After childbirth, the body undergoes a significant healing process. Many people experience vaginal bleeding during this time, known as lochia. The term “placenta scab” is not a formal medical term, but it commonly refers to the wound left inside the uterus where the placenta was attached during pregnancy. This internal wound heals over several weeks, and the discharge from this healing process is the source of postpartum bleeding.
Understanding Postpartum Bleeding
Postpartum bleeding (lochia) is a normal process as the uterus sheds its lining and returns to its pre-pregnancy size. This discharge consists of blood, mucus, and uterine tissue, and it progresses through distinct stages, changing in color and consistency over time. The initial stage, known as lochia rubra, typically lasts for the first three to four days after delivery. During this phase, the discharge is often bright or dark red, resembling a heavy menstrual period, and may contain small blood clots. Soaking one thick maxi pad every two to three hours is considered a normal flow during this early period.
Following lochia rubra, the discharge transitions to lochia serosa, which usually lasts from about day four to day twelve postpartum. In this stage, the bleeding becomes lighter, appearing pinkish-brown and more watery. The flow is moderate, and there are typically fewer or no clots present.
The final stage of postpartum bleeding is lochia alba, which can begin around day 12 and continue for up to six to eight weeks after delivery. At this point, the discharge becomes yellowish-white, contains little to no blood, and has a light flow or is just spotting. This stage is primarily composed of white blood cells and mucus, signaling that the uterine wound is nearing complete healing.
Recognizing Concerning Bleeding
While some bleeding is expected, certain characteristics can indicate a potential complication from the placental site. One significant sign is excessive bleeding, such as soaking through more than one sanitary pad per hour for several consecutive hours. Passing large blood clots, especially those larger than a golf ball or plum, can also be a cause for concern. Normal clots during lochia rubra are typically smaller than a quarter.
A return to bright red, heavy bleeding after the discharge had already lightened is another symptom that warrants attention. This could occur around one to two weeks postpartum and may be associated with the “placenta scab” detaching. However, if this bleeding is heavy or prolonged, it needs medical evaluation. A foul odor from the vaginal discharge, unlike the typical stale or metallic smell of menstrual blood, can suggest an infection.
Other symptoms to watch for include fever, chills, or flu-like symptoms, which may signal an infection. Severe abdominal pain or cramping that does not respond to pain relief can also be a red flag. Dizziness, lightheadedness, blurred vision, or a rapid heart rate, especially when combined with heavy bleeding, can be signs of significant blood loss. These concerning signs may indicate issues such as retained placental fragments, where a piece of the placenta remains in the uterus, or uterine atony, a condition where the uterus does not contract effectively after birth to close off bleeding vessels.
When to Contact Your Doctor
It is important to seek medical attention if any of the concerning signs described above arise during the postpartum period. Contact a healthcare provider immediately for symptoms such as excessive bleeding, large blood clots, or a sudden worsening of discharge. Also seek prompt evaluation for signs of infection like foul-smelling discharge, fever, or chills, or for severe abdominal pain. Any signs of significant blood loss, including dizziness or a rapid heartbeat, require urgent medical care. Always consult a healthcare professional with any concerns about postpartum recovery.