What Causes Post Partum Bleeding?
The first thing you should understand about post-partum bleeding is how much is too much, and when the bleed is considered abnormal. All women will experience some level of bleed following childbirth, even those giving birth via Cesarean Section. This is because the bleed is caused by the rupturing of blood vessels when the placenta is detached from the uterine wall. In a healthy bleed, the flow will naturally slow and stop over the period of 2-4 weeks following the birth.
Postpartum bleeds are generally considered abnormal when:
- The initial bright red flow lasts longer than seven days post birth.
- The bright red flow lightens, or goes away entirely, and then returns. In this instance the bright red flow is unable to be lessened with increased fluids and rest.
- The amount of flow is heavy enough to saturate a standard sanitary napkin in 1 hour or less on a continual basis.
- You pass clots that are the size of a golf ball, lemon, or larger.
- Your discharge has a foul or sour smell
- You experience fever, chills, or feel faint
- You experience regular, sudden gushes of blood
Abnormal post-partum bleeding can have simple causes, such as too much activity too soon, or serious causes such as a post-partum hemorrhage. A hemorrhage is typically defined as the loss of more than 1,000 mL of blood following a C-section, or 500 mL of blood following a vaginal birth. Occurring in between 1-10% of all births in the US, hemorrhages generally occur within the first several days following child birth, but can occur as late as six weeks post-partum.
Most commonly, these hemorrhages occur when the uterus fails to contract down to standard size following the delivery, but can also due to unrepaired tears to the cervix or vagina retained placenta within the uterus, an infection.
In most cases, the uterus can be encouraged to contract through administration of oxytocin or placental massage, and the bleeding can be controlled. In some cases you may need to have a procedure called a dilation & curettage (D&C) to remove any retained placenta within the uterus. In the most rare cases a hysterectomy may be needed. Some women experiencing severe abnormal bleeding may also need a blood transfusion.
Certain women may be at an increased risk of hemorrhage following birth. Risk factors often include:
- Twins (or higher) delivery
- Increase of amniotic fluid
- Diagnosis of Placenta Previa, pre-eclampsia, or anemia
- Larger singleton delivery
- Induced labor
- Presence of uterine fibroids
If you suspect that you may be experiencing a heightened flow or display any other signs of a potentially abnormal bleed, it is important to call your OB right away. In the event that you are experiencing any level of lightheadedness or fainting, it is especially important that you head to the hospital as soon as possible, and that you do not attempt to drive yourself. If you do not have someone who is able to drive you, you should call 9-1-1 and take an ambulance.