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Blood Loss- what to expect after birth

Recovery from pregnancy and birth is different for all women. However, all women will experience some vaginal bleeding in the days and weeks after birth. It’s important that you know what is normal and when you should ask for advice from your midwife or doctor.

 

Postnatal blood loss (lochia) – it is normal for women who have given birth (either vaginally or via caesarean section) to bleed from their womb (uterus) until the lining is renewed. The medical name for this loss of blood is ‘lochia’. It is a combination of mucous, tissue and blood that is shed after birth as your womb replaces its lining.

 Everyone is different, however, the blood loss can last from two to six weeks and usually varies in both colour and amount during this time.

The table below will give you a guide to the amount and colour of blood loss that you can generally expect for the first six weeks. 

 

 Guide to colour and amount of Bleeding in the Days/weeks after the birth of your baby

 

The table below describes the normal amount and colour of blood loss as you would see it on a standard absorbent maternity towel:

Days / Week After Birth Guide to Colour Guide to Amount
The first day A fresh red or brownish-red blood loss

Quite a heavy loss, soaking a maternity sanitary towel every few hours.

You may have one or two quite large clots (the size of a tomato) or several smaller ones (about the size of a grape) during the first two to three days after the birth and have no further problems. While clots are not unusual, it is essential to discuss them with your midwife (showing them to your midwife whenever possible).
Days 2-6 Your blood loss should become either a darker brown or pinkish red in colour At first there will be a moderate amount of blood loss (lochia) (a 7-12cm stain on your sanitary towel). This should reduce towards day 6 (to a 5cm stain). You may also pass some very small clots (the size of your little fingernail or less) once or twice in the first 10 days. While this should be a cause for concern, it is important to discuss them with your midwife.
Days 7-10 Staying the same colour or becoming a lighter shade of brown or pinkish red. Getting less although still variable. For most of the time you should not have more than a 5cm stain on your sanitary towel. It should not be soaked at any time. As you start to become more active you may notice your blood loss increase slightly. This is normal however remember to rest and not be too active.
Days 11-14 Staying the same colour or getting lighter. If you are beginning to be more active, the colour might be redder than before. The amount will still be reducing and you may have some sanitary towels which are hardly stained.
Third and fourth weeks If blood loss is still present, it should be paler, possibly a creamy white colour. Continuing to get less with longer periods of very little or no blood loss at all. If the lochia has stopped by the second or third week and then a fresh red blood loss returns again, this could be your menstrual period restarting. Your first period after birth is likely to be heavier than you would usually experience.
At about 6 weeks A small or occasional loss of either brown, pinish red or a creamy yellow coloured blood loss (lochia) Some women continue to have a light, pale stain on their sanitary towel for several weeks; either all the time or some days only. If you have a loss that is a brighter red again, it could be your menstrual period re-starting. However, if you are worred, contact your GP or Health Visitor.

 

Red 

If any of the following are present:

  • Difficulty waking up / unable to rouse - cannot be woken up at all
  • Difficulty breathing or severe breathlessness
  • Vaginal bleeding that is getting much worse or heavy bleeding (bright red and flowing constantly, soaking your sanitary towel and clothes)
  • Any change to your speech including slurred speech
  • Any change to your thinking including confusion

You need urgent help.

Go to the nearest Hospital Emergency (A&E) Department or phone 999

 

Amber

if any of the following are present:

  • You are concerned about the amount of blood you are losing after reading the guide above
  • Your blood loss develops an offensive smell, despite having recently had a bath or shower and changed your sanitary towel (pad).
  • Fever
  • Extreme shivering or muscle pain; passing no urine (in a day); Skin mottled or discoloured

Please ring your maternity unit within the next hour

  • You feel breathless or faint on normal exertion (walking to the toilet, getting dressed etc).

You need to contact a doctor or midwife today.

Please ring your GP surgery or call NHS 111 - dial 111

 

Green

If any of the following are present:

  • Vaginal blood loss has a very slight metallic smell
  • Your blood loss matches the description in the guide above.
  • Your bleeding may be heavier in the morning or after a period of lying down as it pools in your vagina and will be passed when you stand up.
  • You experience a slight increase in bleeding after going out for a gentle walk or returning to chores such as shopping.
  • Your blood loss is heavier following a breastfeed

Self care

 If you are still concerned about your blood loss, contact your Community Midwife or call NHS 111 – dial 111

After pains

After pains following birth are normal and not a cause for concern. You may notice these are worse when you have had more than one child and during a breastfeed. You should expect after pains to improve day by day as your uterus returns to its normal size. Taking regular paracetamol (1g every 4 hours- hours- not exceeding 4g in 24hrs) and ibuprofen (300–400 mg 3–4 times a day) will help with the discomfort.

Reducing your risk of infection: the importance of clean hands

During the first weeks immediately after birth you are at an increased risk of getting a bacterial infection, so good hand hygiene is very important both in hospital and at home. Washing your hands before and after using the toilet/changing your sanitary towel is the simplest, cheapest and most effective way to prevent infection. Here is a useful video on the best way to wash your hands:

You are advised to use maternity towels rather than slim absorbent sanitary towels to allow:

• your perineum (area between your vagina and anus) to heal with minimal irritation

• a more accurate assessment of your blood loss

Use of tampons should be avoided to minimise your risk of an infection.