Postpartum, women will excrete lochia or puerperal blood with quite a lot of volume (equivalent to the volume of menstrual blood) and then gradually decrease. In fact, this bleeding is a natural reaction of the body to expel the remaining blood, tissue and bacteria after delivery and therefore, this condition is completely normal. To find out whether the bleeding is normal or not, make sure you are able to identify the characteristics of normal postpartum bleeding and excessive postpartum hemorrhage (a rare condition but its effects are very dangerous). If you find an anomalous situation or symptom, contact your doctor immediately!
Step
Method 1 of 3: Identifying Normal Postpartum Bleeding
Step 1. Be prepared for heavy bleeding for three to ten days
About a week after giving birth, the vagina will bleed bright red with a very large volume. Most likely, at this stage you will also find several blood clots of varying sizes.
- In the first stage of postpartum bleeding, you will most likely need to change your sanitary napkin every three hours.
- Chances are, you'll also find one or two blood clots the size of a coin, and a few blood clots the size of grapes.
- If you do a cesarean section, chances are the volume of blood that comes out will be slightly more.
- Two to four days postpartum, the color of the puerperal blood should change slightly.
Step 2. Notice the color of the blood coming out
For three to ten days postpartum, the puerperal blood should be bright and dark red in color (the color will fade after about four days). After that duration, the blood color should fade to pink. After a few days, the color of the blood will turn brown and eventually turn yellowish white.
Step 3. Prepare for ongoing bleeding
While ideally you should only bleed heavily for three to ten days after delivery, it's likely that a light to moderate volume of blood will still come out for several weeks postpartum (up to about six weeks). Over time, the volume of blood should decrease and the color will fade.
- Most likely, the blood count and cramping intensity will increase slightly while you're breastfeeding (or shortly thereafter). Don't worry, this condition is normal because breastfeeding will indeed make the uterus contract.
- Most likely, the vagina will also continue to bleed (spotting) after six weeks if you start taking birth control pills. Discuss all possibilities with the doctor!
Step 4. Understand what is happening inside your body
Believe me, the fear that arises can be muted if you understand the natural events that occur in the body of a postpartum woman. After delivery, the baby's placenta will be separated from the uterus. As a result, the blood vessels in the area will open and cause bleeding through the uterus. After the placenta is expelled, the uterus will continue to contract to expel blood and any remaining tissue, fluids, and bacteria from your body. These contractions will likely last for six weeks postpartum, and will need to be done by the body to cleanse the uterus, close open blood vessels, and return to normal function.
- During pregnancy, the amount of blood in your body will increase by 50%. The increase in blood volume occurs because the body is preparing itself to expel postpartum blood.
- If your vagina was torn during delivery, or if you had an episiotomy (an operation in the perineal area to facilitate delivery), there's a good chance that blood will also come out of the tear or postoperative stitches.
Method 2 of 3: Knowing When to Call the Doctor
Step 1. Watch for large blood clots
Generally, puerperal blood will release small to medium-sized clots. Therefore, contact your doctor immediately if the blood clot that comes out is larger than a golf ball.
Step 2. Monitor pattern of use of sanitary napkins
One way to monitor blood volume is to observe the frequency of changing pads. Therefore, try to observe the pattern of using sanitary pads for three hours or more. Call your doctor immediately if for an hour, you need to use more than one pad.
- Instead, do not use tampons because of the risk of introducing bacteria into the vagina.
- Ideally, most of the blood will come out in the first few days and begin to decrease afterward. Call your doctor right away if your blood volume doesn't decrease after a few days!
Step 3. Observe the color of the blood
For a few days after delivery, the blood should be bright red in color. After about four days, the color should start to fade. Call your doctor immediately if after four days or so, the blood that comes out is still bright red.
Step 4. Watch out for any unusual odors
If the blood that comes out has a foul or unpleasant smell, you most likely have a postpartum infection because it should smell like postpartum blood, no different from the smell of menstrual blood. Call your doctor immediately if you find a pungent or unpleasant smell in the blood that is passed!
Generally, a woman who has a postpartum infection will also feel intense pain and have a fever above 38°C
Method 3 of 3: Identifying Excessive Postpartum Bleeding
Step 1. Understand that this condition is rare
In fact, excessive postpartum hemorrhage (PPH) is a fairly rare condition and only affects about 4-6% of women after childbirth. However, this condition is very dangerous and is even the main cause of death for women after childbirth. Therefore, make sure you recognize the various symptoms and risk factors to watch out for!
Step 2. Understand the medical conditions that can increase the risk of excessive postpartum bleeding
In fact, some medical conditions that affect the uterus, placenta, and blood's ability to clot will increase a person's risk for excessive postpartum bleeding.
- Medical conditions that affect the uterus include uterine atony (often called uterine atony), uterine inversion, and uterine rupture.
- Medical conditions that affect the placenta include placental abruption, a complication called placenta accrete/increta/percreta, and placenta pelvia (the placenta covering the cervix).
- Medical conditions that affect the ability of the blood to clot are von Willebrand syndrome and disseminated intravascular coagulation (DIC), and if you are taking anticoagulant drugs such as warfarin, enoxaparin, etc.
Step 3. Understand other risk factors
Indeed, various risk factors can increase a person's risk for excessive postpartum bleeding. If you have one or more of the factors below, your risk for excessive postpartum bleeding will increase, but that doesn't mean you will definitely experience it. Remember, this condition is actually very rare! Some risk factors you need to be aware of:
- Experiencing obesity
- Having a long labor (more than 12 hours)
- Perform an emergency cesarean
- Have anemia
- Have preeclampsia or have high blood pressure
- Have experienced excessive vaginal bleeding in a previous pregnancy
- Have a uterine infection (endometritis)
Step 4. Be aware of the symptoms
Excessive puerperal bleeding often occurs one day before a woman gives birth. However, in some cases the condition also occurs up to two weeks after the birth process takes place. Contact your doctor immediately for proper treatment if you experience the following symptoms:
- Heavy vaginal bleeding that doesn't go away or stops
- A drastic drop in blood pressure or startling symptoms such as blurred vision, clammy skin, very fast heart beat, fainting, or feeling very dizzy
- Pale skin
- Swelling and pain around the vagina and/or perineum
