How long will you bleed after childbirth? How long does bleeding last after childbirth? Reasons to see a doctor

The birth of a child is a wonderful event for the family and a difficult physiological process for the mother, because her body undergoes serious changes. After the birth of the baby, the body gradually returns to its previous forms - the uterus returns to its original size, the reproductive system is restored and again prepares for possible conception.

As you know, a mother does not menstruate as long as she is breastfeeding, but this does not mean that there are no secretions at all. childbirth or lochia may continue for two months after. How long does bleeding last after childbirth, what should it be like, and how to distinguish a natural process from a pathology?

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Duration

When the discharge ends after the birth of a child is the most pressing question for women who have given birth.

Note! Lochia is a secretion that is different in nature from menstruation.

During the birth of a child, the placenta separates from the mucous membrane to which it was attached, and it begins to bleed.

The blood that comes out is postpartum discharge, to which are added the remains of the placenta, mucus and exfoliated epithelium.

They last longer than menstruation, usually during the healing period. In the hospital, this is controlled by doctors, and after discharge, by the woman herself.

How long does discharge last after childbirth? This is an individual process, depending on the speed of healing of the wound in the uterine cavity, its contraction and the rate of renewal of its inner lining. Generally recovery depends from:

• speed of uterine contraction;
• blood clotting rate;
• age;
• uterine conditions;
• physical activity.

If healing is active and not accompanied by complications, then in general it ends in 5-8 weeks, then the lochia also stops.

In appearance, lochia is very similar to menstruation, but its number gradually decreases per day from 0.5 l to 0.1 l.

Characteristic

It is extremely important to monitor the condition and color of the lochia, because these are indicators of how well the healing process is proceeding and whether there are complications. Natural in the first hours bad smell from the vagina, as well as an abundance of blood. Doctors are monitoring the woman’s condition and there is nothing to be afraid of, this is natural. The whole process of discharge after childbirth is divided into stages:

1. In the first day, secretions are extremely active - natural pathways are open, so it is important to maintain hygiene to avoid infection. In the first 7 days of lochia thick and bright(red or burgundy), mixed with mucus and blood clots. At this time, the uterus actively contracts and all remains come out of it.
2. 2-3 weeks: lochia decreases in number, they are no longer rich in color and without mucus. Necessary maintaining hygiene– this will help eliminate the smell. You can already use panty liners and change them after 4-5 hours.
3. 3-4 weeks: there is less blood, it is already light and odorless. The uterus has already stopped contracting, the pathways have closed, so there is no more pain.
4. 4-5 weeks: during this period, lochia usually stops, acquiring before that brown or completely odorless. Sometimes, due to the individual characteristics of the body, this takes up to 8 weeks. This is how long lochia can go.

How long does discharge last after childbirth? They usually end by the fifth week with rapid healing. But don't worry if they continue until 8 weeks - this is normal. You should be concerned if the bleeding stops in 2-3 weeks after childbirth. Usually this is not a good symptom of an existing problem, and a signal that you need to see a doctor. The reasons for this may be:

• uterine inflexion;
• constipation and a constantly full bladder;

It is worth noting that breastfeeding speeds up the recovery process. At the same time, the produced prolactin “freezes” the appendages and menstruation.

Composition and color

What color should the discharge be after childbirth? Lochia varies in characteristics:

1. Bloody: they appear on the first day and have a smell fresh blood. They are bloody in consistency, since they contain clots of dead tissue - this is where all the remains come out and the placenta is separated from the placenta and bleeds.
2. Serous ones are brownish-pink in color and they appear on the 5th day. At the same time, they smell unpleasant, and should carefully observe hygiene standards to avoid infections.
3. White - starts around day 10 and becomes more liquid than the previous ones. They do not smell and their number gradually decreases. White discharge after childbirth, there may also be natural functioning of the genitourinary system if they are homogeneous and odorless. If they have a cheesy consistency, smell sour and are accompanied by vaginal itching - this is a sign of: thrush, inflammation, pathology, impaired secretion of the uterine glands.
4. Brown - when the wound inside stops bleeding, lochia acquires dark shade. This is due to the release of old, already brown blood. They usually appear in the third week and last until 4-6 weeks.
5. Yellow is the norm at 5-8 weeks, when they signal the end of the recovery process and, sometimes, the beginning of the menstrual cycle. It is worth examining if they are accompanied by: an unpleasant persistent odor, itching, burning. This is most likely a sign of a spreading infection in the genitourinary system and it is very important to prevent it from passing into the uterus;
6. Purulent discharge after childbirth is a dangerous sign of inflammation, which can threaten health and life. You should immediately go to the hospital for help, especially if the temperature has risen. Very often this becomes a sign of endometritis - inflammation of the uterus and its mucous membrane.
7. Green discharge after childbirth is another sign of an inflammatory process. Accompanied by fever and pain, usually occurs if inside the afterbirth remains then bleeding may begin. Lochia of this color obliges a woman to immediately consult a gynecologist.

