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Why is my First Postpartum Period Persistent and Heavy?

After childbirth, many women experience a period-like time of bleeding known as lochia. Lochia is derived from a Greek word that translates to "relating to childbirth." This bleeding is completely normal and can persist for up to six weeks postpartum. During this time the color of the menstrual-like discharge can change from bright red to brown, pink or white.

  1. Cause of Bleeding

    • The detachment of the placenta from the uterine wall leaves blood vessels that once led into the placenta open. The uterus continues to contract after birth, and this eventually closes off the vessels and the bleeding ceases. Tears or an episiotomy may increase the amount of visible blood right after birth, but the bleeding will slow as these wounds heal.

    Normal Amount of Blood

    • During the first few days, the blood flow will consist of bright-red blood. Sudden movements that put pressure on the abdomen, or standing up from a sitting position may result in a rush of blood. This is all normal. There may be blood clots in the discharge as well, but so long as no clot is larger than a golf ball, there is no reason to worry. Blood flow heavy enough to fill a sanitary pad an hour or more should be reported to the doctor.

    Postpartum Hemmorhage

    • Postpartum hemorrhage (PPH) generally occurs within the first few hours after giving birth. Lacerations to the cervix, deep tears, or large episiotomies can all cause PPH. Rarely, a ruptured or titled uterus can cause excessive bleeding. Women with a genetic blood clotting disorder or preeclampsia may also be at risk for postpartum hemorrhage. During a hemorrhage, a physician will try to stop the bleeding by prompting the uterus to contract. This can be done with IV oxytocin (pitocin is also given to induce labor). If urination is inhibited, a catheter may be placed to keep a full bladder from placing pressure on the uterus.

    Further Complications and Intervention

    • If postpartum hemorrhage occurs within the first few days or weeks postpartum, it is known as late postpartum hemorrhage. The cause can be related to small pieces of placenta or amniotic sac left within the uterus, or an infection. If the bleeding becomes life-threatening, a mother may need to be hospitalized. A dilate and curettrage (or D&C) may be done to remove any material left within the uterus. In very rare cases, the uterus will need to be removed (hysterectomy).

    Other Factors

    • Breastfeeding releases oxytocin, a natural hormone that triggers contractions. Pain in the abdomen during nursing is common. This contracting can help slow the bleeding.

      The amount of lochia should decrease each day. Two to four days postpartum, the discharge will be pinkish in color with a watery consistency. Roughly 10 days postpartum, only a small amount of white or yellow discharge should remain. This is mostly made of white blood cells from the uterine lining.

      Starting birth control shortly after giving birth can increase the amount of bleeding that is experienced. The mini-pill, a progestin-only pill, and Depo-Provera are likely to increase bleeding a month or longer, according to the Baby Center website.

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