Postpartum Bleeding: What To Expect In The Weeks After Birth
After your baby is born, your body starts its healing process, which includes vaginal bleeding called "lochia". This is expected, and the bleeding lasts up to six weeks as your uterus sheds the lining that developed during pregnancy. Your discharge will change throughout the process, starting as bright red and heavy, then becoming lighter and whiter as healing progresses. Learning about what to expect at each stage can give you more confidence about what is and is not normal.
Every new mother wants to know how much blood is normal, how long it will last, and at what point something is wrong. This guide will explain what is normal in terms of the stages of lochia, what is normal in terms of postpartum bleeding, and how you can assist your body in this healing time. If you're interested in personalised postpartum care, Floralia Wellness is dedicated to helping new mothers navigate this tender season. Our personalised postpartum care focuses on replenishing nutrient stores after pregnancy.
Bleeding after giving birth
When you are pregnant, your uterus receives a rich blood supply to support your placenta and your growing baby. Large blood vessels develop in the area of your uterus where the placenta is implanted. When the placenta separates from your uterus, the blood vessels are left open, which causes your uterus to contract in an effort to compress the bleeding vessels and reduce the amount of blood that is lost. This is why you may experience cramping in your lower abdomen in the first few days following delivery.
This is your body's own method for dealing with blood loss. The uterine contractions gradually seal off the open vessels, and at the same time, there is sloughing and rebuilding of the uterine lining. This whole process takes several weeks, which is why postpartum bleeding persists beyond the first week. The amount of blood lost and the rate at which it diminishes depend on how well your uterus is contracting and on your progress in postpartum recovery. Postpartum haemorrhage is clinically defined as excessive postpartum blood loss. It is divided into primary (occurring within 24 hours) and secondary (occurring within 12 weeks postpartum), and the causes are divided into the four T's: tone, trauma, tissue, and thrombin.
How breastfeeding affects postpartum bleeding
When you are breastfeeding, your body releases the hormone oxytocin, and it is this hormone that stimulates uterine contractions. You may feel cramping or experience a gush of vaginal bleeding during or after a feed, especially in the first week or two. This can be worrying, but it is actually your uterus doing its job.
These oxytocin-driven contractions help your uterus return to its original shape sooner, which in turn helps the bleeding stop sooner. Some breastfeeding women find that the lochia clears a little sooner than in women who do not breastfeed. However, this is highly individual. If you do not breastfeed your baby, your uterus will shrink and heal on its own, though it may take a little longer.
The three stages of lochia
Lochia changes in colour and volume as your body heals. The changes follow a predictable pattern that you can use to track your own healing. The three stages overlap somewhat, because bodies don't always follow a calendar. The progression from heavy, dark red blood to lighter, yellowish white discharge is an indication that healing is on the right track.
Lochia rubra (days 1 to 4)
This is the first stage, and also the heaviest. You can expect your blood to be bright red or dark red in colour. It may feel like your period is heavier than normal. You may also notice some blood clots during this stage. You can expect your bleeding to be heaviest on the first day after giving birth and then gradually decrease in the following days. You may need to change your sanitary pad every couple of hours. This is also the stage in which your body is shedding the most blood and tissue from your uterus through your birth canal. If your clots are large, bigger than 50 cents, or if your sanitary pad is soaked in an hour or less, let your midwife know.
Lochia serosa (days 4 to 12)
As the initial heavy bleeding subsides, lochia will now be a thinner discharge that is often described as having a reddish-brown or pinkish colour. The discharge will be significantly less in volume, and you will notice that you are not changing pads as often. Clots will still be present, although they will be diminishing in size. This is often the point at which new mothers will start to feel slightly more comfortable in their own skin, though it is an indication that your uterus is still healing.
Lochia alba (day 12 to six weeks)
The final stage is the longest. The discharge changes to yellowish white and is mostly composed of mucus and white blood cells rather than blood. The flow is light and sometimes hard to notice. Some days you might think that the discharge has stopped altogether, only to resume after some activity. This is perfectly normal. The yellowish white discharge may come and go for several weeks before it completely dries up.
What does normal lochia smell like
Normal lochia has a stale, slightly musty odour, similar to menstrual blood during menstruation. Lochia should not have an offensive or unpleasant odour. For some women, lochia may not have any significant odour at all, whereas for others, it may be more noticeable in the first week when it is heaviest.
A foul smell is not the same as normal lochia smell. If your discharge is accompanied by a strong, offensive smell, especially if it smells like something is rotting, you could have a uterine infection. Call your doctor or midwife in this case. The key here is that stale or musty is fine, foul is not.
How to manage postpartum bleeding day to day
Managing lochia involves a combination of comfort, hygiene, and paying close attention to your flow so that you notice any changes. The most practical adjustments are needed in the first two weeks. After that, your flow eases up.
