After childbirth, the body begins a six-week recovery period involving significant uterine healing. This process includes a discharge known as lochia, which consists of blood, mucus, and tissue shed from the lining of the uterus. Lochia is a normal part of postnatal recovery, occurring after both vaginal deliveries and C-sections, and often resembles a heavy menstrual period initially. Because blood naturally pools in the uterus before being expelled, the formation and passing of small blood clots are common and expected during this initial phase of healing.
The Definition of Normal Postpartum Clotting
A small amount of clotting in the lochia is a standard finding as the body heals the site where the placenta was attached to the uterine wall. For the first one to two weeks after birth, it is normal to pass occasional small clots. A helpful benchmark for size is that a clot should generally be no larger than a quarter, or roughly the size of a grape.
These blood clots often appear when a person first stands up after lying down or sitting for an extended time. This sudden rush happens because blood has pooled and clotted within the vagina, and gravity helps expel it once the body changes position.
The color of the lochia indicates healing, beginning as bright or dark red (lochia rubra). Over the first week, the discharge transitions to a pinkish-brown or watery consistency (lochia serosa). By about ten to fourteen days postpartum, the lochia eventually becomes a creamy, yellowish-white discharge (lochia alba). Small clots should become less frequent and smaller as the flow lightens and the color changes.
Understanding the Causes of Postpartum Clots
The primary reason for postpartum bleeding and clotting is uterine involution. This describes the uterus contracting and shrinking back down to its pre-pregnancy size over several weeks. After the placenta detaches, it leaves an open wound that must heal, and the uterine muscles contract to compress the blood vessels in that area.
The body sheds the excess lining and tissue built up during pregnancy, which is expelled as lochia. When uterine contractions slow the flow of blood, the blood has a chance to coagulate inside the uterine cavity before release. Passing these small, soft, jelly-like masses confirms that the uterus is effectively cleaning itself out.
Hormones also play a role, as the body releases oxytocin after birth, particularly during breastfeeding, which stimulates these uterine contractions. These contractions cause mild, period-like cramping, sometimes called “afterpains.” This cramping can cause a gush of blood and clots to be passed, confirming the body’s natural healing mechanisms are functioning.
Urgent Warning Signs Associated with Clots
While some clotting is normal, certain signs indicate excessive bleeding or a potentially serious thrombotic event. The most immediate concern related to uterine bleeding is postpartum hemorrhage (PPH), which involves heavy blood loss up to twelve weeks after delivery.
Signs of Postpartum Hemorrhage (PPH)
One clear warning sign is passing clots that are consistently larger than a golf ball or egg. Another sign of PPH is saturating more than one full menstrual pad in an hour for two or more consecutive hours. This heavy flow, especially if accompanied by a return to bright red bleeding after the lochia had lightened, requires immediate medical attention. Symptoms related to severe blood loss include feeling dizzy or lightheaded, a rapid heart rate, or feeling faint.
Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE)
Beyond lochia clots, a different type of dangerous clot can form in the deep veins of the legs, known as deep vein thrombosis (DVT). Symptoms of DVT include localized swelling, severe pain, redness, or warmth in the calf or thigh. A pulmonary embolism (PE) occurs when a clot travels to the lungs, presenting as sudden chest pain or trouble breathing. These signs, which may also include a rapid heart rate, require emergency medical evaluation.