How to Recognize Postpartum Bleeding or Menstrual Blood

Vaginal bleeding is a common occurrence for most women after childbirth and typically lasts between 6 to 8 weeks. Following this period, the regular menstrual cycle generally resumes once the mother either stops breastfeeding or is using contraception. Sometimes, it can be difficult to distinguish when postpartum bleeding ends and the menstrual cycle begins. However, there are several signs you should be aware of to help identify the change.

Consider the time frame. The timing of your first menstrual cycle after childbirth entirely depends on how long you breastfeed. If you nurse your baby exclusively for the first 3 months, your cycle may return within a few weeks after weaning. However, if you breastfeed for up to 18 months, your period may not return during this period. On the other hand, vaginal bleeding begins immediately after birth and can last around 6 to 8 weeks before gradually tapering off.

• Breastfeeding can delay the return of your period as it stimulates the release of the hormone prolactin, which keeps the levels of progesterone and estrogen low.
• Even women who do not breastfeed may not get their period for a few weeks after giving birth. Approximately 70% of women will have their period return between 6 to 12 weeks postpartum. Menstrual cycles typically last between 3 to 6 days.

Check the Color of the Blood. Postpartum bleeding will have a different color than menstrual blood, so it's important to keep track of this.

• Initially, the blood will be bright red for the first 3 days. From day 4 to day 10, the discharge will shift from bright red to dark red with various components like old blood, white blood cells, and tissue from the uterine lining.
• After day 10, you may notice white discharge. This consists of white blood cells, mucus, and epithelial cells.
• While menstrual blood can start as bright red, it will change to dark red, brown, or black near the end of the cycle.

Pay Attention to the Amount of Blood Flow. Postpartum bleeding is usually heavier than a regular period. Typically, the first 4 days will see a heavier flow, which decreases over the next few days or weeks.

• If you soak a postpartum pad within an hour and this continues for at least 3 consecutive hours, or if you pass a clot larger than a golf ball after the first two or three days, call your doctor immediately.
• For regular periods, the heaviest flow occurs in the first 3 to 4 days, but you'll typically lose about 10 to 80 ml of blood.
• A simple way to calculate the blood amount is by knowing that one pad can hold about 5 ml of blood. So, you can multiply the number of pads you use by 5 to estimate the total milliliters of blood lost.

Recognizing Postpartum Hemorrhage. You may experience postpartum hemorrhage, which affects about 1 to 5 out of every 100 women. Hemorrhage is different from normal postpartum bleeding and requires immediate medical care. This occurs when the placenta detaches from the cervix or other tissues, or due to blood clotting disorders. If left untreated, it can lead to shock and death. Signs of hemorrhage include:

• Vaginal bleeding that soaks more than one pad in an hour for 2 hours straight, or continues with bright red blood and/or large blood clots after vaginal discharge has reduced or turned brown.
• Low blood pressure
• Increased heart rate
• Decreased red blood cell count

Adjust Your Diet. Blood loss means you're losing iron. To avoid iron deficiency, increase your iron intake through your daily diet. There are many iron-rich foods, such as:

• Lentils and pinto or kidney beans
• Chicken, liver, or beef
• Broccoli or asparagus
• Okra, parsley, and seaweed
• Collard greens or beets
• Raisins, prunes, dried apricots, or prune juice
• Rice bran
• Molasses

Take Iron Supplements. After childbirth, if the bleeding is normal or light, there's usually no need for medication, as this condition will typically resolve within 6 weeks to two months. However, your doctor may suggest or prescribe iron supplements to help treat any signs of iron deficiency caused by blood loss.

• Most over-the-counter iron supplements are effective and are better absorbed when taken with acidic drinks like pineapple juice or orange juice. Consult your doctor or pharmacist if you're unsure which brand to choose.
• You should take these supplements about once a day, but the frequency can be increased based on your anemia condition. It is best to take the supplements after meals to avoid constipation, which is a common side effect. Other digestive issues like nausea or vomiting may also occur, and you may experience green-colored stools.

Medical Treatment for Postpartum Hemorrhage. If you're experiencing postpartum hemorrhage, you need to be transported to a healthcare facility immediately to prevent shock. Treatment includes:

• Blood transfusion is crucial to support vital organs such as the brain, cardiovascular system, kidneys, and liver, while preventing organ damage. Transfusion helps replenish the blood lost.
• Oxytocin is administered intravenously to stimulate uterine contractions and control bleeding.
• Oxytocin works by stimulating the uterus to contract forcefully through receptors in the smooth muscle lining of the uterus. It also increases intracellular calcium to promote contractions.

Understand the Causes of Postpartum Bleeding. If everything goes as expected, the uterus will continue to contract after childbirth to expel any remaining placenta. This process also seals the blood vessels that previously nourished the baby. Postpartum bleeding is composed of these residual parts.

• The bleeding happens when the uterus enters the "contraction phase" — a normal physiological response where the uterus returns to its pre-pregnancy state. It's important to manage this phase to prevent any unwanted complications.
• After some time, the uterine lining will shed and be expelled from the body. This is known as lochia.
• These processes are entirely normal. The uterus will heal on its own, and the bleeding/lochia will disappear within 6 weeks.

Understand the Causes of Menstrual Bleeding. Throughout a woman's menstrual cycle, the uterus is lined with a nutrient-rich endometrium to prepare for the potential implantation of a fertilized egg.

• If fertilization doesn't occur, the endometrial lining will shrink and shed before being expelled from the body along with the unfertilized egg. As the uterus removes the old lining, a new one forms, and the menstrual cycle begins again.
• Each menstrual cycle typically lasts from 2 to 7 days and repeats every 28 days on average, although every woman’s cycle may vary.

Recognizing Abnormal Postpartum Bleeding. In some cases, after childbirth, excessive bleeding can occur, posing a risk to health. Excessive bleeding is defined as when one or more pads are soaked within an hour, blood clots the size of or larger than a golf ball are observed, or bright red blood continues to be noticed after four days. There are several potential causes for this condition, such as:

• Uterine Atony — This is the most common cause of excessive postpartum bleeding. It happens when the uterus fails to contract properly due to prolonged labor, infections, exhaustion, or the use of pain-relieving medications (such as NSAIDs, nitrates), causing blood to flow freely from the body.
• Retained Placenta — This occurs when the placenta doesn't fully detach from the uterus. Any remaining placenta in the uterus can lead to bleeding after childbirth.
• Uterine Trauma — Uterine trauma can result from various causes, such as intense labor where attempts are made to expel the retained placenta from the body (using hands, special instruments, or labor-inducing drugs like Oxytocin). This can damage the reproductive organs or the uterine lining, leading to significant bleeding.
• Other Causes — Potential underlying causes of postpartum hemorrhage include a distended uterus (possibly from a multiple pregnancy), preeclampsia, infections, or obesity.