To avoid complications, a woman should avoid douching and using chemical contraceptives. It is important to maintain intimate hygiene and adhere to bed rest.

Appearance black suckers normal - this happens when their composition changes and the body experiences hormonal changes.

Deviations

When the healing process of the uterus is complicated, the woman begins to experience pain, the temperature rises and she begins to bleed with an uncharacteristic color and odor.

This should be the basis for a visit to the doctor. Exists several types of serious complications, but each of them is dangerous and can cause significant harm to the health and life of a woman:

1. Infections – the spread of infections is indicated by yellowish-green secretions with a rotten smell. Along with them, the temperature rises and severe abdominal pain begins. If you consult a doctor in a timely manner and undergo tests, the woman is given a diagnosis (the pathogen is identified) and treatment is prescribed that allows the body to overcome the infection and continue the recovery process.
2. – occurs when the muscles of the uterus are weakened. In this case, the woman is given oxytocin injection, which causes the uterus to contract rapidly.
3. Stagnation - the abdominal muscles are weakened, the uterus begins to tilt back and there will be a bend, which interferes with the flow of blood. Due to the accumulation of blood clots and unwanted mucus in the uterine cavity, inflammation occurs, which can lead to serious pathologies. In such a situation it is necessary restore lochia output, and for this, the gynecologist administers two drugs intravenously to the woman: Oxytocin - to enhance contractions; No-spa - to relieve cervical spasms.

To prevent stagnation, a woman should more often lie on your stomach do not engage in activities and drink plenty of water.

To avoid complications, you should strictly follow the doctor's instructions, observe hygiene standards and practice prevention.

Prevention

Prevention of complications primarily involves regular monitoring by a doctor. Only timely tests and examinations can prevent the development of serious pathologies. In case of stagnation or severe pain, the doctor will be able to prescribe drugs that accelerate contractions of the uterus and cleanse its cavity. To others prophylactic agents include:

1. 4-5 hours after birth, a woman is recommended to get up and start walking.
2. Necessarily do an ultrasound before discharge, to make sure that the cavity is clean from the placenta, and to monitor the process of its contraction.
3. Avoid heavy physical activity or heavy lifting in the first few weeks. It is best to lie on your stomach more and rest.
4. Be sure to observe hygienic care of the body and especially the vagina (wash every 4-5 hours, shower in the morning and evening).
5. Process the seam, if there is one.
6. Don't take a bath, since heating will increase blood flow and there is a risk of infection of the genitals.
7. Douching should not be done.
8. Use diapers or pads as hygiene products, but not tampons! Tampons block the exit from the uterus and delay the outflow of blood, which slows down the process of recovery and cleansing, and also creates the risk of inflammation. With the help of pads and diapers it is convenient to monitor the intensity and state of secretions.

Important! If the condition and color of the discharge changes, pain appears, or temperature rises, you should immediately call a doctor.

Useful video: how long can discharge last after childbirth?

Conclusion

How long does bleeding last after childbirth? - is actually not the most important question. It is much more important that they are normal color and consistency. Women should closely monitor their condition in the first two months after giving birth. It is this period that is dangerous due to the emergence of unexpected difficulties that can develop into pathology. Therefore, it is important to regularly see a gynecologist and undergo all the necessary tests, while simultaneously strengthening the immune system and the health of the body as a whole.

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After the birth of a child, lochia is secreted from the woman's genital tract for several weeks. Their number gradually decreases, which indicates wound healing after separation of the placenta. Many women are interested in the question: how long does bleeding last after a normal birth?

This is a very important factor, since it can be used to determine the degree of recovery of the body and deviations from the norm. Over time, lochia changes its composition and color. At first the woman is in the maternity hospital, but then discharged home.

