B is for Bleeding

After your baby is born you will experience a discharge called lochia which is comprised of blood, mucus, and uterine tissue.  This discharge is experienced by all new mothers whether they gave birth vaginally or via cesarean.  This bleeding is to clear out your uterine lining and usually lasts about six weeks, gradually decreasing and changing to more mucus over that time.  The first five to ten days your bleeding will be heavy (comparable to a heavy period), bright red, and have some small clots – this is known as lochia rubra.  If you have any clots the size of a golf ball or larger you need to let your doctor know right away.  After the first week your bleeding will become more pinkish or brownish, and the clots should decrease and become less frequent – known as lochia serosa.  By the end of the first six weeks the lochia should no longer contain blood and be only yellow or white mucus discharge – known as lochia alba.  If you had twins or triplets your bleeding will likely be heaver and longer.

You will have additional bleeding and discomfort if you had a tear or episiotomy.  If so, using a perineal squirt bottle can help with keeping the vaginal area clean.

At the hospital they will give you some lovely mesh underwear, a chux pad, and a heavy duty pad to wear to catch all the bleeding.  One thing I found immensely helpful was adult Depends.  I bought adult Depends for in case my water broke before going to the hospital so I wouldn’t make a mess in the car.  Having the extras for the postpartum bleeding was wonderful!  They feel so much more supporting than the mesh undies and they keep your regular underwear from getting bled on as well.  If you feel like they don’t have enough absorption you can put the hospital pad inside them instead of the mesh undies like I did.  These days adult diapers are so discrete no one will notice.  During this time of bleeding you can only use pads; tampons can lead to an infection.  Once the bleeding stops completely and your cervix is closed, it is safe to resume tampon use – so they are safe when you have your first period.  You also want to avoid swimming, sex, and inserting anything into your vagina during these six weeks to decrease your chance of infection.

The first few days, you will have small gushes of blood each time you breastfeed and every time the nurse gives you the lovely fundal massage.  You will also experience moderate to intense cramping during this time, known as afterpains.  The reason you will bleed more when nursing is because nursing releases oxytocin which stimulates the uterus to contract causing the small gush of blood.  This is a good thing, as it means your uterus is effectively contracting to return to its normal pre-pregnancy size.  Your uterus should be back to its pre-pregnancy size by six to eight weeks.

The more you move around in the first few weeks, the more you will bleed.  If your bleeding has diminished but picks back up you should consider slowing down and resting more.  When you stand you may also have a small gush of blood, this is common because the way it pools in your vagina while sitting.

If you have extremely heavy bleeding, this is considered a postpartum hemorrhage; this is rare and usually occurs in the first day.  However, it is possible to have a postpartum hemorrhage within the first twelve weeks – again, this is rare.  Once discharged if you soak through a heavy duty pad in under an hour or pass clots the size of or larger than a golf ball, call your doctor immediately and go to the ER.  This can cause your blood pressure to drop resulting in lack of blood flow to your organs causing you to go into shock.  Treatment may involve medicine, fundal massage, laparotomy, blood transfusion, or hysterectomy. 

Other reasons for concern include discharge with a foul smell, fever over 100.4 °F, bright-red or heavy bleeding in the second week, dizziness, or an irregular heartbeat.

Your first menstrual cycle after birth will vary.  This depends mostly on whether you are breast or bottle-feeding.  If you are bottle-feeding your first period may occur between six to twelve weeks after delivery, and the first few are likely to be irregular.  Breastfeeding typically delays the first menstrual cycle.  Some breastfeeding mothers won’t have their first period until they wean their babies, while others will have it return at the regular six to twelve week span.  The return may correlate with when your baby begins sleeping through the night.  I personally had mine return around the six month mark, so I had at least a small reprieve.  However, neither of my babies were sleeping through the night at that point!

Next week I will be blogging on the letter C… C is for Cesarean Recovery.