Okay, here’s the expanded question:: I’m a new mom, 3 days postpartum after a vaginal delivery with a second-degree tear. I know to expect bleeding, but I’m a little worried about what’s “normal” and what might be a sign of a problem like postpartum hemorrhage. Specifically, how much bleeding is considered normal in the first few days, weeks, and even up to a couple of months after giving birth? What colors and consistencies are typical at different stages of postpartum bleeding (lochia)? What are some red flags that would indicate I should contact my doctor or go to the emergency room, such as the size of clots or frequency of pad changes? I’m also curious if breastfeeding affects the amount or duration of postpartum bleeding.
Answer
The bleeding after giving birth, called lochia, is considered normal for up to six weeks postpartum. The amount and color of lochia change over time.
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Lochia rubra (days 1-3): This is the initial stage and consists of mostly blood, along with some fetal membranes, decidua (the lining of the uterus during pregnancy), and meconium (the infant’s first stool). The flow is heavy and bright red, similar to a heavy menstrual period. Some women may pass small blood clots.
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Lochia serosa (days 4-10): The flow decreases and becomes more watery and pinkish or brownish-red. It contains less blood and more serous fluid, white blood cells, and some cervical mucus. The amount of bleeding is moderate.
- Lochia alba (days 11-6 weeks): The lochia transitions to a whitish or yellowish-white color. It primarily consists of leukocytes (white blood cells), decidual cells, epithelial cells, cholesterol, and fat. The flow is light, and may stop and start.
What’s considered normal:
- First few days: Soaking one pad every 1-2 hours is common. Passing small blood clots (smaller than a plum) is also considered normal.
- Over time: The flow should gradually decrease in both amount and color intensity.
- Activities: The flow might increase temporarily after breastfeeding or physical activity due to uterine contractions.
When to seek medical attention:
- Heavy bleeding: Soaking one pad in an hour or less for two hours in a row.
- Large blood clots: Passing clots larger than a plum.
- Foul odor: Lochia with a bad smell can indicate an infection.
- Persistent bright red bleeding: If the bleeding remains bright red beyond the first few days or if it increases after becoming lighter.
- Other symptoms: Fever, chills, pelvic pain, abdominal tenderness, increased heart rate, dizziness, or blurred vision.
- Sudden decrease or absence of lochia: This may indicate a postpartum hemorrhage, or a retained placental fragment.
These symptoms can indicate a postpartum hemorrhage or infection, requiring immediate medical attention.