What to use and what to avoid
Use maternity-grade or super-absorbent pads in the early days and change them often. One of the simplest ways to avoid infection is to make sure that pad changes are frequent. You should also avoid tampons for at least six weeks after giving birth. This is because anything inserted into the vagina at this time will increase the risk of uterine infection. The same goes for menstrual cups. Stick with external pads until your midwife or GP gives you the all-clear that your healing is progressing as it should.
When bleeding gets temporarily heavier
This can be a shock to new mothers. You may think that your bleeding has slowed to a lighter pace, and then you get up from resting or sitting, only to experience a sudden gushing. This happens because your body has simply accumulated blood, which then, with the force of gravity, rushes out as you stand up. It is not a setback.
You will also likely experience heavier bleeding in the mornings when you first get up and out of bed, after your first walk or other gentle physical activity, during and after breastfeeding, and sometimes after a long period of sitting still. These are all times when the blood flow to the uterus is increased and/or when the uterus is stimulated to contract, and the effect is a sudden surge in vaginal discharge. As long as it returns to normal in short order and you are not saturating pads at an alarming rate, ithis is perfectly normal.
The main thing to look out for is a return to bright red bleeding if your lochia has already changed to a pinkish or brownish colour. This may be your body’s way of telling you that you’re doing too much physically, so it’s a good idea to rest and see if the bleeding settles.
How postpartum bleeding differs after a caesarean
If you had a caesarean section, you will still experience lochia. The uterine lining still needs to shed, regardless of how your baby was delivered, as this process is not related to vaginal birth but to the placenta separating from the uterine wall.
There are, however, a couple of differences worth knowing about. Some women may notice that their initial bleeding is slightly less than what is expected in a vaginal birth, simply because some of the blood may have been removed during the procedure. This is not always the case, and it is not something to rely on, but worth knowing in case your initial bleeding is less than expected.
While the length of time for postpartum bleeding is similar for caesarean and vaginal births, lasting up to six weeks, your overall healing time is different as you are also healing from abdominal surgery. This means that you will be less mobile in the first few days, and this will affect your bleeding. By being less active, you will experience that pooling and gushing that is associated with postpartum bleeding. It will also take you longer to be able to move around.
One thing to be especially mindful of is abdominal pain that is getting worse rather than better in the first week, or a sudden increase in bleeding. Both of these could be signs that your healing from your caesarean is not progressing as it should. Your normal postpartum check with your midwife or doctor will pick up on these complications, but do not hesitate to reach out if you feel something is wrong.
Postpartum bleeding and your pelvic floor recovery
Your pelvic floor and your uterus are not recovering independently of each other. They occupy the same space in your lower abdomen and pelvis, and they affect each other in those early weeks of delivery.
As your uterus is contracting to stop bleeding and return to its normal size, your pelvic floor muscles are also in the early stages of healing, especially if you had a vaginal birth. The pelvic floor muscles are stretched and strained throughout pregnancy and the birth process. Your pelvic floor muscles are at their weakest in the first few weeks after giving birth. This is important to understand because actions that increase pressure in your abdomen (lifting, straining during a bowel movement, standing upright, or coughing) may cause increased blood flow to the pelvic area, leading to a surge in your vaginal bleeding.
This is one of the reasons why being aware of your pelvic floor is important during the early stages of your postpartum healing, even before you start pelvic floor rehabilitation. Managing the pressure on your pelvic floor (for example, exhaling when you lift your baby and not straining when you use the toilet) not only helps the healing of your pelvic floor but also the healing of your uterus. Many women do not know that these two are connected, and dealing with them separately misses the bigger picture of healing your whole body. If you are looking for guidance during this time, a practitioner with expertise in postpartum care can guide you through your healing priorities in both areas.
If you notice that certain activities seem to trigger heavier bleeding or the return of bright red blood, that is also useful information. It tells you that your body is not quite ready for that level of activity. Adjusting your activities is both a bleeding management strategy and a pelvic floor protection strategy.
Warning signs that need medical attention
Most of the time, bleeding after childbirth follows a predictable pattern, as explained above. In most cases, there are no complications. However, serious bleeding can occur, and it is important to know how to identify it.
Normal postpartum bleeding vs postpartum haemorrhage
While normal postpartum bleeding is heavy in the first few days following birth and then gradually diminishes in the weeks that follow, postpartum haemorrhage is different. It is defined as the loss of more than 500ml of blood from the vagina following birth. It may occur in the first 24 hours following birth (primary postpartum haemorrhage), or in the period from 24 hours until six weeks following birth (secondary postpartum haemorrhage). Postpartum haemorrhage affects 5 to 15 in 100 births in Australia.
