Blood loss after your baby’s birth
Now that you have had your baby, your body will begin the process of recovering and healing from the experience of pregnancy and childbirth. Just as your body changed during pregnancy to meet the needs of your developing baby, it will now begin to return to its non-pregnant state. An important aspect of this process includes the uterus (womb) contracting down and reducing in size until it sits inside your pelvis again and cannot be felt abdominally. This process is called ‘involution’ and is often an exciting time because you can look forward to getting back into the clothes in your pre-pregnancy wardrobe! Involution is also associated with vaginal blood loss and this feature provides helpful information about what is considered ‘normal’ for the amount and colour of your blood loss during the six weeks immediately following your baby’s birth. It also includes information about the return of menstruation (your periods), and signs and symptoms to be aware of that might indicate your body is not recovering as it should be.
How quickly you recover from your baby’s birth varies between individual women and the type of labour and birth that was experienced. If you had a caesarean section or an assisted birth (with ventouse or forceps) for example, it can take you longer to recover. It is however, normal for all women who have given birth to lose blood from their uterus until its lining has renewed. This vaginal loss is also known as, ‘lochia’ and can last from anything between two and six weeks following your baby’s birth, usually varying in colour during this time. Immediately following the baby’s birth, your vaginal loss mainly consists of blood; therefore, it tends to be a bright red colour, but the colour and the amount change over time and is very individual. It is important to keep the vaginal area clean and to change sanitary pads when they become soiled, for hygienic reasons, but also for an indication if anything has changed – where you are using fewer pads, or where you find you are using more if the amount of loss becomes heavier again.
Vaginal blood loss following the birth, rather like the blood you lose when you’re having a period, has a distinct mild odour, which has a kind of metallic (iron-like) quality. It is a normal heavy smell, which tends to be more noticeable in the first two or three postnatal days, when the loss is heavier; it shouldn’t however, have an ‘offensive’ or bad/smelly odour. Some women will find that they continue to have a small vaginal blood loss for several weeks after their baby’s birth and the colour often tends to stay the same. Usually it is either a browny-red or pinky-red colour, which leaves only a slight stain on a sanitary pad. If you have a loss that returns to a brighter red colour again, it could be that your periods have re-started and you are fertile again. If you have not considered it already, you should be aware that if you have intercourse (sex) without contraceptive protection, you could become pregnant again. Should you feel in any way concerned about the colour or amount of your vaginal loss, you should always contact your midwife or doctor for their advice.
The amount of blood loss following childbirth can be affected by a number of factors, which will now be considered individually.
Where you are breastfeeding or expressing breast milk
When you are breastfeeding or expressing breastmilk for your baby, there is increased hormone activity, which helps your body to return more quickly to its non-pregnant state. The action of your baby suckling at the breast encourages the release of the hormone ‘oxytocin’. This hormone acts on your uterus, causing it to contract down. You might be aware of these contractions, which are more commonly known as ‘afterpains’, and in some women can feel quite uncomfortable, even painful. However, for other women these contractions are painless, the only sign that their uterus is contracting down being a slightly heavier blood loss on their sanitary pad, or a return to a red coloured loss during or just after breastfeeding their baby, or when expressing milk.
Going to the toilet
Once you’ve given birth, the prospect of going to the toilet, particularly to have the use of your bowels (a ‘poo’) can be quite daunting. Should you have any concerns or problems, it is important that you speak to your midwife or doctor who will be able to help and advise you. If you have a full bladder and/or are having problems passing urine or have become constipated and need to strain in order to empty your bowels, it is common for the blood loss from your vagina to become heavier, or a red colour for a while. This is because your uterus is positioned between your bladder (in front) and bowel (behind), so any fullness in either can restrict the uterus’s ability to contract down. However, once space has been made, because you’ve passed urine or opened your bowels, the uterus contracts down, which helps to expel/push out the blood. You may notice that you also feel cramp-like pains in your uterus or in your pelvis, generally, and you may also pass small red blood clots. These tend to settle down without causing any problems. All of these symptoms are perfectly normal and commonly experienced by a lot of new mums!
However, should any clots that you pass be found to be larger in size than a ten pence piece, or you notice that you are continuing to pass clots, or your blood loss has become heavier, it is important that you tell your midwife or doctor immediately. Wherever possible, whether at home or in hospital, try to keep heavily stained sanitary pads or any clots that you’ve passed, so that your midwife or doctor can check them. Sometimes a small piece of the placenta (afterbirth) or a tiny part of the amniotic sac (membranes) that nourished your baby while they were inside your womb can be left inside you. Your midwife or doctor will be able to check your pad to see whether or not this might be the case and will advise you accordingly.
As your body recovers from giving birth, you will feel ready to start increasing your level of physical activity. This might include taking your newborn for a walk in their pram, doing the grocery shopping, general light housework, or participating in postnatal exercise classes. Where there is increased activity, it is common to notice that the amount of blood loss on your sanitary pad has increased; it should however, remain the same colour. The colour can range from being a browny-red, to a more pinky-red loss, as opposed to being the bright red colour that is present during the initial few days after you’ve had your baby. Equally, if you have been resting for a while the blood loss from your womb may collect in your vagina and form into a clot; this then becomes dislodged and is passed once you start moving. Some women notice this when they first get up in the morning, or when they get up having been sat for a while feeding their baby. Passing small clots like this is quite normal and providing your blood loss following this does not increase, you do not need to be concerned.
When things aren’t as they should be
You may notice that your vaginal loss has an unpleasant smell, particularly, when you have only recently changed your sanitary pad, or have just had a shower or bath. It may also be that the colour of your loss has changed from how it was and you may also have pains in your lower abdomen, lower back and/or pelvis (these are different from the pains associated with being constipated or having afterpains). Sometimes, women can also start feeling shivery and unwell – a bit like having the flu. All of these symptoms can indicate that you have developed an infection. The infection could be inside your womb – this might be the case, where your waters broke a long time before your baby’s birth, or where your labour was long and there was a lot of intervention. Infection can also develop in the area around the vagina, particularly if you had tears or an episiotomy (a cut in the perineum). If left untreated, mild infections can cause serious illness, therefore, if you notice any of these symptoms, it is important that you tell your midwife or doctor immediately, so that they can check you over and organise the appropriate treatment straightaway.
The important thing to remember is that women are very individual and for this reason it can be difficult to predict how you will recover once you have given birth. Taking care of yourself, eating a healthy well balanced diet, getting as much rest and sleep as you can and allowing your body the time it needs to recover, will all help this process. Where you have any concerns at all, always contact your midwife or doctor for their advice.