New mothers often worry about postpartum bleeding, especially if it increases around two weeks. Understanding the typical progression of bleeding can help clarify what is normal and when to seek medical attention.
The Natural Progression of Postpartum Bleeding
After childbirth, the body undergoes a natural process of shedding the uterine lining, a discharge known as lochia. This process helps the uterus return to its pre-pregnancy size and state. Lochia is composed of blood, mucus, and uterine tissue.
The appearance and flow of lochia change over several weeks. Initially, it is bright or dark red and heavy, similar to a significant menstrual period, often containing small clots. This phase, called lochia rubra, usually lasts for the first three to four days. Around day four to twelve, the discharge becomes more watery and transitions to a pinkish-brown color, known as lochia serosa. The final stage, lochia alba, begins around day ten to fourteen and can continue for up to six weeks, appearing as a creamy, yellowish-white discharge.
Why Bleeding May Seem to Increase at Two Weeks
It is common for postpartum bleeding to appear to lighten or even stop, only to increase again around the two-week mark. This increase is often a normal part of the body’s healing. One reason for this is increased physical activity as new mothers begin to feel more able to move around.
Another factor is the ongoing process of uterine involution, where the uterus continues to contract and shrink back to its pre-pregnancy size. As the uterus contracts, it expels remaining blood and tissue. The area where the placenta was attached also forms a scab, and as this scab detaches, it can cause a temporary increase in bright red bleeding, sometimes called eschar bleeding. This temporary increase in bleeding is typically brief, lasting only a few hours.
When to Seek Medical Advice
While some fluctuations in postpartum bleeding are normal, certain signs warrant immediate medical attention. Very heavy bleeding, such as soaking through more than one sanitary pad per hour for several consecutive hours, is a concerning symptom. Passing large blood clots, especially those larger than a golf ball or a plum, also indicates a need for medical evaluation.
Other warning signs include a sudden return of excessive bleeding after it had lightened, or if the bleeding becomes bright red again and increases significantly. Seek immediate medical attention for symptoms such as:
Foul-smelling vaginal discharge
Fever over 100.4°F (38°C)
Severe abdominal pain
Dizziness
Lightheadedness
Rapid heartbeat
Understanding Other Potential Causes
Beyond the normal healing process, certain medical conditions can lead to abnormal postpartum bleeding and other symptoms. Retained placental fragments occur when parts of the placenta remain in the uterus after delivery. This can cause persistent heavy bleeding, the passage of large clots, fever, and foul-smelling discharge.
Postpartum infection, such as endometritis, involves inflammation of the uterine lining. Symptoms often include fever, lower abdominal pain, and a foul-smelling vaginal discharge. In some instances, it may also present with an increase in vaginal bleeding. Though less common, a uterine tear or laceration can also cause excessive bleeding after childbirth.