If at first medical personnel monitor her condition, then in the future she must do this independently. The amount and nature of discharge indicates the state of health, so you need to notice deviations from the norm in time.

How long does it take to bleed after childbirth?

For 2 hours, the woman and the newborn are in the maternity ward. At this time, normal discharge is quite copious and bloody, but its total amount should not exceed 400 ml. To prevent complications such as bleeding, they can drain urine through a catheter, put ice on the stomach, and administer drugs intravenously to speed up uterine contractions.

These few hours are the most dangerous, because the muscles of the uterus are relaxed and contractions may not occur, and the onset of blood loss may not manifest itself in anything other than dizziness and weakness. So if these symptoms appear and the sheet/diaper gets wet quickly, you should urgently call a nurse.

Complications can also arise from ruptures of the tissues of the birth canal, so the obstetrician carefully examines the vagina and cervix, and if their integrity is damaged, take the necessary measures, that is, suturing the wounds. If the tear is not sutured completely, a hematoma may form, which is subsequently opened and re-sutured.

How long does bleeding last after childbirth?

The recovery process is successful if in the first 2-3 days the lochia is bloody in nature and quite abundant (up to 300 ml in 3 days). At this time, the gasket should fill completely in just 1-2 hours.

Lochia may have blood clots after childbirth, a musty odor similar to menstrual odor. Gradually their number decreases, and they acquire a brownish-red hue, intensifying with movement. They also appear on palpation of the abdomen.

To prevent bleeding, you must follow certain rules:

• Go to the toilet immediately when you have the urge to urinate. During the first 24 hours, you need to visit the restroom at least every 3 hours. An overfilled bladder interferes with the contraction process;
• Attach the baby to the breast at his first request. The fact is that when the nipples are irritated, oxytocin is released, the hormone responsible for contractions. Blood leaking after childbirth may increase during breastfeeding and be accompanied by cramping pain in the lower abdomen;
• Sleep and rest lying on your stomach. This position promotes the release of blood clots. The uterus may tilt posteriorly, but lying on your stomach will bring it closer to the abdominal wall. This way the outflow will improve;
• Place ice on your stomach several times a day, which will improve the condition of blood vessels and speed up contractions.

When the uterus is overstretched and labor is complicated, oxytocin injections are prescribed to stimulate contractions.

It is worth noting that an increase in the amount of discharge should be a reason to consult a doctor, because it may indicate late bleeding. This phenomenon can occur not only in the first days, but also several weeks after birth. So even at home you need to pay attention to how much fluid is released.

Late bleeding is usually caused by a stuck piece of placenta. Sometimes it is not diagnosed immediately after birth, then it leads to complications that can be detected during a vaginal examination or ultrasound. If the diagnosis is confirmed, the remains are removed under general anesthesia. At the same time, infusion and antibacterial therapy are carried out.

Sometimes this phenomenon occurs due to a blood clotting disorder, which can be caused by various diseases. Stopping such blood loss is the most difficult thing.

Most often, complications arise due to insufficient contraction of the uterine muscles. Bleeding after childbirth in this case is also painless, but very profuse. To stop it, reducing agents are administered, and blood loss is also replaced with intravenous fluids or blood products. If necessary, resort to surgical intervention.

Early cessation of lochia is also a reason to visit a doctor. Perhaps there is lochiometra - an accumulation of secretions in the uterine cavity. This pathology occurs when the organ is overstretched or bent backwards.

If this condition is not eliminated in time, endometritis will appear - inflammation of the uterine mucosa, because lochia is a good breeding ground for microbes. Treatment mainly consists of taking Oxytocin and No-shpa.

Blood after childbirth at home

So how much does one bleed after childbirth? The average time is 6-8 weeks. This is exactly the period required for the uterus to develop back after pregnancy and childbirth. The total amount of lochia ranges from 500 to 1500 ml.

In the first week, they can be compared to normal menstruation, only more abundant and with clots. With each subsequent day, their volume will decrease and their color will approach yellowish-white. By the end of 4 weeks they are very scanty, one might say spotty, and after another 14 days they should become the same as before pregnancy.

For those who breastfeed, they end earlier, since the uterus contracts much faster. But for women who have had a caesarean section, recovery is slower because the stitch interferes with the normal reverse process, and bleeding takes longer than usual.

