Postpartum blood clots and bleeding: What to expect
During this recovery time, the woman's body begins the process of restoring itself to a pre-pregnancy state and prepares for breastfeeding.
In this article, we look at what kind of bleeding to expect after childbirth and when to see a doctor.
Blood clots after birth
With so many changes after childbirth, it can be hard to know what kind of bleeding to expect.
There are two types of blood clots that women may experience after childbirth:
- Clots that are passed through the vagina in the days after birth, which are from the shedding of the womb's lining and the detachment of the placenta.
- Clots that happen inside the body's veins — these are rare but can be life-threatening.
While some bleeding and clotting are to be expected, a woman should speak to a doctor about excessive or large clots, unusually heavy bleeding, or any worrisome symptoms.
It is also crucial to know the signs of a dangerous blood clot inside a vein.
Healthy blood can clot or stick together to help prevent excessive bleeding from a cut or an injury.
As the body sheds the placenta after childbirth, blood may pool inside the uterus and form clots. In the first 24 hours, when blood flow is the highest, many women pass one or more large clots.
When a woman is pregnant, her body makes more blood-clotting factors, which help prevent excessive bleeding during childbirth. However, this also puts a woman at higher risk of developing a dangerous blood clot inside a vein.
According to the American Heart Association, a woman's risk of developing one of these clots is more than 10 times higher than normal in the 6 weeks after giving birth.
Another study shows that this risk may be even up to 22 times higher during this period. The risk of these clots returns to normal after 18 weeks following delivery.
What to expect after birth
The normal discharge of the uterine lining after childbirth is called lochia. It is made up of blood, mucus, other tissue, and some bacteria.
Most women find that their flow of lochia is heaviest in the first 1 to 3 days after birth and gradually gets lighter over the following weeks.
Every woman is different, but most women can expect:
- First 24 hours after birth: Bleeding is heaviest with bright red blood. Clots may range in size from large (a golf ball) to small (a quarter). Any soaking of a sanitary pad within one hour should be brought to the attention of the medical staff, as this can be a sign of serious bleeding.
- Up to 6 days after birth: Blood flow should gradually become lighter and may be close to a normal menstrual period flow. Clots will be the size of a quarter or smaller. The blood may become brownish or fade to a watery, pinkish red. If bright red blood continues to flow, women should speak to a doctor, as it may indicate that bleeding is not slowing down properly.
- 7 to 10 days after birth: Blood should continue to be mostly dark brownish or a faded pinkish red. The flow should be lighter than it was in the first week. However, breast-feeding women may notice a small gush of blood during or after nursing or pumping.
- 11 to 14 days after birth: The blood flow should continue to lighten, and any clots will be very small. Some women notice that their flow becomes temporarily heavier or brighter in color after doing physical activity.
- 2 to 6 weeks after birth: Women may go several hours without any bleeding at all. The flow may change to white or yellow as the uterus works to return to its pre-pregnant state.
- 6 weeks after birth: Small amounts of brown or yellow spotting are normal. The new start of a heavy flow could be a woman's menstrual period, especially if she is not breast-feeding. However, any new bleeding or clots should be checked by a doctor or midwife.
Women should not use tampons or put anything in the vagina for at least 6 weeks after giving birth. Some women may need to wait longer.
Women should typically see their doctor or midwife 4 to 6 weeks after delivery for a checkup. A woman may need to see her doctor sooner if she experienced any complications or had a cesarean delivery.
Signs of a dangerous blood clot
Pregnant women and those who have just given birth are at risk of deep vein thrombosis.
If a blood clot forms inside a vein after childbirth, the body may not be able to dissolve it. Sometimes, this clot can break free inside the vein and travel to the lung, known as a pulmonary embolism.
Because a woman has a particularly high risk of developing blood clots in the vein after giving birth, she should be aware of any potential signs that could point to a life-threatening clot.
Signs and symptoms of a dangerous clot include:
- pain, redness, swelling, or warmth in one leg, which may indicate deep vein thrombosis (DVT)
- shortness of breath or trouble breathing
- chest pain
- dizziness or fainting
- chills or clammy skin
- rapid heart rate
Some women are at higher risk of getting one of these clots. Additional risk factors include:
- having a prior blood clot
- a family history of blood clots or blood clotting disorders
- being overweight
- being over age 35
- being on bedrest during pregnancy or sitting for long periods
- having multiples (twins, triplets)
- having another medical condition, such as an autoimmune disease, cancer, or diabetes
Can blood clots be prevented?
Moving around and exercising when given a doctor's approval may help prevent blood clots.
Passing some blood clots in the lochia is normal after giving birth and cannot be prevented.
However, there are ways to help prevent complications from life-threatening blood clots inside the body. These include:
- getting up and moving regularly throughout the day
- being aware of any personal risk factors for blood clots, and sharing these with the doctor or obstetrician
- beginning exercise when given doctor's approval to do so
- seeing the doctor as recommended for postpartum visits
- knowing the signs and symptoms of a blood clot listed above
Postpartum hemorrhage or excessive bleeding
Postpartum hemorrhage or excessive bleeding after birth can occur for a variety of reasons. Continued bleeding can lead to severe, life-threatening blood loss.
Postpartum hemorrhage is a significant complication for women giving birth worldwide, though mortality is decreasing over time.
The reasons typically include:
- the uterus not contracting and clamping down as it should (this is the most common)
- injury to the birth canal, cervix, or other structures
- clotting problems
- part of the placenta remaining attached to the uterus
After a woman gives birth, her uterus may be checked regularly by her doctors and nurses to ensure it is contracting and becoming smaller. If the uterus feels soft and floppy, or the woman is bleeding excessively, emergency medical care is needed.
Treatment for postpartum hemorrhage can include:
- Undergoing a procedure in which the doctor puts pressure on the uterus with their hands to help it contract.
- Inserting a small balloon inside the uterus to stop bleeding.
- Taking oxytocin or a similar medication that causes uterine contractions.
- A specialized procedure to block blood flow to arteries of the uterus.
- A blood transfusion to replace lost blood.
- In severe, life-threatening cases, surgery to remove the uterus (hysterectomy).
When to see a doctor
With so many changes happening to a woman's body after giving birth, it can be hard to know what is normal. Pregnant women should speak with a healthcare professional about what kind of bleeding to expect. They can also discuss any risk factors they might have for developing dangerous internal clots.
In general, any unusual symptoms, excessive or large clots, heavy bleeding, signs of a clot in a vein, and feeling unwell are reasons to speak to a doctor or midwife.