Bleeding After C-Section: Causes And How Long It Lasts

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Bleeding after C-section is normal. Also called lochia, this bleeding consists of mucus, tissue, and blood that the uterus sheds as it replaces its lining following the delivery (1) (2).

Bleeding after cesarean delivery may be heavy and bright red during the first week after birth and become lighter and brownish over time. It usually continues for 24 to 42 days after birth; however, some women may bleed for a little longer (1).

Read this post to know more about the causes of bleeding after C-section and ways to manage it.

In This Article

How Heavy Is The Bleeding After A C-Section?

Bleeding may be heavier when the mother wakes up in the morning

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The amount of blood loss after a C-section depends on several factors (1) (3).

Bleeding is heavy and bright red after breastfeeding because the oxytocinⁱXA hormone secreted by the pituitary gland to stimulate contractions during childbirth and lactation released during the process compresses the uterus, thus producing more blood.
Any physical activity may cause bleeding during the first two weeks after delivery.
Heavier bleeding may also be experienced after you wake up in the morning because the blood may accumulate in the vagina while you are sleeping at night.

Quick fact

1% to 5% of women have a postpartum hemorrhage, which is more likely with a C-section birth (8).

The following bleeding pattern is commonly seen in women after a C-section. However, it may vary from one person to another (1).

Days/weeks	Color of the blood	Amount of blood loss
Day 1	Fresh red to brownish-red	Heavy flow Soaks one maternity pad in a few hours Small blood clots
Days 2 to 6	Dark brown or pinkish-red	Moderate flow 7-12cm stains on the maternity pad Small blood clots
Days 7 to 10	Darker brown or pinkish-red; turns lighter	Lighter flow Less than a 7cm stain on the pad
Days 11 to 14	Darker brown or pinkish-red; turns lighter	Lighter flow Stains start decreasing
Week 3 to 4	Pale, creamy white blood	Lighter flow
Week 5 to 6	Brown, pinkish-red, or creamy yellow	Lighter flow and only on some days

Source: nct

What Causes Bleeding After C-Section?

The placental site may be responsible for heavy bleeding

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During delivery, the placentaⁱXA temporary organ that develops during pregnancy and provides the fetus with oxygen and nutrients detaches from the uterus lining (endometrium), leaving behind an open wound of around 8.5in in diameter (placental site). This wound takes time to heal. As the uterus heals, the residual tissue slowly comes out in the form of uterine bleeding and vaginal discharge (4). In the case of vaginal delivery, up to a half-quart (500ml) of blood is lost, whereas in the case of cesarean delivery, up to a quart (1000ml) of blood is lost (5).

Bleeding after birth (lochia) can be divided into three stages (4).

1. Lochia rubra

This stage lasts for the first four days after delivery.
You may experience regular abdominal cramps as the uterus begins to contract to its original size.
The lochia is bright red with clots caused due to the pooling of blood.

2. Lochia serosa

This stage lasts for around ten days.
You may notice the blood changing from bright red to pink or brown. The color change occurs as the number of white blood cells in the blood increases.
The placental site continues to heal during this stage.
If you are not breastfeeding, you may notice the discharge of cervical fluid. However, if you are breastfeeding, the cervical fluid may not be seen yet.

3. Lochia alba

This is the final and the longest stage.
The lochia turns yellowish or whitish. It mainly consists of white blood cells, cervical mucusⁱXA gel-like discharge produced by the cervix that indicates the most fertile time of your menstrual cycle , and epithelial tissueⁱXA major tissue that covers the internal and external surface of the body, body cavities, and hollow organs .
The placental site continues to heal rapidly.

How To Manage Bleeding After C-Section?

Bleeding after C-section can be managed by using maternity pads. These pads offer more comfort than regular sanitary pads and allow you to check the amount of blood loss (3).

You may keep these pointers in mind to decrease the risk of infections (3).

Avoid the use of tampons or menstrual cups for the first six weeks after childbirth.
Change the sanitary pads at regular intervals.

Use sanitary pads to manage bleeding after C-section

Image: Shutterstock

Wash your hands before and after changing the sanitary pads.

When To Call The Doctor?

You should contact your doctor if you notice the following symptoms (3) (6).

Sudden heavy bleeding (soaking of one pad in one to two hours)
Large blood clot (bigger than the size of a golf ball)
Change in the color of the blood (changes to bright red)
Dizziness and weakness
Chills with fever

Contact your doctor if you experience fever and chills after a c-section

Image: Shutterstock

Foul-smelling vaginal discharge or blood
Severe pain in lower abdomen

Quick fact

Previous postpartum hemorrhages, a BMI above of 35, twin or triplet pregnancy, placenta previa, placental abruption, pre-eclampsia, anemia, and fibroids may increase the risk of postpartum hemorrhage (1).

Frequently Asked Questions

1. What if I bleed longer than six weeks after a C-section?

It is normal for a woman to bleed for four to six weeks after a C-section. Some women may bleed for a little longer. However, the bleeding should stop by 12 weeks after birth (3). If the bleeding continues beyond that or becomes heavier, it is advisable to consult a doctor as it might indicate signs of infections.

2. What are the symptoms of postpartum hemorrhage after a cesarean delivery?

After the delivery of a baby, the uterus normally contracts and expels the placenta, and the blood vessels in the area where the placenta was attached compress due to uterine contractions. However, in around 4% of women, the uterine contraction may not be strong enough (uterine atony), leaving the blood vessels to bleed freely. This condition can lead to postpartum hemorrhage (7).

Some symptoms of postpartum hemorrhage include (7)

Excessive bleeding
Severe drop in blood pressure
Elevation in heart rate
Decrease in red blood cell count
Tissue pain and swelling in the vaginal and perinealⁱXThe space between the anus and vulva forms the floor of the pelvic cavity area

3. Is it normal to have on-and-off bleeding after a C-section?

Bleeding after the C-section is heavy initially, and it lessens over time. There may be uterine cramping and a slight increase in blood flow each time you breastfeed due to the hormones-induced uterine contractions. The bleeding may also be heavier when you wake up in the morning as the blood gets pooled in the vagina because you are lying down all night. Barring these minor changes, any bleeding that suddenly starts or increases in volume needs prompt medical attention (3).

4. How much blood loss is too much during a C-section?

Losing more than 1000ml of blood after C-section may be worrisome and needs immediate medical care (7).

Bleeding after a cesarean birth is a normal process in which the uterus expels the extra tissue and blood and returns to its original size. Good nutrition, proper hydration, and adequate rest can help you recover faster during the postpartum period. However, you should regularly monitor the amount and duration of your blood flow.

Infographic: What Are The Stages Of Bleeding After A C-Section?

After a C-section, many women experience vaginal bleeding (lochia) in various stages that may linger for a few days. Understanding these bleeding stages might help women know when to seek medical attention and ensure a healthy postpartum recovery. The infographic below explains the different types of post-cesarean bleeding stages and their features.

different stages of vaginal bleeding (infographic)

Get high-quality PDF version by clicking below.

Download Infographic

Key Pointers

Bleeding after a C-section is a common occurrence.
The bleeding is caused by the removal of residual tissue from the uterus.
The amount of blood loss after a C-section can vary and is influenced by factors such as breastfeeding and physical activity.
Maternity pads can be used to manage the bleeding.
If sudden heavy bleeding or dizziness occurs, it is important to consult a doctor immediately.

References:

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