What to do if there is bleeding after childbirth?

It is important to follow special rules of personal hygiene during the postpartum period. Lochia contains microbial flora, which, under favorable conditions, can contribute to the development of the inflammatory process. That is why it is necessary that the discharge does not linger in the uterus and comes out of it.

1. For your own comfort, use pads or special disposable panties. Change them every 3 hours. It is recommended to give preference to the soft surface of these products, because this way you can better determine the nature of the discharge. You should not take flavored ones, as they often cause allergic reactions. You should also not use tampons.
2. You need to wash yourself after every trip to the toilet. You can't take a bath, only shower. The genitals are washed only from the outside, from front to back. At this time, douching is not used to avoid infection.
3. It bleeds more during significant physical exertion, so it is not recommended to lift things that are too heavy.

It is necessary to seek medical help in the following situations:

• Lochia has acquired a purulent character and a sharp and unpleasant odor. These phenomena indicate endometritis. It is usually accompanied by fever and pain in the lower abdomen;
• Blood discharge has increased after it began to decrease or its volume is constantly large. These conditions may indicate that there is still an afterbirth in the uterus, which prevents the contraction of the organ and its restoration;
• Curdled vaginal discharge is a sign of yeast colpitis, which is popularly called thrush. Typically this disease is characterized by itching in the vaginal and labia areas. Sometimes redness of the skin in the groin occurs. The risk of developing thrush increases significantly when taking antibiotics;
• The blood stopped abruptly. This happens when the cervix is ​​blocked by a blood clot. This condition requires medical intervention. It is worth noting that the risk increases after a cesarean section;
• If you have to change several pads in an hour, this indicates severe bleeding. In this situation, you need to call emergency help.

The above complications do not go away on their own. Sometimes hospital treatment is required. Therefore, it is very important to seek help from specialists in a timely manner.

Bleeding after childbirth is a normal process during which the uterine cavity naturally rids itself of lochia and remnants of placental tissue. The very nature of the bleeding, its pain, severity and duration (duration) are always different, and can vary greatly from woman to woman. How long does bleeding last after childbirth? This question worries all young mothers, especially those giving birth for the first time.

All women know that without bleeding, childbirth is hardly possible. Everyone is concerned about the question: how long should the blood flow, how long will the blood flow after childbirth?

Blood can flow for several reasons.

1. Poor blood clotting parameters. This parameter is always individual in nature, and it often happens that blood flows out of the woman’s genital organs in small liquid streams, and there are no signs of the beginning of the coagulation process. This situation can be foreseen if the woman undergoes appropriate tests before giving birth.
2. Rapid (quick) birth, which caused serious injuries to the birth canal.
3. Incremental tissue of the placenta and membranes, which prevents normal contractions of the uterus. This also causes bleeding.
4. Inability of the reproductive organs to contract due to excessive tissue stretching caused by the large size of the fetus (either multiple births or polyhydramnios).
5. Some individual gynecological problems are fibroids, fibroids, long uterine recovery, problems with myometrial contraction.

How long does it take to bleed after childbirth? It's always different.

How long can bleeding last?

How long does bleeding last after childbirth? This depends on several factors:

• how the pregnancy progressed;
• when did the discharge start?
• how the birth took place - natural, or had to resort to stimulation;
• How natural are uterine contractions?
• whether there are any complications after childbirth;
• what is the general individual health status of the woman;
• what are the features of lactation (breastfeeding at the request of the child reduces the number of lochia and stimulates the contractile activity of the uterus);
• whether placenta accreta occurs.

Each of these reasons, to one degree or another, influences how long postpartum bleeding will last (continue).

Personal hygiene rules after childbirth

How much blood will bleed after childbirth largely depends on the woman’s compliance with a number of recommendations. To stop bleeding as quickly as possible and avoid possible complications, you need to follow several rules.

1. Go to the toilet regularly to prevent pressure from a full bowel and bladder on the uterus. The uterus should contract normally.
2. Maintain thorough cleanliness and hygiene to prevent infection.
3. Avoid any physical activity and sexual relations for at least one and a half months after childbirth.
4. When sleeping, try to lie on your stomach.
5. Establish a breastfeeding routine as much as possible.

