After childbirth, vaginal bleeding and blood clots are a common and expected part of the body’s natural recovery. Understanding what is normal during this postpartum period can alleviate concerns. This article explains the nature of postpartum bleeding and clarifies what size and type of blood clots are healthy.
The Nature of Postpartum Bleeding
The vaginal discharge after childbirth is lochia, representing the body’s healing process. Lochia consists of blood, mucus, and uterine tissue, including remnants of fetal membranes and the uterine lining where the placenta attached. The uterus, expanded during pregnancy, contracts to shed this material and shrink back to its original size.
Lochia progresses through several stages, changing in color and consistency over weeks. Initially, lochia rubra is bright or dark red and heavy, often lasting three to four days after birth, similar to a heavy menstrual period. This phase may include small clots. Around four to twelve days postpartum, the discharge transitions to lochia serosa, which is thinner, more watery, and pinkish-brown, with a lighter flow and fewer clots. The final stage, lochia alba, usually begins around day 12 and can continue for up to six weeks, appearing yellowish-white with minimal to no blood or clots.
What Constitutes a Normal Blood Clot
Passing blood clots after birth is normal as the uterus expels remaining tissue and blood. In the initial 24 hours following delivery, it is common to pass clots resembling the size of a grape or prune. Some clots during this early period can be larger, up to the size of a golf ball. These larger clots often occur when getting up after lying down, as blood can pool in the vagina and then be released.
Normal blood clots have a jelly-like texture and are bright red, darkening as bleeding subsides. The frequency and size of clots should decrease significantly over the first few days and weeks postpartum. While occasional small clots may still be present during the lochia serosa stage, they should be much smaller than those seen immediately postpartum. Breastfeeding can also trigger uterine contractions, potentially leading to increased bleeding or the temporary passage of small clots.
Recognizing Abnormal Clots and Bleeding
While some blood clotting is normal, certain signs indicate medical attention is necessary. Warning signs include passing blood clots larger than a golf ball, especially if occurring frequently or more than 24 hours after birth. Soaking through more than one sanitary pad per hour for several consecutive hours also indicates excessive bleeding.
Other symptoms include bright red bleeding that does not lighten, especially after the third day postpartum. A foul odor from the vaginal discharge, differing from lochia’s normal musty or metallic smell, could signal an infection. Accompanying symptoms such as fever, chills, dizziness, a racing heart, blurred vision, or severe abdominal pain require urgent medical consultation, as these can be signs of complications like postpartum hemorrhage.