After birth, the body undergoes a significant healing process, which includes the natural expulsion of blood, tissue, and clots from the uterus. This experience, while common, often raises questions for new parents about what constitutes normal bleeding and what might be a cause for concern. Understanding these changes is an important part of postpartum recovery.
Understanding Typical Postpartum Bleeding
The vaginal discharge after childbirth is known as lochia. It is a normal part of the body’s recovery as the uterus heals and returns to its pre-pregnancy size. Lochia typically lasts for several weeks, often up to six, though it can persist for up to eight weeks. Its appearance and consistency change over time, progressing through distinct stages.
Initially, for the first three to four days, lochia is bright or dark red and may be heavy, similar to a menstrual period. This stage, called lochia rubra, commonly includes small blood clots. These normal clots are generally no larger than a grape or plum, and they often have a jelly-like consistency. You might notice more noticeable clots or a heavier flow after periods of rest or during physical activity, as blood can pool in the vagina and then be released.
Following the initial heavy flow, lochia transitions to a pinkish-brown color and becomes more watery, a stage known as lochia serosa, which can last from day four up to twelve days postpartum. During this phase, clotting is typically minimal or absent. The final stage, lochia alba, begins around day 10 to 14 and can last for several weeks, characterized by a creamy, yellowish-white discharge with little to no blood or clots. Normal lochia has a stale, musty, or metallic odor, similar to menstrual blood, but should not smell foul.
Recognizing Concerning Clots and Symptoms
While some bleeding and clotting are expected after birth, certain signs indicate a need for immediate medical attention. A blood clot larger than a golf ball or lemon is generally considered concerning. Passing several large clots in a short period, especially if golf-ball sized, also warrants evaluation.
Beyond clot size, other symptoms can signal a potential complication. Soaking through more than one maxi pad per hour for two or more consecutive hours is a significant warning sign of excessive bleeding. Persistent bright red bleeding that does not slow down or appears to increase, even after the first few days, is also concerning. Foul-smelling vaginal discharge can indicate an infection.
Sudden or severe abdominal pain or cramping that does not ease could be a sign of complications. Symptoms of excessive blood loss or shock, such as dizziness, lightheadedness, weakness, feeling faint, rapid heartbeat, or pale and clammy skin, require urgent medical care. These signs, especially when combined with heavy bleeding or large clots, may indicate conditions like postpartum hemorrhage or infection, which need prompt diagnosis and and treatment.
Factors Contributing to Abnormal Clotting
Excessive bleeding and larger-than-normal blood clots after birth can stem from several medical conditions. One common cause is uterine atony, which occurs when the uterus does not contract effectively after birth. Normally, uterine contractions compress blood vessels at the placental site, preventing excessive bleeding; if the uterus remains soft and boggy, these vessels continue to bleed freely.
Another factor can be retained placental fragments, meaning some part of the placenta remains inside the uterus after delivery. This can prevent the uterus from contracting fully, leading to persistent and sometimes heavy bleeding, and may be accompanied by fever or foul-smelling discharge. Uterine infections, such as endometritis, an infection of the uterine lining, can also contribute to abnormal bleeding and clotting, presenting with fever, pelvic pain, and unusually heavy or foul-smelling vaginal discharge.
Lacerations or tears in the birth canal, including the cervix or vagina, that did not heal properly or were not identified can also cause increased bleeding. This bleeding is often bright red and may persist even if the uterus feels firm. Underlying blood clotting disorders can also impair the body’s ability to form clots, leading to prolonged or excessive bleeding.
When to Contact Your Healthcare Provider
Prompt communication with a healthcare provider is important if you experience any concerning symptoms after birth. If you observe blood clots larger than a golf ball or lemon, or if you are soaking through more than one maxi pad per hour for two or more consecutive hours, contact your doctor, midwife, or emergency services immediately. These are key indicators that medical attention is needed.
When reaching out, be prepared to provide specific details about your symptoms. This includes the amount of bleeding, the size and frequency of any clots, and any other accompanying symptoms such as dizziness, pain, or changes in discharge odor. Medical intervention may involve medications to help the uterus contract, manual removal of retained tissue, or other procedures, depending on the underlying cause. Seeking timely professional advice is crucial for a safe and complete recovery during the postpartum period.