How long it takes to bleed after childbirth is always an individual matter. Therefore, to the general standard requirements for each woman, an even longer list of recommendations can be added, the correct implementation of which determines not only the success of postpartum treatment of the woman’s body, but also the effectiveness of preparation for the next pregnancy.

Prevention and diagnostic procedures

Modern medicine makes it possible to timely assess the risks of postpartum hemorrhage. A woman should be examined during pregnancy for hemoglobin levels, red blood cell counts and platelet counts in the blood serum. It is necessary to determine the bleeding and clotting time. Then it will be possible to guess how many days the bleeding lasts after childbirth, how much blood can come out after childbirth. This procedure is required.

Norm and pathology

Normally, postpartum discharge from the uterus () lasts no more than 1.5 months. The woman does not experience much inconvenience from them. During the first 20 hours, blood may flow most intensely, and there is nothing to worry about. After a few days, the amount and intensity of discharge will begin to gradually decrease. If pregnancy and childbirth went well, and if after childbirth a normal lactation regime quickly established, then the mucous layer of the uterus will heal quickly.

• the blood flows dark red for more than three days;
• the discharge has acquired an unpleasant odor;
• the postpartum hemorrhage not only continues in the postpartum woman, but blood loss increases, and there is a need to change hygiene products every hour;
• the number of damages (ruptures) after childbirth does not decrease;
• the woman is very weak, her temperature is not normal, and even loss of consciousness is possible;
• bleeding does not stop after 6 weeks.

Normal bleeding

Postpartum hemorrhage is usually divided into several stages. The main differences are the color and intensity of the discharge. On the very first day after birth, blood flows profusely, the discharge is much larger than during menstruation, it has a bright scarlet color. On the first day after birth, bleeding occurs from the vessels that connected the placenta to the wall of the uterus. This is precisely the reason why blood bleeds profusely at first. How long can you bleed for the first time after childbirth? In a normal physiological state – no more than 4 days.

Pathology

To avoid complications after childbirth, you must be able to distinguish pathology from the norm.

• bleeds unevenly after childbirth - minor discharge is suddenly replaced by bright scarlet blood;
• 2 weeks after birth, not only bleeding, but also pain persists;
• The bleeding is still bright red a month after birth.

In what cases is medical help required?

When should you seek help from a doctor? Regardless of how much blood flows after childbirth, if the discharge becomes more frequent, heavier and redder, then immediate medical attention is needed. First of all, go to the gynecologist. Moreover, if the bleeding has not gone away and does not go away for more than 4 days.

Bleeding in the early postpartum period is a normal physiological process that should not frighten a woman. After the expulsion of the fetus and placenta, the uterus actively contracts, “pushing out” the remaining blood, clots and everything that remains in its cavity after childbirth. A few days after birth, the bleeding becomes less and is replaced by spotting - lochia. They will bother the woman for about 5-8 weeks, until the endometrium in the uterus has completely healed.

Lochia does not pose a danger to the female body, but it is necessary to constantly monitor their quantity and consistency so as not to miss the onset of true uterine bleeding.

Bleeding occurring during the postpartum period is one of the most common causes of death in women. In order not to miss time and seek medical help in time, it is important to know the signs by which pathological bleeding can be distinguished from normal discharge.

Important! The appearance of any of the signs (the main one is the need to change hygiene products every hour) indicating the possibility of bleeding, you must call an ambulance. Before her arrival, the woman must be placed on the bed with her legs slightly elevated. This position will help avoid large blood loss.

Lochia usually appears in a woman 2-3 days after childbirth. Until this point, bleeding is considered normal, but even here it is necessary to monitor the amount of blood released. If, while still in the maternity hospital, the postpartum mother has to change sanitary pads every 45-60 minutes, she must inform the midwife or nurse on duty about this.

Bloody discharge after the birth of a baby can normally last up to 8 weeks. In young women, the recovery process is faster, so for them this period is usually reduced to 5-6 weeks. A woman’s nutrition during the postpartum period plays a big role in this. In order for the endometrium to heal faster, you need to include the following foods in your diet:

• cold-pressed vegetable oils (premium class);
• nuts (Brazil, walnut, hazelnut);
• dried fruits (dried apricots, figs);
• greens (any type of greens and leafy salads);
• fatty fish;
• meat (veal, beef, lean pork and lamb);
• fruits and vegetables.

