Are you having bright, red bleeding at 4 weeks postpartum? Here is what is going on, from a postpartum nurse.
Before panicking, let’s look at 4 reasons that bright red bleeding at 4 weeks can be normal. Could it be lochia, a first period, or postpartum hemorrhage? Here’s how you can tell.
As you know, a vaginal delivery or cesarean delivery both bring with it vaginal bleeding. The amount of time this lasts can vary greatly depending on the type of birth, and whether you are breastfeeding or bottle-feeding. It also depends on how many babies you have birthed or if you delivered a large baby. There are several reasons you could still have bright, red bleeding at 4 weeks postpartum.
New moms may be surprised at how long their postpartum bleeding can last following the birth of a baby. Many postpartum women are also taken aback by the way bleeding comes and goes. So many questions come with postpartum bleeding. As a postpartum nurse and childbirth educator, I have been asked many times the questions below. Let’s get you some answers!
We’re going to look at some possibilities. I’m going to help you figure out if it’s lochia, your first period, or if you need to call your doctor.
Cause of the Bleeding: it is still lochia?
Though lochia can behave similarly to a menstrual period, it is different. Lochia will last several weeks after birth. It contains blood, mucous, and uterine tissue. As the wound left from your placenta in your uterus heals, typically the vaginal discharge of lochia will get less and less. But this is a SLOW process.
Lochia, after birth vaginal discharge, comes in three stages of lochia: lochia rubra, lochia serosa, and lochia alba.
Typically, you will experience heavy bleeding the first few days after both vaginal delivery and cesarean delivery. This is a great time to use the large maternity pads your birthing center or hospital provides. Some women prefer disposable underwear as opposed to large underwear plus a large pad. Disposable underwear may also help protect clothes more from possible leakage. Once you are discharged home, you can use regular sanitary pads (though an overnight sanitary pad may be the best choice for a week or so).
By the end of the first week, you may notice less blood flow or lochia changes.
Lochia rubra is bright red blood. Pink-tinged or brownish bleeding is called lochia serosa. White to yellowish discharge is lochia alba.
There’s a difference: Vaginal Birth vs Cesarean Birth Bleeding
With a vaginal birth, you can typically expect lochia bleeding for 4-6 weeks. Usually, bleeding will be the heaviest during the first two days after birth. Around day 3, you usually notice heavy flow to turn more to medium flow, but you will still need heavy sanitary pads for several days. After one week, bleeding is lighter with some possible transition to lochia serosa.
Vaginal Birth Bleeding:
- 1-3 days after birth: heavy bleeding
- 3-7 days after birth: medium flow
- 7-21days after birth: light flow with a possibly medium day depending on your activity
- 21-42 days: light pink to yellow discharge
Even if your bleeding has lightened up, it can pick up and taper off again depending on your activity. Be sure to read below the signs when you need to give your health care provider a call. If you had an episiotomy or perineal tear, you may pass stitches after two weeks. These look like tiny threads. Feel free to flush them.
I had never been told that I may pass stitches so I had no clue what they were when it happened. Was everything ok? Was this a sign of infection? Was something falling out? Yes, no, and no. Some of the stitches dissolve, but every now and then you will actually see some pass on your pad or in the toilet.
C-section Birth Bleeding:
You may be surprised to find that women who have a cesarean delivery also experience vaginal bleeding. Usually, moms who have had a c-section can expect to bleed a little less than moms who had a vaginal birth. The lochia flow tends to be a little lighter and only lasts for 2-3 weeks after birth. This is because of the way the uterus is cleaned following surgery.
- 1-3 days after birth: heavy bleeding
- 3-7 days after birth: medium to light bleeding
- 7-21 days after birth: light bleeding, to pink and yellow discharge
4 Weeks Postpartum Bleeding: Why and What to Expect
So, what now? You’ve been bleeding for a few weeks, but you thought it was about gone. You skipped a day of bleeding or maybe even two, and now you go to the bathroom, wipe, and…bright red bleeding at 4 weeks postpartum! What in the world?
This can happen for a number of reasons.
1. Have you increased your activity?
If you’ve been doing more lately, like incorporating light exercise, going for walks, or even running more errands, you may notice an increase in bright red bleeding (even if you were having a lighter flow). This can be normal. Give your body some time to rest. Prop your feet up if you can. See below for signs that you need to see your healthcare provider.
2. Have you been resting longer than usual?
Vaginal bleeding tends to pool in the vagina until we stand up and gravity takes effect. This is when we may feel a rush of bleeding or notice bleeding we haven’t had for several hours.
