How best to manage postpartum bleeding ?

What are lochia?

Lochia are post-delivery vaginal discharges, observed after both vaginal and Caesarean deliveries . They consist of blood, cervical mucus and uterine debris, including endometrial cells and placental residue.

These discharges play an important role in cleaning and healing the uterus after the placenta has detached. This detachment leaves a wound on the uterine wall, the healing of which is assisted by lochia.

Lochia also contains healing elements and antibodies, helping to prevent infection. They prevent the proliferation of harmful bacteria in the vagina, promoting a healthy vaginal environment during this vulnerable phase.

The characteristics of lochia, such as color, consistency and volume, offer important clues to a woman’s postpartum health. Particularly copious lochia, or lochia containing significant blood clots, may signal a complication requiring immediate medical attention.

What does postpartum bleeding look like ?

Post-partum bleeding, also known as lochia, evolves through several distinct phases during the recovery period following childbirth. These phases are differentiated by the color, consistency and volume of the discharge.

• Lochia Rubra: Immediately after delivery, lochia is usually profuse, dark red or shiny, similar to heavy menstrual bleeding. This stage, called lochia rubra, usually lasts 2 to 4 days and may include small blood clots and uterine debris, such as endometrial cells and placental remnants.

• Lochia Serosa: Between the 5th and 9th day after delivery, the lochia changes color and consistency, becoming more liquid, with pinkish, pale brown or yellowish hues. This phase, known as lochia serosa, is characterized by a reduction in blood and an increase in mucus and leukocytes (white blood cells).

• Lochia Alba: In the final phase, which generally lasts from the 10th to the 14th week post-partum, the lochia turns yellow or white and becomes more watery in consistency. This stage, known as lochia alba, signals that the healing process is almost complete and the uterus has almost returned to its normal size and shape.

It’s important to note that these phases can vary from one woman to another, and that lochia can last from 2 to 6 weeks. Elements such as breast-feeding, physical exercise or simply standing up can lead to a temporary increase in lochia.

Progression of post-partum bleeding

Duration of lochia

The duration of lochia varies from woman to woman, generally from 4 to 6 weeks after delivery. This period is influenced by the mode of delivery (vaginal or Caesarean) and breastfeeding. Breastfeeding can shorten this period thanks to oxytocin, which promotes uterine contractions and accelerates healing.

Interruption and resumption of lochia

Lochia may stop temporarily and then resume. The ” little return of childbirth “, generally occurring between the 10th and 12th day after delivery, can lead to a resumption of bleeding for 2 to 3 days, similar to light menstrual bleeding. This phenomenon is due to the drop in pregnancy hormones and generally does not signal any complications.

Is it normal to bleed one month after giving birth ?

Lochia can last up to 6 weeks, but should normally diminish in intensity and frequency after the first month. Mild bleeding may nevertheless persist in some women beyond this period. If bleeding intensifies or persists after six weeks, a medical consultation is recommended to rule out any complications.

Variations in lochia color and abundance

Lochia changes in color and abundance over time. Initially, they are abundant and bright red with blood clots for the first 3 to 4 days. Then, they become less abundant and take on a light brown or pink color between the 5th day and the following 2 weeks. After around 2 weeks, lochia becomes more watery and whitish or yellowish, before gradually diminishing until it stops completely.

Differences between lochia and return from childbirth

Understanding the difference between lochia and the return of childbirth, often referred to as the ” return of menstruation ” , is essential to grasping the changes in a woman’s body after childbirth. Although they both occur in the post-partum period, they differ in their causes, characteristics and durations.

Cause and purpose: Lochia, or vaginal discharge, is the result of healing where the placenta has detached, and the process of cleaning the uterus post-delivery. They play an important role in healing and returning the uterus to its original size and shape.

The return of childbirth, on the other hand, marks the resumption of menstrual cycles after childbirth, signaling the woman’s ability to conceive again. It also indicates that the ovaries are functioning normally.

Duration: Lochia can last from 4 to 6 weeks, with a gradual reduction in intensity and frequency. The return of labor generally occurs between 6 and 8 weeks after delivery, although this may vary depending on breastfeeding.

Exclusive breastfeeding may delay the onset of childbirth due to prolactin’s inhibitory effect on ovulation.

