All women have some vaginal bleeding after giving birth. However, sometimes it can be hard to know what is considered normal and what might be too much.
It is normal to bleed for up to 6 weeks after giving birth, and this is independent of whether you delivered vaginally or by C-section. Every day, your bleeding should be getting less and less (the exception can be when you start being more active, as that can cause a brief increase in your bleeding). Additionally, your bleeding should go from being bright red blood to darker old blood, to eventually a brownish color before it stops completely.
Overall, here are the main reasons for postpartum bleeding—keep in mind that some are considered perfectly normal, while others are the sign that something is definitely wrong and you should seek medical care.
1. Normal bleeding as your uterus shrinks. As your uterus goes back to its pre-pregnancy size, you will experience normal postpartum bleeding. It may temporarily increase as you breastfeed, since the hormone that is released with nursing (oxytocin) also makes your uterus contract.
2. Your period has returned. This one is often completely forgotten, especially since you haven’t had a period for over 10 months! If it’s been 4-6 weeks since your delivery and your bleeding suddenly increases to that of a period, it just might be that. However, if you are exclusively breastfeeding your period shouldn’t return so soon, so be sure to check in with your doctor or midwife to make sure something else isn’t going on.
3. Part of the placenta was left in place. This is called retained placenta and occurs when part of the placenta remains stuck on the wall of the uterus. Symptoms can include heavier than normal vaginal bleeding, abnormal discharge, fevers, or abdominal pain (if an infection has occurred on top of this). An ultrasound can help confirm this diagnosis, and oftentimes this is treated with a surgical procedure called a D&C to remove the placental fragment.
4. Bleeding from a laceration or episiotomy. If any of these open up, they may begin to bleed again. A quick exam by your doctor or midwife can confirm this.
5. An infection in the uterus. Signs of a uterine infection are similar to #3. You may also feel achy all over or have nausea or vomiting, too. Definitely let your provider know if you feel this way so they can see you!
6. A blood disorder, such as a problem with clotting. Some blood disorders, both related and unrelated to pregnancy, can lead to increased postpartum bleeding and even a postpartum hemorrhage. One example is HELLP syndrome.
7. Increased activity (sex, exercise). The first time you exercise or have sex, you may notice that your bleeding picks up again. As long as it is not too heavy and you don’t feel dizzy from it, you should be OK. More than this means you need to rest and call your doctor or midwife.
8. Placental site involution. Around 2 weeks postpartum the site where your placenta attached can involute, or shed. This can lead to very brisk bleeding, but it is usually very brief (a few hours, for example). Still, if it’s heavier than soaking a pad an hour or you feel lightheaded, don’t be shy in calling your doctor so they can make sure all is well.
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