After the placenta is expelled, an open wound forms at the site of its attachment to the uterine wall, which bleeds until complete healing. In order for the damaged endometrium to heal faster, a woman needs to maintain a calm regimen, not lift heavy things or objects that exceed the weight of the baby, and include more foods containing vitamins E, A and ascorbic acid in the menu. Among the drinks, a decoction of rose hips and raspberry leaves is especially useful. Extracts contained in raspberry leaves stimulate uterine contractions and help to quickly cope with postpartum bleeding.

Bleeding increased a month after birth

Any change in the amount of discharge a few weeks after birth is an alarming sign that may indicate the development of serious diseases. If the amount of blood released increases sharply, you should consult a gynecologist. The doctor will conduct an examination, palpate the uterus, determine whether it is painful, and make a conclusion about the need for an inpatient examination.

Some mothers refuse the proposed hospitalization because they do not want to be separated from their baby. Under no circumstances should you do this, especially if the woman plans to have another child in the future. The most common pathology that occurs in women who have recently given birth is inflammation of the uterine mucosa (endometritis). This is a serious disease that can lead to infection of the organ and the onset of a purulent-inflammatory process. If bacterial organisms and toxins enter the systemic circulation, the likelihood of sepsis (blood poisoning) will be very high. In the absence of timely assistance and improper treatment, death is possible.

Note! Every year, about 11 thousand women around the world die from excessive blood loss after childbirth. According to experts, more than half of them could have been saved if they had gone to the hospital in time.

When should you see a doctor?

The postpartum period is a dangerous time when the likelihood of complications increases several times. A woman’s body is weakened by pregnancy and childbirth, and therefore cannot cope with stress, which becomes significantly greater after the birth of a baby in the house. If possible, during this period it is better to take the help of a grandmother, sister or friend who could take on part of the responsibilities for caring for the baby. If a woman has to cope with everything on her own, she must be attentive to her own body. It is necessary to contact an observing gynecologist in the following cases:

• the discharge has acquired a bright scarlet color;
• bleeding increased 2-4 weeks after birth;
• there is pain in the abdomen or lower back;
• the discharge has acquired an unpleasant odor;
• clots began to come out of the uterus;
• The temperature began to rise regularly.

Advice! In women who are breastfeeding, measuring temperature in the armpit is not very informative, especially in the first days after the birth of the child. If lactation has not yet been established, there may be an increase in temperature due to slight lactostasis, so postpartum women are advised to measure body temperature at the elbow.

Will the bleeding stop after a few days?

In some cases, a woman may notice that 4-7 days after giving birth, the discharge has stopped completely. This happens abruptly and is often accompanied by a deterioration in well-being. If such a situation arises, it is necessary to urgently go to the hospital, since the only cause of this phenomenon is hematometra (accumulation of blood in the uterus).

Blood can accumulate due to insufficient contraction of the uterus, so the woman is advised to take all measures to prevent this condition. The nurse will talk about this in detail after the woman is transferred to the postpartum ward. In order for the uterus to contract well, as well as to relieve swelling, young mothers need:

• lie down and sleep on your stomach more often;
• get out of bed more often and walk around the ward or along the corridor;
• put cold on the lower abdomen (heating pads or ice bottles can be found in the refrigerator compartment).

If it was still not possible to avoid the formation of hematometra, it is important to go to the hospital in time, since stagnation of blood in the uterus can lead to the spread of infection and inflammation in the organ cavity. The main symptoms of the pathology are cessation of discharge and severe nagging pain in the lower abdomen. When these symptoms appear, a woman should call an ambulance.

The doctor in the department will conduct an ultrasound scan, determine the exact diagnosis and, if confirmed, prescribe treatment. You can stimulate the uterus to contract using the hormone oxytocin, but most experts prefer a more effective method - surgical curettage or vacuum aspiration. Both procedures are quite traumatic, but their use is necessary to prevent dangerous complications.

Video - Postpartum period. Recovery. Ultrasound. Nutrition. Hygiene

Could bleeding be menstruation?

If the discharge stops 1-1.5 months after birth, and starts again a couple of weeks later, this may be early menstruation. If a woman is not bothered by nausea and dizziness, the temperature is normal, and the discharge is moderate, there is no need to worry. It is necessary to observe the situation for 3-5 days. Menstrual blood has a darker shade and a peculiar smell, so it is quite easy to distinguish between periods and bleeding.

