Postpartum Bleeding and Warning Signs After Delivery

Bleeding after childbirth is normal. It is called lochia, and it can last for several weeks. It starts heavy and red, then slowly turns pink, brown and finally yellowish-white.

What is not normal is sudden very heavy bleeding, large clots, a bad smell or fever. This guide shows you the difference so you know when to relax and when to call for help.

What is lochia?

Lochia is the discharge your body passes after birth as the womb heals and sheds the lining that supported your baby. Cleveland Clinic explains that it contains blood, mucus and tissue from the womb. It happens after both vaginal birth and cesarean birth. After a cesarean the bleeding is usually lighter, but it still continues for several weeks.

The three stages of lochia

1. Lochia rubra (first days): dark or bright red and heavy, like a heavy period, with small clots. It usually lasts at least three to four days. Cleveland Clinic says you may soak a thick maternity pad every two to three hours at first.
2. Lochia serosa (about day 4 to 12): pinkish-brown, thinner and more watery, with a lighter flow and few or no clots.
3. Lochia alba (from about day 12): yellowish-white with little or no blood, which can last up to about six weeks.

Overall, lochia usually lasts up to six weeks. It can occasionally last up to eight. The NHS gives a similar picture: bleeding is heavy and bright red at first, then reduces and turns brownish until it stops.

What can make bleeding look heavier?

It is common for bleeding to increase for a short time with physical activity, when you get up in the morning, or while breastfeeding. Breastfeeding makes the womb contract, which can push out more blood and cause period-like cramps. The NHS says this is expected. Bleeding that varies a little from day to day is not unusual, but it should follow a general trend of getting lighter.

Tip: keep a simple note of how many pads you use each day and the colour. It gives your doctor clear information at your check-up.

How to care for yourself during lochia

• Use thick sanitary pads and change them regularly. Wash your hands before and after.
• Avoid tampons and menstrual cups. The NHS advises waiting until after your 6-week postnatal check, because they can raise infection risk. Cleveland Clinic gives the same six-week advice.
• Rest as much as you can, and accept help with chores and cooking.
• Keep the genital area clean with water and dry it gently. Avoid douching.
• Avoid sex until your doctor says it is safe, often around six weeks.
• Remember that pregnancy is possible even before your period returns. Cleveland Clinic notes it can happen as early as three weeks after birth, so ask your doctor about contraception.

Warning signs of heavy bleeding

Sudden heavy bleeding after delivery is called postpartum haemorrhage. It needs emergency treatment. Seek help straight away if:

• The bleeding is sudden and very heavy
• You feel faint, dizzy or weak, or your heart is pounding
• You are soaking a pad about every hour for several hours
• You pass clots as large as a golf ball or bigger
• The bleeding is bright red and keeps flowing

When to be cautious: the NHS advises calling emergency services at once if bleeding is sudden and very heavy and you feel faint or dizzy or your heart is racing. Do not wait for your next appointment. Use our emergency page or go straight to the nearest hospital.

Warning signs of infection

The NHS and Cleveland Clinic say these can point to an infection of the womb or wound and need prompt review:

• A temperature above 38 degrees Celsius, or chills and flu-like symptoms
• Lochia with a foul or fishy smell, or a green colour
• Tummy pain that gets worse
• Worsening pain or swelling in the genital area or at a stitch or incision
• Redness, warmth or discharge at a cesarean wound (MedlinePlus)
• Bleeding that becomes heavier instead of lighter

Other bleeding patterns to mention to your doctor

• Red bleeding that lasts longer than a week, because it can mean the womb is not shrinking back as it should (Cleveland Clinic).
• Bleeding that stops and then starts again.
• After a cesarean, bleeding that is still very heavy like a period after more than 4 days, or light bleeding that lasts beyond 4 weeks (MedlinePlus).

These often have simple causes and treatments, but they need a doctor's check.

Other warning signs after delivery

MedlinePlus lists other signs to report quickly, including swelling or pain in one leg (a possible blood clot) and, rarely, signs of high blood pressure after birth such as a headache that does not go away, vision changes, or swelling of the hands and face. Feeling very low or having thoughts of harming yourself or your baby also needs prompt help. Read about this in postpartum depression signs and support.

What to expect at a check-up

Your doctor will ask about your bleeding, pain, temperature, feeding and mood. They may check your blood pressure, feel your tummy to see that the womb is shrinking, and look at any stitches or wound. Blood tests may be done if you have lost a lot of blood or feel very tired. Treatment depends on the cause and may include medicines or a procedure. Our postnatal and newborn care page describes this stage of care, and you can read our postpartum recovery guide for more.

When to see a doctor

Call your doctor or go to hospital without delay for any of the red flags above. You do not need to wait for your six-week visit if something feels wrong. Trust your instincts. If you are unsure, it is always fine to ask.

Talk to a doctor

If you have questions about your own situation, you are welcome to book an appointment or call us on +91 944 103 0587. Chaitanya Hospital in Kadapa offers 24/7 delivery and emergency care, and teleconsultation is available. This article is for general awareness and is not a substitute for a doctor's advice.