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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.
After pains – these are cramps or pains in the lower pelvis (area between your hips) which may occur as your womb (uterus) ‘contracts’ allowing it to shrink to its normal size and position.
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.
After pains
Caused by an increase in the hormone oxytocin; after pains can vary from mild, period-type pains to something similar to labour contractions. After pains become less frequent and less uncomfortable after a few days, but can continue for about seven to ten days. You should discuss appropriate pain relief (analgesia) with your midwife.
Postnatal blood loss (lochia)
Everyone is different, however, the blood loss (lochia) 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 (lochia) that you can generally expect for the first six weeks. If you have any concerns, you should discuss them with your midwife or GP.
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.
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.
It’s important to remember to:
• remove jewellery and your watch before washing your hands
• keep your nails short
•avoid touching stitches, wound dressings, drips or catheters unnecessarily
When washing your hands remember to concentrate on your:
• nail beds
• thumbs
• palms
• back of the hands
• wrists
Wash your hands for around 20 seconds.
Here is a useful video on the best way to wash your hands:
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 (lochia) 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 have than a 7cm stain on your sanitary towel. It should now be soaked at any time. |
| 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 (lochia) 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 (lochia) 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. However, if you are worred, contact your GP or Health Visitor. |
| 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. |
When should you worry?
If any of the following are present:
- Unable to wake (unrousable)
- Your bleeding is bright red and is flowing constantly soaking your pad and clothes.
- You have signs of sepsis
You need urgent help.
Go to the nearest Hospital Emergency (A&E) Department or phone 999
If any of the following are present:
- You pass any large clots (the size of a 50 pence piece or larger)
- You repeatedly pass clots larger than the tip of your finger after the first 24 hours
- You are completely soaking a maternity pas (sanitary towel designed for use after giving birth) within an hour
- Your blood loss becomes heavier than it was initially or continues as a heavy or moderate loss for longer than a week
- Your blood loss develops an unpleasant smell, despite having recently had a bath or shower and changed your sanitary towel (pad). Your blood loss might also have changed in colour from what you have been experiencing.
- You have 'flu like symptoms: sore throat, headache, diarrhoea, shivering or muscle pain.
- You feel breathless or faint on normal exertion (walking to the toiler, getting dressed etc).
You need to contact a doctor or midwife today.
Please ring your GP surgery or call NHS 111 - dial 111
If any of the following are present:
- Vaginal blood loss has a very slight metallic smell
- Your blood loss matches the description in the table 'Guide to colour and amount of bleeding in the days/weeks after the birth of your baby' 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.
Self care
If you are still concerned about your blood loss, contact your Community Midwife or call NHS 111 – dial 111
