What is Postpartum Bleeding?
Postpartum bleeding, also known as lochia, is a normal part of healing after giving birth.
Shortly after your baby is born, the placenta that was firmly attached to your uterus via many blood vessels begins to separate and detach itself. After the birth of the placenta (usually 10-20 minutes after the baby), what’s left inside your uterus is essentially a large wound the size of a dinner plate.
Oxytocin – the hormone of labor and birth is also a key player during the immediate postpartum. In the first few days and weeks after birth, every time your baby latches onto your breast, oxytocin is released. This not only pumps your body full of endorphins to endure round-the-clock newborn care, but it also contracts your uterus (felt more as menstrual-like cramping in the first few hours and/or day). This involution process helps close the placental wound and reposition the uterus back down into your pelvis.
During the postpartum period, it’s normal to bleed vaginally for 4-8 weeks (depending on the mode of delivery).
For the first few days and/or weeks, your bleeding aka lochia (which contains blood, mucus, and uterine tissue) will be bright red and heavy in amount. Then it slows to a more medium flow that is darker in color and lasts a few weeks. The final phase of bleeding will be a scant amount of light pink and/or colored discharge for 1-2 weeks.
Every day the amount of lochia should be going down. However, let your bleeding be your barometer! This will dictate what and how much activity is appropriate for you in the days and weeks after giving birth.
How to support this normal recovery?
Spend 7 days in the bed, 7 days on the bed, and 7 days around the bed. The slower you take it initially, the quicker you will ultimately recover. While some may feel physically and emotionally well in the days after birth, the body requires one to slow down and give it the recovery time it needs. When you expend energy in the form of even a simple task of going up and down a set of stairs for example, your body runs out of steam in holding your uterus closed. As a result, your uterus opens which takes pressure off the placental wound and you bleed more.
Given the recommended time off your feet, it’s important to have a postpartum plan in place. (See previous Journal article “This Midwife Shares Why You Need A Postpartum Plan” for more.) This means organizing in person, hands on help to support the household while you focus on nourishing your baby and healing your body. Managing
expectations of eager grandparents, friends, and other family of what is needed (ie dishes, laundry, walking the dog, getting groceries, etc.) will reduce stress and risk of complications.
At around 2-3 weeks postpartum, you can start to slowly integrate normal household activities as well as start going for short daily walks. However, again, listen to your body and watch your bleeding.
How much bleeding is too much?
The rule of thumb is if you soak through one pad (an overnight, heavy absorbent menstrual pad) in less than an hour or through two pads (one placed on top of the other) in two hours, then this is too much bleeding. Also, if you pass a blood clot larger than the size of a golf ball multiple times in a day. You may see a larger clot of blood when you get up to pee for the first time in the morning after laying down all night as blood can pool in the vagina and coagulate. Best to always check in with your provider though. In the meantime, a sure way to slow the bleeding is to get off your feet, nurse and cuddle your baby for the rest of the day. This helps release oxytocin which will initiate a nice squeeze on your uterus and decrease stress hormones that tax your immune system.
As long as you are bleeding, you are at risk for infection. This means nothing goes inside your vagina (baths are okay) during this time. The most common type of infection is a breast infection called mastitis. While this happens usually as a result of a poor latch and trauma to the nipple, it can also happen to the mother who is physically doing too much too soon. The body does not lie and will, if need be, force you to slow down if other signs of recovery are ignored.
Once your lochia has stopped completely for at least one week, it is safe to resume routine physical activity, including more vigorous exercise and sex. As a side note, I strongly encourage one to seek out a pelvic floor physical therapist at this point to support your body as it continues to change in the first year postpartum.
This is a crucial time of not only rest and recovery but to also bond with your new baby and integrate a new experience. Honor the initiation of this fourth trimester by allowing yourself to be still and present to what is needed.
