The postpartum period involves significant physical changes as the body recovers from pregnancy and childbirth. This recovery naturally includes bleeding and the passing of blood clots, which can be alarming to new parents. Understanding the difference between these normal symptoms and urgent warning signs is important for a safe recovery. This article clarifies what is typical during the first weeks after delivery and identifies indicators of complications, such as retained placenta and excessive clotting, that require medical attention.
Understanding Retained Placenta
A retained placenta (RP) occurs when the placenta, or fragments of it, remain inside the uterus after delivery. Normally, the placenta detaches from the uterine wall and is expelled during the third stage of labor, typically within 30 minutes of birth. When this process fails, the placental tissue prevents the uterus from contracting fully, leaving blood vessels open and leading to severe blood loss.
RP is a major cause of postpartum hemorrhage (PPH), which can be immediate or delayed. Secondary PPH happens between 24 hours and up to 12 weeks after delivery when the body attempts to expel remaining fragments.
Signs of RP include sudden, heavy vaginal bleeding that starts after the initial flow had lessened. Other symptoms are a persistent fever, suggesting infection (endometritis), or a foul-smelling discharge. The uterus may also fail to return to its pre-pregnancy size, known as subinvolution, because the retained tissue impedes contraction.
Normal Postpartum Bleeding and Clotting (Lochia)
The vaginal discharge after childbirth, known as lochia, is a normal part of the healing process. This discharge is a combination of blood, mucus, and tissue shed from the uterine lining. Lochia generally lasts for up to six weeks, though the color and flow change significantly over that time.
The first stage, lochia rubra, is heavy and bright or dark red, lasting for the first three to four days. It is normal to pass small blood clots during this phase, especially when standing up after rest. These clots are usually smaller than a quarter or a grape.
The flow then transitions into lochia serosa, which is pinkish-brown and watery, lasting from days four through twelve. The final stage, lochia alba, is a yellowish-white discharge that continues for several weeks. A temporary increase in red bleeding can occur with physical exertion or during breastfeeding, but this should quickly subside.
Identifying Abnormal Clots and Hemorrhage Indicators
While small clots are expected, the size and frequency of clots are the clearest indicators of a potentially serious problem. The threshold for concern is passing a blood clot larger than a golf ball or egg. Passing even one clot of this size warrants immediate contact with a healthcare provider for evaluation.
Another warning sign is the saturation rate of sanitary pads, which indicates the volume of blood loss. Soaking through more than one full-sized sanitary pad in a single hour for two or more consecutive hours signals excessive bleeding. This heavy bleeding, particularly if it is a sudden gush of bright red blood, is a strong indicator of postpartum hemorrhage.
Physical symptoms that accompany excessive blood loss include feeling dizzy, light-headed, or faint, which are signs of a drop in blood pressure. A rapid heart rate, pale skin, and sudden shortness of breath also require attention.
Immediate Action and Medical Intervention
When warning signs like abnormally large clots or excessive bleeding are present, prompt action is necessary. If you pass a clot larger than a golf ball or soak more than one pad per hour, seek emergency care immediately, as rapid blood loss can lead to hypovolemic shock.
While awaiting medical help, gently massage the fundus (the top of the uterus) to encourage contraction. This technique involves firmly massaging the uterus with one hand above the pubic bone and the other on the abdomen. Uterine massage helps compress open blood vessels and reduce bleeding.
Persistent fever, foul-smelling discharge, or abdominal pain suggest a possible infection or secondary PPH. These symptoms should be reported to your doctor immediately, as they may indicate endometritis or retained fragments requiring treatment.