TRAINING FOR TWO

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Written by

Roxanne Albert, BSN, RNC-OB

Vaginal Bleeding in Postpartum – 4 Phases

What is a normal vaginal bleeding timeline? When should i seek help?

Vaginal Bleeding

Vaginal Bleeding occurs after both vaginal and c-section births! This is because the vaginal bleeding is not coming from the actual vaginal canal, it is really coming from the wound created at the placenta attachment site on the uterus. This wound has to go through the healing process. 

We want to monitor vaginal bleeding for signs that we need to seek help from a healthcare professional for reasons like hemorrhage or infection. 

Reason to seek Help:

  • Soaking a pad in 1-2 hours
  • Passing any clots bigger than an egg
  • Feeling lightheaded, faint, dizzy when moving
  • Looking pale
  • Feeling Weak and fatigue, more than usual
  • Foul odor discharge
  • Fever over 100.4F
These are signs of a postpartum hemorrhage or an infection! Postpartum hemorrhage can occur at any time during the postpartum period! The highest risk is during the first 24 hours, but it can be delayed when you return home from the birth location, so it is important to monitor!

Vaginal Bleeding Timeline

It is normal for the body to take between 3-6 weeks to work through this timeline. It is advised not to return to structured physical activity till bleeding has stopped because it means the wound inside the uterus still needs to heal. 

Lochia

The name for the vaginal discharge is lochia. 

Lochia changes as you progress through the timeline in color, amount, and odor. The color changes from a bright red color, to more dark red, to pink/brown, then eventually being white/yellow. The white/yellow color lasts the longest.

Rubra

This is when the lochia is bright to dark red in color. It typically last 3-4 days at least but may last for a week in some. This is when the flow is heaviest, and may have some smaller clots. 

This is also the period that cramping is most common as the uterus is shrinking in size. 

We typically recommend wearing the disposable underwear for this period of time. 

Serosa

This is when the lochia is pinkish to brown in color. It typically last 4 to 12 days. Flow is more of a moderate amount, clots are not as common in this stage.

Cramping may still be present at this time, but should be less. 

Typically wearing menstrual pads at this stage is appropriate. 

Alba

This is the last stage and longest stage of lochia. The bleeding is yellowish to white in color. You should not see any blood in the discharge, except spotting every once in a while. No Clots at this stage should be seen! This can last from 12 days up to 6 weeks

Learn the science of pregnancy and birth to take the mystery of labor away! Understand why you are feeling what you feel, and learn strategies to confidently move through pregnancy and birth!

Retained Fragments

Sometimes there can be retained fragments from the birth left behind. Usually it is noticed within the first few hours after birth because bleeding is usually heavier. The body sometimes also works it out on it own, you may notice that you have increased cramping and pass a small clot or some sort of small fragment from your body. 

If it does not work itself out it can sit in the uterus and cause long-term problems such as breakthrough bleeding that can occur weeks after birth. This is because the uterus cannot contract back to its normal size and this could impede in the healing process of the placenta wound. 

This is an issue because it could lead to delayed hemorrhages weeks after birth, or low blood counts due to continuous slow vaginal bleeding. 

Seek help from your Provider or go the the Emergency room to get an ultrasound of the uterus to identify if there are any retained fragments inside. 

Symptoms to look for:

  • Breakthrough heavy red bleeding
  • Prolonged Red bleeding
  • Fatigue/Weakness
  • Pale skin
  • Faint/dizziness

Vaginal bleeding really varies among different people. Some have longer bleeding times while other have shorter. Knowing what to expect and when to seek out help is important! 

Learn more about What to Expect Postpartum in our webinar on Sept 27th at 730pm EST