Postpartum Bleeding and Blood Clots (Fun or what?!)

In pregnancy, a bleeding and blood clot discussion may not be high on your list of topics to enjoy with morning coffee. As registered nurses, we can guarantee, however, you will be glad you had this information after your baby arrives. After nine blessed months of freedom from worry about ‘Aunt Flo’s’ arrival, suddenly questions about postpartum bleeding and blood clots will top your list.

To save frantic Googling when the time arrives, here are the answers to the most common questions you are likely to have.

Why do women bleed after having a baby?

Postpartum bleeding is from:

• A raw area where the placenta was attached. During pregnancy, the placenta is attached to the wall of your uterus. Once the placenta detaches, it leaves a wound that bleeds until it heals.
• Sloughing of the uterus’ lining. Your body sheds the lining of the uterus in the days after birth. This causes a period like bleeding called ‘lochia’.
• A tear or episiotomy. This type of bleeding lasts only a short time and typically stops once the wound is sutured.

After birth, your uterus will squeeze or contract to control bleeding. If it does not ‘kick into gear’ and begin to contract, your healthcare provider may massage your uterus or give you a special medication. Breastfeeding is a natural way to help this process as it releases a hormone that causes contractions.

Typical postpartum bleeding timeline

Day 1-2
For the first few days after baby’s birth, your blood flow will be bright red and about as heavy as your menstrual period.

Day 3-4
By the time your baby is three or four days old, you should begin to see a more pinkish watery flow.

Day 8-10
By 8-10 days after delivery, your flow should be mostly thick and yellowish in color.

How long does it take to stop bleeding after giving birth?

It takes about four to six weeks for the area where the placenta was attached to fully heal. You may, therefore, have a little flow or some spotting until 6 weeks after baby’s birth. For most women, it resolves much sooner.

If you find your bleeding becoming bright red and heavier again after Day 3, it could be your body’s way of telling you that you are overdoing it. Try resting to see if it subsides. Bleeding that stays bright red past the first week is unusual; see your healthcare provider.

Can I use tampons after giving birth?

Unfortunately, tampons should not be used for at least 6 weeks after you have given birth. They can introduce bacteria into your vagina, increasing your chance of getting an infection in your uterus.

Are postpartum blood clots normal?

Dark colored and jelly-like:
Blood can pool and clot inside your vagina when you are lying or sitting. A change of position can cause the clot to pass. Blood clots are usually dark-colored and jelly-like in texture. It is common to pass occasional blood clots, the size of a golf ball or smaller.

Clot with stringy whitish bits:
Sometimes a piece of the placenta has been left behind in the uterus. This can cause cramping, heavy bleeding, and blood clots. If you pass a clot with stringy whitish bits you may have passed a piece of tissue. Monitor your symptoms a bit more closely as you will be at a higher risk for heavy bleeding and infection.

Pain, fever and a rotten odor:
Symptoms of an infection in your uterus include pain, fever, and a rotten odor to your blood flow. If you aren’t sure if your flow has a bad odor, chances are it doesn’t; it is usually quite obvious! Be sure to get in touch with your healthcare provider if you develop any signs of infection or if you are passing clots larger than a golf ball.

If you soak an entire maxi-pad, from front to back, in less than an hour, you need to seek medical attention immediately (go to the closest emergency room).

Postpartum blood clots summary

Postpartum bleeding is completely normal after giving birth and can include blood clots that are dark-colored, jelly-like in texture and smaller than a golf ball.

If you experience pain, fever, a rotten odor or have heavy bleeding (soaking an entire maxi-pad from front to back in less than an hour) seek medical attention immediately.