Important! Some women believe that lactation is a 100% effective method of preventing unwanted pregnancy, and believe that menstruation cannot occur during breastfeeding. In 85% of cases this is true, but sometimes a woman’s menstruation begins 2 months after the birth of the child. During this same period, the ability to conceive is restored, so you need to take care of contraception if children are not in the plans of the new mother in the near future.

True uterine bleeding after childbirth is a rare complication, so do not panic if the discharge suddenly increases somewhat. This may be the result of increased physical activity or heavy lifting, so you need to calm down and adjust your work and rest schedule. But if too much blood is released and the woman’s condition worsens, medical attention is needed as soon as possible.

Having given birth to a child, a woman feels joy and relief. Now she can fully feel like a mother. But some troubles may arise that could overshadow this period. We are talking about postpartum bleeding. In most cases, everything is not as scary as it seems, because by this term many understand even scanty discharge that occurs normally. However, deviations from physiological indicators can pose a serious danger, which requires close attention from the woman in labor.

General information

The postpartum period begins from the moment the placenta with membranes leaves the uterus and lasts for 6 weeks. During this time, involutive (reverse) changes occur in the reproductive system and organs that have undergone changes during pregnancy. In other words, the female body gradually returns to its original state.

Immediately after birth, the inner surface of the uterus is an almost continuous wound surface. But due to the contraction of muscle fibers, its size is minimized. The uterus decreases in volume, sinking lower and lower into the pelvic cavity and by the 10th day it is already located behind the symphysis pubis. This is facilitated by breastfeeding, during which the hormone oxytocin is produced.

At the end of 2–3 weeks, the cervical canal also closes. But the mucous membrane - the endometrium - requires a longer recovery. The basal epithelium grows by 10 days after birth, and the complete formation of the functional layer will occur only towards the end of the entire period.

Normal changes

It is very important for women to know how long bleeding lasts after childbirth and how heavy it can be. The physiological discharge that is observed during this period is called lochia. In the first 2–3 days they are quite abundant and consist mainly of blood with clots. In general, the volume of blood loss in the afterbirth and early postpartum periods should not exceed 0.5% of a woman’s body weight. This is considered normal and cannot have a negative effect on the body.

But already at the end of the first week, the discharge becomes more scanty, acquiring a brownish tint. Only under the influence of certain factors, such as physical activity, sexual intercourse or straining, an increase in lochia is observed. Over time, they transform into bloody or yellowish, completely disappearing at 6 weeks. But if the bleeding drags on, becomes profuse, or resumes after a break, you should definitely consult a doctor. And the specialist will already determine what the reason is and give appropriate recommendations.

Physiological discharge is especially abundant during the first 3 days, and then it decreases and becomes less bloody.

Pathological processes

Postpartum hemorrhage is a serious obstetric pathology that poses a real danger to a woman’s life. It can occur in different periods, as reflected in the existing classification:

• Early – within the first 2 hours.
• Later - for the remaining 6 weeks after birth.

When a woman loses more blood than expected, it is necessary to figure out what is causing this and what measures to take. But this needs to be done in the shortest possible time.

Causes

The appearance of bleeding after childbirth is a rather ominous sign, indicating deviations during the physiological period or certain disorders in the woman’s body. The causes of this pathology are:

• Violation of the separation of the placenta and placenta (tight attachment, accretion, retention or pinching of individual particles in the uterus).
• Decreased contractility of the uterus (hypo- or atony).
• Disorders in the coagulation system (coagulopathy).
• Traumatic injuries to the genital tract.

It should be said that most of these conditions have their own predisposing factors and provoking aspects. They should be taken into account when carrying out diagnostic measures. For example, hypo- or atony of the uterus often occurs in women with accompanying phenomena and problems:

• Polyhydramnios, large fetus, multiple pregnancy (hyperdistension of the uterus).
• Tumor processes (fibroids, polyps).
• Late toxicosis.
• Anomalies of uterine development (saddle-shaped, bicornuate).
• Placental complications (presentation, true accretion, abruption).
• Neurohormonal disorders and endocrinopathies.
• Weakness of labor.
• Surgical interventions.
• Inadequate drug therapy (with the prescription of uterotonics, antispasmodics, tocolytics).

