After giving birth, it’s natural for new mamas to have a bloody vaginal discharge called lochia. It is a mixture of blood, mucus, and uterine tissue. This discharge is not the same as postpartum hemorrhage.
What is postpartum hemorrhage (PPH)?
It’s normal to lose up to 500 ml. (just over 17 fl. oz.) of blood during vaginal delivery and up to 1000 ml. (35 fl. oz.) during C-section delivery. If more blood is lost, it’s called early or primary PPH. If blood loss continues through the 2nd to 42nd day after delivery, it is called secondary PPH. Both primary and secondary PPH are dangerous [1]. The advantage of primary PPH is that mama is still under the close supervision of an entire medical staff, who can intervene immediately when an abnormality is detected. Therefore, in the case of secondary PPH, it’s of vital importance that you seek help immediately when you realize the bleeding has not stopped.
What causes PPH?
The most common cause is a weak uterine muscle tone, called atonia. Atonia usually causes bleeding within 24 hours of delivery and is associated with 90% of all PPH.
How do I know if it’s lochia or PPH?
Red lochia similar to menstruation will typically last 3-4 days. After that, there will be less blood in the lochia; it will be clearer and more viscous (because there’s more mucus than blood). This can last between 21 and 60 days [2].
You’re probably dealing with PPH if:
five days after delivery, your discharge still looks like menstruation;
the discharge is accompanied by severe pain;
you are using more than seven high-absorbency menstrual pads per day to absorb the discharge;
your bloody discharge stopped within three to four days, and then started up again earlier than 42 days after delivery [1].
In these cases, call your doctor immediately, as you need emergency care.
What are treatment options for PPH?
First, PPH can be prevented by oxytocin therapy in the third trimester. Oxytocin is a hormone that stimulates the contraction of the uterus. With this contraction, the blood vessels are compressed, and this prevents severe bleeding [1, 3].
If the cause of the bleeding is leftover placenta in the uterus, surgery may be required. In extreme cases of blood loss, your doctor may prescribe a blood transfusion [1, 2].
What if I start bleeding more than 42 days after the birth?
Most likely, you have resumed menstruating. Speak to your doctor, but this is likely no cause for concern.
