Experiencing bleeding around four weeks postpartum can worry new mothers. Understanding the different phases of postpartum bleeding and what to anticipate is helpful for navigating this significant recovery period.
Understanding Postpartum Bleeding
Postpartum bleeding, medically termed lochia, is the vaginal discharge that occurs after childbirth. It is a natural process through which the body expels the uterine lining, blood, mucus, and tissue that supported the pregnancy. Lochia helps the uterus return to its pre-pregnancy size and state.
Lochia follows a typical progression in appearance and volume. Initially, it is bright or dark red, heavy, and may contain small clots, a phase known as lochia rubra, which lasts for the first three to four days. Following this, the discharge becomes thinner and pinkish-brown, termed lochia serosa, usually lasting from about day four to day twelve. The final stage, lochia alba, is a creamy, yellowish-white discharge with little to no blood, which can persist for up to six weeks or sometimes even eight weeks after delivery. This gradual change in color and consistency indicates the uterus is healing and shrinking.
Common Reasons for Bleeding Resurgence at 4 Weeks
It is common for postpartum bleeding to fluctuate and sometimes increase or return around four weeks after childbirth as a normal part of recovery. One common reason for a temporary increase in lochia is increased physical activity. As new mothers gradually resume daily routines and become more mobile, uterine contractions that help expel lochia can be stimulated, leading to a heavier flow.
Hormonal fluctuations also play a role in the changing pattern of postpartum bleeding. The body undergoes significant hormonal shifts as it adjusts from pregnancy, influencing the shedding of the uterine lining and causing variations in lochia. Some individuals may also experience the early return of menstruation around this time. This is often not a true menstrual period, but rather the expulsion of the last remnants from the uterus, which can present as reddish or brownish bleeding, sometimes with clots.
Recognizing Concerning Symptoms
While fluctuations in postpartum bleeding are common, certain signs indicate the bleeding may not be normal and require immediate medical attention. Key signs include excessively heavy bleeding, defined as soaking through more than one sanitary pad in an hour for several consecutive hours. Passing large blood clots, especially those larger than a golf ball or plum, also warrants concern.
Other symptoms signaling a potential complication include a foul-smelling vaginal discharge, which can indicate an infection. A fever (over 100.4 degrees Fahrenheit or 38 degrees Celsius) or chills, particularly when accompanied by abdominal pain, can also point to an infection like endometritis. Severe abdominal pain or cramping not relieved by medication, dizziness, lightheadedness, blurred vision, or a racing heart rate are additional symptoms requiring prompt medical evaluation. These could be signs of a more serious condition like postpartum hemorrhage or retained placental tissue.