3. Did you just nurse?
When we nurse our babies, it releases oxytocin which causes cramping in our uterus. This cramping can cause extra blood to be pushed out and into our vaginas. If we’ve increased activity or been resting longer than usual, nursing can cause the uterus to expel stagnant blood.
4. Your uterus is still healing.
It takes about six weeks for the wound your placenta left at birth to completely heal. This means that at any time during this time frame, you may notice bleeding. Even if you thought you were done with it all, it can still need to get rid of lochia. This is your uterus’ way of clearing itself out.
Could this be your first postpartum period? Keep scrolling.
Is your bleeding soaking a pad in one hour? Call your healthcare provider. This could be postpartum hemorrhage and is something that needs to be taken very seriously!
Is it my First Postpartum Period?
Have you bottle-fed your baby since birth? Then bright red bleeding at 4 weeks or later could be your first period. Usually, this comes around 6 weeks postpartum, but it can come a bit earlier. If this is the case, be thinking about birth control. It is now possible for you to get pregnant again.
Breastfeeding will typically delay your first period by several months. The longer you breastfeed, the longer it usually is before you have your first period. Some women don’t get it until after their baby is one year old! It’s true that when you don’t have a period, you aren’t ovulating BUT at some point you WILL ovulate for the first time and not know it. For this reason, breastfeeding is not a viable method of birth control.
Your first period may be similar to a normal period, but many women will experience more intense cramping and heavier bleeding with the first postpartum period. Don’t be alarmed. Your period should get back to normal as your hormones balance out. If you are soaking a pad in one hour or experience any of the symptoms of postpartum hemorrhage, call your physician or midwife right away.
At this stage in the fourth trimester, some women begin to feel concerned over their breast milk supply. Here are 12 ways how to increase your milk supply, lactation specialist and mother-baby nurse approved!
5 Weeks Postpartum Bleeding Bright Red
Some women will experience bright red postpartum bleeding at 5 weeks. Remember, postpartum bleeding is normal for 4-6 weeks. The same that is true for 4 weeks postpartum bleeding is also true for 5 weeks postpartum bleeding.
If you’ve been doing more lately, like incorporating light exercise, going for walks, or even running more errands, you may notice an increase in bright red bleeding (even if you had less lochia). This can be normal. Give your body some time to rest. Prop your feet up if you can. See below for signs that you need to see your healthcare provider.
Your uterus may also still be healing. If you just nursed your baby, did you notice extra cramping? Sometimes with extra cramping, we notice more blood than we’ve experienced before. This is your uterus’ way of clearing itself out.
Have you been at rest for longer than normal? Vaginal bleeding tends to pool in the vagina until we stand up and gravity takes effect. This is when we may feel a rush of bleeding or notice bleeding we haven’t had for several hours.
Common Cause of Postpartum Hemorrhage
Postpartum hemorrhage can happen for a number of reasons. If you are experiencing any of these symptoms, stop reading and call your doctor now! Don’t wait. You need medical attention.
Uterine atony, a boggy uterus, can hinder uterine contractions, cause heavy bleeding from uterine blood vessels, and put new moms at greater risk for postpartum hemorrhage. Uterine massage is a great exercise to prevent this from happening. Learn the Art of Uterine Massage from a pro!
Other possible risk factors are high blood pressure or an overdistended uterus from giving birth to multiples. An overdistended uterus can be when a mom gives birth to twins or triplets or if she has given birth to multiple children over a few years. The uterine muscle becomes enlarged causing it to be at greater risk for blood clots and excessive bleeding as it works to return back to normal size.
Retained placental tissues can also be a risk of infection.
There are several signs that you should call your doctor with postpartum bleeding. Some of these are passing golf ball size large clots, soaking a pad in one hour, weakness, dizziness, or passing out. Also, watch for rapid heart rate and other signs of infection. If you are experiencing any of these common symptoms of postpartum hemorrhage, see medical attention or emergency care right away.
4 Weeks Postpartum Bleeding: Why and What to Expect
Bright, red bleeding can be completely normal at 4 weeks. BUT if you are soaking a pad in an hour or passing golf-ball size clots, it’s time to get help. If the bright, red bleeding ISN’T soaking a pad in one hour and isn’t heavy, you more than likely are still having some lochia rubra. This will soon pass. When in doubt, check in with your healthcare provider. Best wishes to you in this postpartum season of life!
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