Why do we bleed after birth?
After we give birth to our beautiful bundles of joy, the work is not over – we still need to deliver the placenta, whole. On delivery of the placenta, its bed becomes exposed where blood vessels are left open as the uterus tries to contract itself back down to its normal size (roughly your fist). This makes for a lot of expulsion from the uterus where you’ll pass excess fluid, left over tissue and blood. This is known as your lochia.
Heavy bleeding after birth – post partum haemorrhage
Sometimes there are things that can get in the way of your uterus getting back into pre-pregnancy shape and when this happens there is a tendency for the uterus to bleed. If your uterus bleeds over 500ml of blood this is called post-partum haemorrhage.
There are two types of post-partum haemorrhage. The first occurs within the period immediately after delivery and up to the first 24 hours. This is why the healthcare team seem obsessed with how much blood you are losing and ask you over and over AND over. Luckily the team are usually on hand to look after this type of bleed if you are still in hospital.
The second type of post-partum haemorrhage happens anywhere within the 24hours to six weeks after the delivery.
By this time you are probably at home and your head is swimming with so much information and advice. Your primary goal at this point is to try to keep your little human alive. So much so, that some of us forget to look after ourselves and by extension, our uterus.
What is normal bleeding after a baby?
Your lochia makes many transitions in the time after you have a baby.
Week 1 – your lochia will resemble a heavy period where there may be small clots. If you are breastfeeding, you will probably notice an increase in flow after a feed. This is because breastfeeding triggers hormones that help your uterus contract back to its pre-pregnancy state.
Week 2-6 – you will notice your lochia change colour from red to pink and then to yellow to dark brown, diminishing in quantity.
When do I worry about my bleeding?
If at any stage you become worried about your bleeding, you should seek medical attention immediately. Here are some red flags that you may overlook:
1. Changing your pad every hour. This is an emergency and a sign of heavy bleeding, so please go to the hospital immediately as this can be life-threatening.
2. Passing large clots. The most common analogy being the size of a lemon.
3. You develop headaches, may feel tired, drained or thirsty all the time. People may comment on how pale you look. You may become short of breath or you may feel your heart racing in your chest.
4. Your lochia smells foul or has a green discharge.
5. You develop a fever or start to feel like you have the flu; muscle aches, feverish, sweating and tiredness.
What does this mean?
The most common cause of Type 2 heavy bleeding after pregnancy is a piece of tissue left behind from the birth, commonly placenta in the uterus. We doctors use the term Retained Products of Conception. The other common cause is infection.
This should make you seek medical attention.
What can I expect from my doctor?
After talking with you and performing an abdominal and internal examination, your doctor may order tests including a blood count and ultrasound in order to have a look and see what is happening in your uterus. Your doctor may also take some swabs during your internal examination to test for infection.
For some, your doctor will require you to have a procedure to explore the uterus and look for and remove any of these retained products. This is done under a general anaesthetic where any tissue removed will be sent to a lab.
Treatment plans will include a course of antibiotics according to the bugs identified from your swabs. It is important that you follow up with your doctor to get results from the swabs and ensure you are on the right course of antibiotics. Please finish the full course of antibiotics as prescribed by your doctor.
Depending on your blood count levels, your doctor may require you to receive treatment to boost your blood count. For some, increasing your dietary intake of iron is enough. For others, iron supplements or even an iron infusion (iron through a drip) is required. There are also some women who will need a direct blood transfusion.
Generally, your doctor will require you to come back in for follow up. This may include a follow-up blood test to check your blood count, an important part of your treatment plan.
In conclusion
It is just as vital to look after yourself post-birth as when you did during pregnancy. While those first few weeks are centred on your baby, it is just as important to take a quiet moment to check in with yourself and see how you are going. If you have any concerns, please do not hesitate to seek medical attention.
Jeni Wellington is a full-time mother of 2 and in her “spare-time” is settling into the family-friendly career of a GP. She is author and creator of the Betty Butter Blog, an avenue through which she shares her simplified recipes, budding interests in food photography and the general chaos that comes with being a working mum trying to have it all.