The difference between heavy normal bleeding and a haemorrhage may not be easy to assess on your own. Signs that your blood loss may be a haemorrhage include saturating a pad every hour or two, passing large clots that are larger than a golf ball, feeling dizzy or faint, having blurred vision, and a rapid heart rate. Postpartum haemorrhage is life-threatening if left untreated. If you are unsure whether your bleeding is within normal limits, it is always better to seek medical attention than to wait.
The risk factors for PPH include a long or complicated labour, a large baby, multiple pregnancy, or a bleeding disorder. Another significant factor is anaemia during pregnancy. According to a 2025 systematic review and meta-analysis, there was an increased probability of PPH in pregnant women with anaemia compared to those who were non-anaemic. A blood test or blood transfusion may be needed if your blood loss was substantial and your blood pressure was affected. These symptoms should be monitored by your medical team, but you should also be able to recognise them yourself.
Signs of uterine infection
Uterine infection following birth is rare but must be caught quickly. The most significant symptom is that your lochia has a foul smell, unlike your normal stale or musty-smelling lochia. Other symptoms include fever, chills, abdominal discomfort (especially if your uterus is tender to the touch), and generally feeling poorly, with your symptoms not improving but getting worse.
If you are experiencing any of these symptoms, it is advisable to contact your doctor or midwife promptly. Uterine infections can be treated with antibiotics; however, if allowed to progress, these infections can be severe.
When to call your doctor or midwife
Trust your instincts on this one. If your bleeding is causing you concern, call. You do not have to wait until your symptoms fit neatly into a list. Your midwife or doctor would much rather hear from you and reassure you than have you at home worrying.
There are also certain circumstances in which it is important to speak with your doctor. For example, if you have been bleeding so much that it soaks through a pad in less than an hour, if you are passing large clots, if your bleeding is still bright red even though it had started to lighten, if your discharge smells bad, if you have fever or chills, if your abdominal pain is getting worse, if you feel faint or dizzy, or if all the symptoms you are experiencing seem to be getting worse instead of better.
A phone call to your midwife will also help you understand if your symptoms are within normal limits or need to be evaluated. It's always good to be cautious and make sure.
A naturopathic approach to postpartum care
The weeks after birth are demanding on your body. You have lost blood, depleted the nutrient stores accumulated during pregnancy, and if breastfeeding, this will continue to draw on your reserves. You are also recovering from the birth itself, either the vaginal process or surgery.
This is where naturopathic care can support you, alongside your midwife or doctor in your postpartum healing. There are several areas that Floralia Wellness practitioners commonly help new mothers with in this postnatal period.
Iron levels are usually the first thing to be addressed. Your body has lost blood during and after the birth process. If your energy levels are flat and climbing the stairs leaves you breathless, or if your brain feels foggy and disconnected, your iron levels may be depleted, and a blood test will reveal your levels. A naturopath can recommend the right type and dosage of iron supplements. Not all iron supplements are the same. Some are better tolerated than others, depending on your individual digestive system after birth. A Cochrane review in 2024 that looked at the treatment options for postpartum iron deficiency anaemia found that intravenous iron might be slightly more effective in alleviating fatigue in the early weeks post-birth compared to taking iron orally. However, it’s worth talking to a clinical nutritionist who can assess your nutritional levels and recommend the most appropriate iron supplements and approach to restore your iron levels.
Nutritional replenishment is more than just replenishing iron. Your body also needs zinc, B vitamins, vitamin C, and protein to rebuild tissues and support your immune system, as well as milk production if breastfeeding. Your naturopath can review your dietary habits and symptoms and fill in the gaps with practitioner-grade vitamins, herbs and nutrients that are personalised to your body's unique requirements, rather than a mass-market vitamin designed for new mothers.
Herbal medicine may also support uterine healing. Some herbs have a long history of traditional use in supporting uterine tone and blood flow after childbirth. There are active studies on plant-based medicine for this purpose. A pipeline analysis of herbal supplements for the prevention of postpartum haemorrhage, published in the International Journal of Gynecology and Obstetrics in 2022, found that motherwort, shepherd's purse, and grape seed extract are currently being studied for this purpose, though results are still limited.
One clinical trial specifically tested sublingual shepherd's purse extract in addition to conventional oxytocin and found that it significantly reduced postpartum bleeding in the treatment group compared to those receiving only conventional oxytocin, although the number of participants in this trial was small and it is used in addition to conventional treatment, not instead of it. A qualified naturopath will select an herb that is safe to take during breastfeeding and suitable for your individual case.
Floralia Wellness offers holistic postpartum services that complement your existing medical team, rather than replacing any part of it. Our practitioners draw on the principles of naturopathic medicine, Chinese medicine, and clinical nutrition to support women through all stages of reproductive health. If the early weeks of motherhood are feeling physically draining, or if you are feeling stuck in your healing process, naturopathic support is available to assist you in your recovery.
