Postpartum bleeding

Bleeding after giving birth is expected, including after a caesarean. This postpartum bleeding is called lochia and comes mainly from the area inside the womb where the placenta was attached. It usually starts heavier and gradually becomes lighter over the following weeks.

What matters is not simply whether you are bleeding, but how the bleeding changes and how you feel. Sudden or very heavy bleeding, bleeding that becomes heavier, clots or tissue, an unpleasant smell, fever or worsening pain need medical attention.

If you are ever unsure whether the amount of bleeding you are experiencing is expected, contact your midwife, maternity unit, health visitor or GP. You do not need to work it out alone.

What is postpartum bleeding?

Lochia is the vaginal bleeding and discharge that happens while the womb recovers after birth.

It happens after both vaginal and caesarean births. RCOG explains that most of the blood comes from the area where the placenta was attached to the womb, although bleeding can also come from cuts or tears caused during birth.

The NHS says bleeding can be quite heavy at first. It then generally becomes lighter, changes colour and eventually stops.

Postpartum bleeding is therefore different from a menstrual period, even though it may look similar at certain stages.

How long does bleeding after birth last?

There is variation from person to person.

The NHS says lochia usually continues for a few weeks and often stops after around 6 to 8 weeks, although it can last longer. RCOG also notes that bleeding can continue for several weeks after delivery.

The pattern should generally move towards less bleeding rather than more.

That does not mean every day will look exactly the same. The amount and appearance can fluctuate. If the bleeding noticeably increases, however, NICE advises seeking medical advice.

If you are still bleeding and are worried about the amount, duration, smell or any accompanying symptoms, speak to your healthcare team.

What colour should postpartum bleeding be?

Postpartum bleeding changes as recovery progresses.

The NHS explains that bleeding is initially red and then gradually becomes browner as it decreases. The exact appearance and timing can vary.

Rather than trying to match your bleeding to a precise day-by-day colour chart, pay attention to the overall pattern and to symptoms that may suggest you need assessment.

An unpleasant smell, increasing bleeding, clots or tissue, fever, shivering, or abdominal, pelvic or perineal pain are reasons to seek medical advice according to NICE.

Is bleeding normal after a caesarean?

Yes. Vaginal bleeding after birth also happens following a caesarean.

The bleeding is related to the womb healing after the placenta separates, so it is not limited to people who have given birth vaginally.

Your caesarean wound has its own recovery needs as well. If you notice increasing redness, swelling, pain or discharge from the wound, contact your midwife or GP.

If you are uncertain whether blood is coming from your vagina or your surgical wound, seek medical advice.

Can postpartum bleeding become heavier sometimes?

You may notice some variation in bleeding during the postnatal period. The NHS notes that bleeding can look redder and heavier during breastfeeding because breastfeeding causes the womb to contract.

However, increasing bleeding should not automatically be dismissed as a normal fluctuation.

NICE specifically advises seeking medical advice if vaginal bleeding increases after birth. The same applies if you pass clots, placental tissue or membranes, or develop symptoms of possible infection.

If you are worried about a change, contact your midwife, maternity unit, health visitor or GP rather than waiting to see whether it becomes more severe.

What is postpartum haemorrhage?

Postpartum haemorrhage, often shortened to PPH, means abnormally heavy bleeding after birth.

RCOG distinguishes between primary and secondary postpartum haemorrhage. Primary PPH happens within the first 24 hours after birth. Secondary PPH is abnormal or heavy vaginal bleeding occurring from 24 hours to 12 weeks after birth.

A secondary PPH can sometimes be associated with infection in the womb or placental tissue remaining inside the womb.

This is different from ordinary lochia. If bleeding becomes very heavy or you feel faint, dizzy or unwell, urgent assessment is needed.

What can make bleeding after birth concerning?

The amount of blood is only part of the picture.

NICE advises seeking medical advice if postpartum bleeding is sudden or very heavy, increases, or includes clots, placental tissue or membranes.

Symptoms that can suggest infection also need assessment. These include abdominal, pelvic or perineal pain, fever, shivering, or vaginal bleeding or discharge with an unpleasant smell.

The NHS similarly advises contacting a GP, midwife or health visitor if bleeding becomes heavier or does not become lighter, if you develop a temperature above 38°C, if the bleeding smells unusual, if you have clots, or if abdominal or perineal pain is getting worse.

You can also ask for medical advice simply because you are concerned. You do not need to meet a particular threshold before contacting your healthcare team.

Using pads after birth

The NHS recommends using highly absorbent period pads for the heavier bleeding after birth and changing them regularly.

Wash your hands before and after changing a pad.

The NHS advises against using tampons until after your 6-week postnatal check because of the increased chance of infection.

Pads can also make it easier to notice changes in the amount, colour and appearance of your bleeding. If you are worried about what you are seeing, tell your midwife or GP.

What about your first period after birth?

Postpartum bleeding is not the same thing as your menstrual cycle restarting.

When periods return varies, particularly because feeding can affect when ovulation and menstruation resume. This means it may not always be obvious whether later bleeding is still lochia or a period.

If bleeding has stopped and then you develop new bleeding that concerns you, or you are unsure what you are experiencing, speak to your GP, midwife or health visitor.

Do not assume unexpected heavy bleeding is simply your first period if you feel unwell or have other warning symptoms.

When to get professional advice

Contact your midwife, maternity unit, health visitor or GP if your postpartum bleeding gets heavier, does not seem to be reducing, smells unusual, contains clots or tissue, or you are worried about it.

Seek medical advice if bleeding is accompanied by a temperature above 38°C, shivering, worsening abdominal or pelvic pain, worsening pain around the perineum, or an unpleasant-smelling vaginal discharge. These can be signs that further assessment is needed.

NICE advises seeking medical advice without delay for sudden or very heavy vaginal bleeding, persistent or increasing bleeding, or symptoms suggesting infection.

Call 999 if the bleeding is sudden and very heavy and you feel faint, dizzy or have a pounding heart. The NHS identifies this combination as a possible postpartum haemorrhage requiring emergency treatment.

If you are unsure how urgent your symptoms are and cannot reach your maternity team or GP, NHS 111 can advise you on the appropriate service. For severe or life-threatening symptoms, call 999.