The causes of coagulopathic bleeding can be general diseases of the hemostatic system or hemorrhagic diathesis, which include hemophilia, von Willebrand disease, hypofibrinogenemia and others. But secondary conditions are much more important, in particular, DIC syndrome (disseminated intravascular coagulation). It develops under various conditions:

• Premature placental abruption.
• Preeclampsia (severe preeclampsia, eclampsia).
• Frozen pregnancy.
• Amniotic fluid embolism.
• Massive blood loss.
• Transfusion of a large volume of blood.
• Extragenital diseases (diabetes mellitus, heart defects, kidney and liver pathology, oncology).

Given the variety of possible causes, each case requires individual consideration. To understand what processes became the source of bleeding, an appropriate examination is necessary. But only a doctor can carry out a full diagnosis, so the only way to solve the problem is through consultation with a specialist.

The causes of postpartum hemorrhage can be various conditions - associated with obstetric complications, gynecological or extragenital pathology.

Symptoms

Bleeding in the early stages, i.e. in the first 2 hours after birth, can occur for almost any reason listed above. But most often we are talking about placental (afterbirth) anomalies, uterine hypo- or atony. Signs of coagulopathy may also be observed, but this is less common. In the first case, there is a delay in the placenta in the uterus - it does not come out for half an hour - or appears with a defect on the surface (signs of the presence of an additional lobule). The doctor checks for special symptoms indicating separation of the placenta:

• Schroeder - the uterus becomes narrower and lengthens, deviating to the side.
• Alfeld - lengthening of the outer edge of the umbilical cord.
• Küstner-Chukalov - when pressing above the pubis, the umbilical cord does not retract.

If they are negative, then the placenta is still attached to the uterus and auxiliary techniques are required to remove it and, accordingly, stop the bleeding. With hypotension, the uterus may initially contract normally and then relax, leading to a gradual increase in symptoms.

There are also the opposite cases, when massive blood loss immediately occurs. On palpation, the uterus is soft to the touch, enlarged - the bottom is located above the navel line. She does not respond to external stimuli: massage or administration of uterotonics. Excessive bleeding leads to an increase in general symptoms:

• Dizziness.
• Weakness.
• Pallor.
• Pressure drop.
• Increased heart rate.

Uncontrolled bleeding leads to hemorrhagic shock and disseminated intravascular coagulation syndrome. And the latter is characterized by microcirculatory and ischemic disorders due to numerous thromboses of small vessels. But later hypocoagulation develops due to the depletion of reserves of the coagulation system. In turn, this is manifested by the following symptoms:

• Hemorrhages into the skin and mucous membranes.
• Bleeding from various parts of the body: uterus, surgical wounds, teeth, kidneys, lungs, gastrointestinal tract.
• Local necrosis of the skin and mucous membranes.
• Multiple organ failure.
• Anemia and intravascular hemolysis.
• Euphoria, disorientation, impaired consciousness.

This is a very serious condition that poses a threat to the life of the postpartum mother. Severe and advanced cases, unfortunately, end unfavorably. But with early emergency measures, the prognosis is much better.

Another situation in which blood may appear after childbirth is rupture of the woman’s genital tract. They are observed quite often, especially with a large fetus, post-term pregnancy, rapid labor and the use of aids (obstetric forceps). Bleeding can become protracted and noticeable already in the early period. Tears often spread to adjacent tissues: from the vagina to the perineum, from the cervix to the uterus. If the urinary tract is damaged, blood will leak from the urethra (hematuria).

Clinical symptoms of postpartum hemorrhage can vary significantly, which makes the diagnosis easier. But common signs also exist.

Additional diagnostics

To accurately determine the cause of spotting after the birth of a child, the doctor will prescribe additional tests. Depending on the situation, they are carried out on a planned or urgent basis. As a rule, the following diagnostic procedures are necessary:

• Detailed general blood test (erythrocytes, platelets, hemoglobin, hematocrit, color index, ESR).
• Coagulogram (fibrinogen, prothrombin index, plasma coagulation and recalcification time, fibrinolytic activity).
• Ultrasound of the uterus.
• Hysteroscopy.
• Colposcopy.

It is necessary to establish the cause of bleeding as early as possible, which is where the results of additional studies help. Based on them, the doctor will prescribe the woman a therapeutic correction to eliminate the source of the pathology and its consequences. And by what methods this will be done - conservative or surgical - depends on the severity and origin of the bleeding. But in any case, you can hope for a full restoration of health.