Possible Causes of Postpartum Bleeding On and Off

It is normal to have vaginal bleeding after you delivered your baby. It is actually your body's way to get rid of additional blood supply as well as any supporting tissue in the uterus that is no longer in use. Postpartum bleeding, also called lochia, is perfectly natural and nothing to worry about, so long as you do not have other symptoms. What if you experience postpartum bleeding on and off?

It Coubd Be Your Period

If you do not breastfeed or take hormone medications, bleeding on and off can actually be your period. Here are some tips to help you determine whether it is postpartum bleeding or period.

1. Pay Attention to the Color

There will be a slight difference in the color of the blood during menstruation and postpartum bleeding. For instance:

  • You are going to have bright red blood for the first three days after birth – this indicates postpartum bleeding. The color may change to reddish brown from day 4 to 10. You may also notice old blood, and tissue debris. You may notice whitish discharge after 10 days – this usually consists of mucus, white blood cells, and epithelial cells.
  • In case of menstruation, you will have bright red bleeding in the beginning but it will soon turn to dark red, brown, or even black by the end of menstruation. Just paying attention to this change will help you differentiate between postpartum bleeding and menstruation.

2. Pay Attention to the Blood Flow

  • Postpartum bleeding is usually heavier than menstruation, especially during the first four days. The flow will reduce significantly after a few days or so.
  • The flow of blood is usually heavy with menstruation as well, but that is for the first 3-4 days only. The average blood loss is usually no more than 10-80 ml. A tampon can hold about 5 ml of blood, so count how many tampons you use to calculate the quantity of blood you've lost.

It Can Be Late Postpartum Hemorrhage

If you have postpartum bleeding on and off, it could be due to late postpartum hemorrhage. It refers to a condition when you have severe bleeding that can happen from 24 hours to 12 weeks after delivery. You develop this condition when your uterus fails to contract normally – this could be due to fragments of the placenta in the uterus or an infection in the uterus. Sometimes, you have a late postpartum hemorrhage because of an inherited disorder, such as von Willebrand's disease that affects your blood's ability to clot.

You should call your doctor if you notice any of the following signs:

  • Your bleeding is so heavy that you are soaking more than one sanitary pad in one hour.
  • You notice bright red bleeding that appears at least 4 days after delivery.
  • You have bleeding along with clots that are of the size of a golf ball.

Call emergency service if you bleed profusely or have any signs of shock, including weakness, lightheadedness, palpitations, shallow breathing, restlessness, clammy skin, or confusion.

Treatment for Late Postpartum Hemorrhage

If your postpartum bleeding on and off is due to late postpartum hemorrhage, you may have to use the following treatment options.

  • Your doctor may suggest hospitalization to ensure you do not have to deal with serious complications. He/she will keep you under observation and start an IV to provide you with medication and fluid. This will help your uterus to contract better. Sometimes, your doctor also give you antibiotics to clear an infection.
  • If you have tissue in the uterus, your doctor may decide to perform a surgical procedure called a dilation and curettage (D&C). He/she removes the tissue through this procedure. In serious cases, you may require a hysterectomy.
  • You may require IV medication even after the bleeding has stopped. This may continue for another 24 hours to ensure that your uterus stays contracted. It is also important to take antibiotics for as long as your doctor recommend.
  • You will stay under the observation of your medical team for a few more days after the bleeding has stopped to ensure you do not have postpartum bleeding on and off, or you do not have any signs of infection. You might feel lightheaded while recovering, so do not try to get out of your bed without help.
  • Once you feel better, you have to take plenty of rest and pay attention to your diet. A combination of balanced diet, fluids, rest, and prenatal vitamins with folic acid may help you recover quickly. You may also need to take iron supplements if you have lost excessive blood. 
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