Characteristics: At first, lochia are abundant and bright red, composed of blood, cervical mucus and uterine debris. Over time, they change color and consistency, from red to pink, then to yellow, and finally to white or brown. Menstruation may be longer and more abundant than before pregnancy, accompanied by menstrual symptoms such as cramps and bloating.

Petit Retour de Couches: It’s important to be aware of the existence of “petit retour de couches”, a phenomenon that occurs between lochia and the actual return of labor. Characterized by dark vaginal bleeding due to a drop in hormones, it can last about a month and should not be confused with lochia or the return of childbirth.

When should I seek medical help ?

Although lochia is a normal part of the recovery process after childbirth, it can sometimes signal complications requiring immediate medical intervention. Knowing how to recognize the warning signs is essential to seeking medical help without delay.

Excessive or prolonged bleeding

After childbirth, excessive bleeding or bleeding that continues beyond the expected period may indicate a serious complication. If you experience heavy vaginal bleeding that lasts longer than normal, or if you lose more than a liter of blood in the 24 hours following delivery, it’s essential to consult a healthcare professional. Uterine atony, characterized by insufficient contraction of the uterus, and retained placental fragments are often the cause of this bleeding.

Secondary post-partum hemorrhage, occurring between 24 hours and 12 weeks after delivery, may manifest itself as sporadic or heavy vaginal bleeding. This bleeding may be a sign of hypovolemic shock, accompanied by symptoms such as pallor, chills and increased heart rate.

Malodorous discharge or discharge accompanied by fever

Malodorous discharge or discharge accompanied by fever may indicate a post-partum infection. Endometritis, an infection of the uterus, can cause lower abdominal pain, fever, chills and foul-smelling vaginal discharge.

These symptoms require immediate antibiotic treatment to prevent serious complications.

In addition, coagulation disorders, the presence of uterine fibroids or the use of certain medications can also lead to unusual bleeding, and require assessment by a healthcare professional. In the event of intense abdominal pain, high fever or abnormal vaginal discharge, it is imperative to seek medical advice without delay.

Tips for managing postpartum bleeding

Which sanitary pads are best for you ?

To manage bleeding after childbirth, it’s essential to choose the right sanitary pads. Pads designed for the post-partum period are highly recommended. They are larger and more absorbent than ordinary pads. What’s more, they are often plastic-free and very soft, which is perfect for sensitive skin at this time.

Adult diapers can be a comfortable and safe alternative, offering extra protection. However, menstrual pants should be avoided for the first few days after birth, due to heavy bleeding and the risk of leakage.

Recommended hygiene practices

Good hygiene is essential to avoid infection and promote optimal healing. It’s advisable to change sanitary towels frequently, every time you go to the toilet or as soon as they become saturated, to prevent the risk of infection.

Regular showers and cleansing of the perineal area with lukewarm water are also recommended. Vaginal baths and douches should be avoided until the lochia has stopped, to reduce the risk of infection. Choose 100% cotton towels to reduce irritation and allergies.

Activities to avoid to prevent complications

For an uncomplicated recovery, it’s important to limit certain activities. Rest as much as possible, especially in the first few weeks after delivery. Avoid strenuous exercise to avoid aggravating the bleeding or slowing down the healing process.

It is advisable to postpone intense physical activity until your body is ready. Moderate exercise such as walking, cycling or postnatal yoga, carried out gradually and under medical supervision, can however be beneficial for recovery.

Conclusion

Lochia, composed of blood, cervical mucus and uterine debris, is a normal and essential stage in the recovery from childbirth. They generally last from 4 to 6 weeks and are divided into several phases, from lochia rubra to lochia alba.

To manage this bleeding, it’s essential to adopt impeccable hygiene, changing sanitary towels regularly and avoiding the use of tampons. It’s equally important to get enough rest and maintain a balanced diet.

Watch carefully for any signs of infection or complications, such as heavy bleeding, foul-smelling discharge or fever, and consult a healthcare professional immediately if you suspect a problem. By taking care of yourself and staying well-informed, you’ll navigate this post-partum period with confidence, promoting optimal healing. Never hesitate to seek medical help when in doubt, and use this time to focus on your recovery and your child’s well-being.