Keeping New Mums Safe: Risks of Bleeding After Delivery – Pt 2

By Fisayo Aturamu

Here, in the second part of the series on bleeding after delivery (postpartum haemorrhage), we look at abnormal bleeding compared to the normal, that is, lochia.

Events After the Baby’s Delivery

Bleeding after birth occurs because, following the delivery of the baby, the placenta separates from the uterus.

This leaves the blood vessels where the placenta was attached open and so, they bleed into the uterus.^[6]

After the delivery of the placenta, the womb (a muscular organ) continues to ‘contract’.

In the same way muscles in the arm relax and stiffen, this contraction is important.

And this makes the womb release blood from its blood vessels and push out any leftover tissue in it.

This is the natural way the womb restores itself and may take up to 6 weeks to happen in most women after birth.

What is Lochia?

Lochia is the vaginal discharge of the period immediately following delivery – also known as the ‘postpartum’ period.

It may (initially) be bright red and heavy with a few blood clots.

Now, the clots may range from the size of a small coin to a cotton wool ball for the first 2 to 4 days, resembling menstrual flow.

Lochia should not be confused with postpartum haemorrhage or PPH.

PPH is a term that describes abnormal, excessive bleeding that happens from the time of delivery to 6 weeks afterwards.

On the other hand, lochia is a result of the uterus replacing its lining after birth and delivery. It contains some blood and mucus discharge from the womb.^[8]

The appearance of lochia changes over time.

Other Ways Lochia differs from Postpartum Haemorrhage

Therefore, by the 4^th day after delivery, lochia is either pink or brown with little or no blood clots, and then a yellowish-white discharge by the 10^th day.

Although initially, it is heavy, its amount also decreases gradually during this time.

Adequate hygiene must be maintained throughout this period to prevent infections.

Also, we advise ladies to avoid using tampons as they make an infection more likely, and it’s harder to monitor blood loss.

Sanitary towels are preferable.^[8]

Factors That Affect Normal Blood Loss After Delivery

In addition, breastfeeding mothers may notice a little increase in bleeding when breastfeeding – this is normal.

During breastfeeding, the brain releases a hormone called Oxytocin which causes the uterus to contract and release blood from its vessels.^[8]

And lastly, exercising or strenuous activities soon after pregnancy may also cause a slight increase in lochia bleeding.^[4],[9]

In the final part of the series, we look at symptoms that suggest Postpartum haemorrhage as well as problems that increase the risk of PPH happening.

More Reading:

• Preventing Mums bleeding after delivery – Part 1
• Bleeding after Baby’s Delivery – Pt 3
• 4 Common Risk Conditions for Early Pregnancy Bleeding
• High Protein Diets – What you should know
• Bleeding from cuts or other injuries

References (accessed 7th January 2019)

• Ngwenya S., 2016. Postpartum hemorrhage: incidence, risk factors, and outcomes in a low-resource setting. Int J Womens Health [e-journal] pp. 647-650. Available through: US National Library of Medicine National Institutes of Health website.
• Kelly C. Wormer, Suzanne B. Bryat, 2018. Pregnancy, Acute Postpartum Hemorrhage. Treasure Island (FL): StatPearls Publishing [online]. Available through: US National Library of Medicine National Institutes of Health website.  
• Faduyile F. A., Soyemi S. S., Emiogun F.E., Obafunwa J. O., 2017. A 10 year autopsy-based study of maternal mortality in Lagos State University Teaching Hospital, Lagos, Nigeria. Nigerian Journal of Clinical Medicine website [online] 20:131-135.     
• Ezugwu, E.C., Agu, P.U., Nwoke, M.O. and Ezugwu, F.O., 2014. Reducing maternal deaths in a low resource setting in Nigeria. Nigerian Journal of Clinical Practice, [e-journal] 17(1), pp. 62-66.  
• World Health Organization, 2018. Maternal Mortality.      
• CureJoy Editorial, 2018. Postpartum Bleeding: What To Expect After Giving Birth.    
• Leontine Alkema, Doris Chou, Daniel Hogan, Sanqian Zang, Ann-Beth Moller, Alison Gemmil, et al., 2016. Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group. The Lancet [online] 387(10017) pp. 462-474.  
• University Hospital Southampton NHS Foundation Trust Patient information factsheet. Blood loss – what to expect after the birth of your baby. [pdf]     
• Stephanie Watson, Holly Ernst, 2018. Is Postpartum Bleeding Normal? Healthline

Editing by AskAwayHealth Team

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