by caesarean section. This discharge is called lochia. It contains blood, mucus and tissue shed while the uterus heals.

Lochia is usually heavier and redder during the first few days. It should gradually become lighter, changing to pink or brown and later to a pale or yellowish discharge. It commonly continues for several weeks, although its duration varies between women.

Bleeding that is extremely heavy, becomes heavier rather than lighter, or returns suddenly with other symptoms should not be assumed to be normal recovery.

What may be normal after delivery?

During the early recovery period, you may notice:

• Bleeding similar to or heavier than a menstrual period initially
• A gradual reduction in the amount of blood
• Colour changing from red to pink, brown and then lighter
• Occasional small clots
• A temporary increase while breastfeeding, because the uterus contracts
• Slightly more discharge after getting up following a period of lying down
• A mild increase after greater physical activity that settles with rest

A caesarean delivery does not prevent lochia because the inside of the uterus still needs to heal.

When should you contact your doctor?

Arrange medical advice if:

• Bleeding is not gradually reducing
• Fresh red bleeding returns after having become lighter
• You repeatedly pass clots
• The discharge develops an unpleasant or foul smell
• You have lower-abdominal or pelvic pain that is worsening
• You develop fever or chills
• You feel unusually tired, dizzy, breathless or weak
• Bleeding becomes heavier whenever you increase activity and does not settle with rest
• You are unsure whether the blood is coming from the vagina, a caesarean wound, piles or a tear
• You are taking blood-thinning medicine or have a bleeding disorder

Abnormal or heavy bleeding occurring from 24 hours to 12 weeks after birth is called secondary postpartum haemorrhage. It may be related to infection, tissue remaining inside the uterus or another cause and requires medical assessment.

What can you do during recovery?

• Use maternity or sanitary pads so that the amount and colour can be observed
• Change pads regularly and wash your hands before and afterward
• Avoid tampons and menstrual cups during early postnatal healing unless your clinician advises otherwise
• Increase activity gradually and rest if bleeding becomes temporarily heavier
• Drink enough fluids and follow advice about iron if you became anaemic
• Attend the recommended postnatal follow-up
• Record when heavier bleeding began, how quickly pads are filling and whether clots or other symptoms are present

Do not attempt to treat heavy bleeding with leftover medicines. Do not delay urgent assessment while arranging a routine appointment or video consultation.

What assessment may be needed?

Depending on the symptoms, a clinician may check:

• Pulse, blood pressure, temperature and overall condition
• The amount and source of bleeding
• Abdominal and uterine tenderness
• Caesarean, episiotomy or tear wounds
• Haemoglobin and other blood tests
• Signs of infection
• Pelvic ultrasound when clinically appropriate

Treatment depends on the cause and may include medicines to help the uterus contract, antibiotics, iron treatment, removal of retained tissue, intravenous fluids or other hospital care. Not every patient requires every test or treatment.

Seek emergency or urgent in-person care if

• Bleeding suddenly becomes very heavy or is rapidly increasing
• You are soaking through one or more large pads in an hour, particularly if this continues
• Blood is flowing continuously or pooling
• You pass clots larger than a golf ball or repeatedly pass large clots
• You feel faint, confused, breathless, extremely weak or have a racing heartbeat
• Your skin becomes unusually pale, cold or clammy
• Heavy bleeding occurs with severe abdominal or pelvic pain
• You have fever, chills, worsening uterine pain or foul-smelling discharge
• You collapse or feel that you may lose consciousness

Very heavy postpartum bleeding can become an emergency quickly. Seek emergency help rather than waiting to see whether it stops.