Having blood clots after childbirth is a normal part of the body’s recovery process. The body must shed the uterine lining built up during pregnancy, a discharge known as lochia, which includes blood, mucus, and tissue. As the uterus shrinks back to its pre-pregnancy size, it releases this material, leading to vaginal bleeding that can last for several weeks. Clots are typically passed in the first few days postpartum.
The Process of Postpartum Bleeding (Lochia)
Postpartum bleeding, or lochia, is the discharge that occurs as the uterus contracts to return to its original size. The bleeding originates primarily from the site where the placenta was attached to the uterine wall, which is essentially a large, open wound that needs to heal. This involves the shedding of the decidua, the specialized lining of the uterus during pregnancy.
Lochia follows a distinct progression, beginning with the heaviest flow, lochia rubra. This stage lasts for the first three to four days after delivery and is characterized by bright or dark red blood. Small blood clots are most common during this initial phase. The discharge then transitions to lochia serosa, a lighter, watery, pinkish-brown discharge that typically lasts until about day ten to fourteen postpartum. The final stage, lochia alba, is yellowish-white and very light, consisting mostly of white blood cells and mucus. Lochia can continue for up to six weeks after childbirth, gradually decreasing in volume and changing color.
Clots form when blood pools inside the uterus before expulsion. When a person lies down, the blood collects, allowing clotting factors to activate. When they stand up or change position, the pooled, coagulated blood is released, often resulting in a sudden gush of blood and clots.
Differentiating Normal and Concerning Clots
The size of a blood clot is the primary metric used to determine if it is within the normal range of postpartum recovery. A normal clot is small, typically no larger than a quarter or a grape. These smaller clots are expected, especially during the first week postpartum, as the body clears out the remaining tissue.
Clots requiring immediate medical attention measure larger than a golf ball or an egg. Passing a single, large clot may not signal a problem, but passing multiple large clots over a short period is a serious warning sign. If the size of the clots consistently exceeds the size of a golf ball, it may indicate the uterus is not contracting effectively to compress blood vessels at the placental site.
The frequency and timing of clot passage also provide important context. Passing clots intermittently, particularly when getting up after rest, is normal and related to gravitational pooling of blood. However, if the passage of large clots becomes frequent, or if the bleeding continues to get heavier, this suggests a complication.
Other characteristics of the lochia can indicate a potential issue. A foul or offensive odor, distinct from the normal metallic or musty smell of blood, may signal a uterine infection. If the lochia rubra stage (bright red, heavy bleeding) persists beyond the first week, or if the discharge reverts to heavy, bright red bleeding after having lightened, medical evaluation is warranted.
Recognizing Signs of Postpartum Hemorrhage
While some bleeding is normal, persistent, excessive bleeding is a sign of Postpartum Hemorrhage (PPH). A primary indicator of excessive blood loss is soaking through more than one full-sized maternity pad in an hour, continuing for two or more consecutive hours. Any blood loss accompanied by a sudden drop in blood pressure or other systemic symptoms should be considered an emergency.
Systemic warning signs accompany concerning bleeding and indicate the body is going into shock from blood loss. These symptoms include:
- A sudden increase in heart rate.
- Lightheadedness or dizziness.
- Feeling faint upon standing.
- Pale, cold, or clammy skin.
- Blurred vision or extreme weakness.
Postpartum hemorrhage can occur immediately after delivery or manifest as secondary PPH up to twelve weeks following childbirth. If you experience systemic symptoms alongside heavy bleeding or the passage of golf ball-sized or larger clots, seek immediate medical assistance. A fever or chills combined with pain and foul-smelling discharge may signal an infection requiring prompt care.