The period following childbirth involves many physical changes, and one of the most common is postpartum bleeding, medically known as lochia. It is natural to feel anxious when observing this bleeding, especially when it includes blood clots. This process is a necessary part of the body’s healing, signaling that the uterus is beginning its return to its pre-pregnancy state. Understanding this process can help manage concerns about the flow and the size of any clots.
Understanding Lochia and the Clotting Process
Lochia is the discharge of blood, mucus, and tissue that the body expels as the uterus recovers from pregnancy. This discharge is primarily composed of the decidua, the specialized lining of the uterus built up to support the pregnancy.
A large wound is left inside the uterus where the placenta detached from the uterine wall. To prevent excessive blood loss from the open blood vessels, the uterus, which is a powerful muscular organ, begins to contract. These contractions, sometimes felt as “afterpains,” compress the blood vessels, effectively sealing them off.
Clots form when blood pools within the uterus or vagina before being expelled, allowing the blood components to coagulate. The passing of these jelly-like masses of blood and tissue is an expected outcome of the healing process. The presence of small clots confirms that the body’s natural restorative functions are working correctly.
Identifying Normal Blood Clots After Birth
In the first few days following delivery, it is normal to pass small blood clots, particularly during movement. Normal clots are typically no larger than the size of a grape or a dime. These occasional masses are simply blood that pooled in the vagina while lying down or sitting, which is then released when you stand up.
The consistency of normal clots is often described as gelatinous or jelly-like. They may contain small pieces of tissue or mucus from the uterine lining being shed. While the flow is heaviest in the first 24 to 72 hours, the size and frequency of these small clots should gradually decrease over the first week postpartum.
It is common to notice a brief increase in bleeding or the passage of a small clot after breastfeeding or increased physical activity. This temporary change occurs because the hormone oxytocin, released during nursing or exercise, triggers stronger uterine contractions. The flow should quickly return to a lighter state.
Immediate Warning Signs and Abnormal Clotting
While small clots are expected, a change in size or frequency can signal that the uterus is not contracting effectively or that blood loss is excessive. Clots that are consistently larger than a golf ball, or about the size of a lemon, require immediate medical attention.
Passing multiple large clots within a short time frame is a significant warning sign. If you are soaking through more than one full-sized maternity pad in an hour for two or more consecutive hours, this saturation rate indicates excessive blood loss. Bleeding that suddenly returns to a heavy, bright red flow after it had already lightened is also concerning.
Other symptoms accompanying heavy bleeding or large clots require an immediate call to your medical team. These include feeling dizzy, lightheaded, or faint, which can be signs of significant blood loss. A rapid heart rate, fever, chills, persistent abdominal pain, or a foul odor from the discharge can indicate an infection or other complication.
The Postpartum Bleeding Timeline
The progression of lochia follows a predictable timeline, with changes in color and volume. The first stage, known as Lochia Rubra, lasts for about three to four days immediately after birth. The discharge is bright red or dark red, and the flow is similar to a heavy menstrual period, often including small clots.
The second stage is Lochia Serosa, which typically lasts from day four to around day ten postpartum. The discharge becomes much lighter in flow and transitions to a pinkish-brown color, containing more serum and less blood. Clotting should be significantly reduced or absent during this stage.
The final stage is Lochia Alba, which can last from the second week up to six weeks postpartum. The discharge is minimal and changes to a yellowish or whitish color, consisting mainly of white blood cells, mucus, and tissue debris. By this point, all clotting should have ceased.