Postpartum bleeding & periods: what to expect after birth.

Whether you give birth vaginally or via caesarean section (a.k.a. a 'c-section'), you're going to experience vaginal bleeding for quite a few weeks afterwards as your uterus recovers, repairs itself and returns to its regular size and shape (incredible, hey?!). 

Whilst we're often told what to expect from labour: lots of pushing, a possible tear-down there, uncomfortable swelling, or perhaps discomfort from a caesarean section delivery... we aren't always told what to expect from our post-birth bleed.

So here's that info you've been wondering about, Moxette: from what to expect from the postpartum bleeding phase and how to best manage it, to what you need to know about the return to your regular menstrual cycle post-birth.

POSTPARTUM BLEED vs. REGULAR MENSTRUAL PERIOD - WHAT'S THE DIFFERENCE?

Your postpartum bleed - as in, the flow and discharge you'll experience straight after giving birth, and medically known as 'lochia' - is made up of blood, mucus uterine tissue and amniotic fluid. It sounds similar to your menstrual perdio, but it not quite the same as menstruation.

Menstruation refers to the cyclical shedding of your uterine lining that occurs as part of your reproductive cycle, whereas lochia is a part of the postpartum recovery process, lasts longer, and will change in texture and appearance over the weeks post-birth. And, whilst the blood from your menstrual period comes from the shedding of the lining of your uterus, the blood in lochia also comes from the wound where the placenta was attached.

THE STAGES OF POSTPARTUM BLEEDING (LOCHIA), EXPLAINED

The bleeding that happens directly after birth, a.k.a lochia, typically occurs in three stages:

LOCHIA RUBRA 

This is the initial stage of postpartum bleeding, usually lasting for about 3-5 days after delivery. You can expect your flow to be bright red in colour and may contain small blood clots (these are nothing to be alarmed about, Moxette, but if they persist, check in with your Doctor).

LOCHIA SEROSA 

Your flow during this phase transitions to a pinkish-brown color and typically lasts for about 1-2 weeks.

LOCHIA ALBA 

As the postpartum bleeding nears its end, it will turn creamy or yellowish-white. Lochia alba usually starts around week 2 and continues for another 2 - 4 weeks, gradually decreasing in volume until it stops completely.

HOW LONG DO YOU BLEED FOR AFTER YOU GIVE BIRTH?

"Your flow after giving birth can last up to six (6) weeks," says Sydney-based Obstetrician and Gynaecologist Dr. Nicole Stamatopoulos. "It starts like a heavy period but can decrease in flow quite quickly, sometimes within a week," she adds.

If bleeding persists longer than six weeks, Dr. Stamatopoulos recommends making an appointment to see your GP or Obstetrician.

DO YOU STILL BLEED EVEN IF YOU HAVE A C-SECTION?

Yes, you do, as your body is expelling the uterine lining, tissue and mucus which helped prepare for birth that it no longer needs, so that your uterus can heal.

HOW MUCH BLOOD IS TOO MUCH?

Lochia might start off pretty heavy in the few days straight after birth, but you shoud see it naturally taper off after a couple of days. If you feel like you're experiencing heavier blood loss, it may be a sign of postpartum haemorrhage, which can be incredibly serious and in some cases, life-threatening so please call your Doctor immediately or go to the ER. 

Signs and symptoms of postpartum haemorhage to look out for are:

• Heavy bleeding that requires you to change your pad every hour or so (or that flows continuously)
• Large clots in your lochia/postpartum bleed (around the size of a prune)
• Blurred vision or dizziness
• Weakness or a feeling of faintness
• Nausea
• Increased heartrate
• Chills or a sudden fever
• Any kind of sudden or severe pain
• Foul-smelling discharge or flow

Postpartum haemmorhage can happen anytime during the first 12 or so after giving birth, so if anything feels wrong at any point, don't hesitate - get checked.

HOW TO CARE FOR YOUR POST-BIRTH BLEED

Your postpartum bleed is probably going to be heavier than your regular period, and so your regular period care probably isn't going to cut it, Moxette - at least in those first few days. Opt for something postpartum-specific, which is likely to be more absorbent and fit-for-purpose, like Moxie Postpartum pads (with a handy warming and cooling reusable gel pack, ideal for soothing perineal post-birth care).

Once the heavy bleeding subsides a little, you may choose to revert back to your regular period care, but note that it's wearables only for at leat the first six weeks (or as recommended by your Doctor) - so that means pads or period undies - no tampons, menstrual cups or anything that's inserted into the vagina.

WHEN WILL MY REGULAR PERIOD COME BACK AFTER PREGNANCY?

"Commencement of your menstrual cycle after birth can vary," says Dr. Stamatopoulos. "If you decide not to breastfeed, you can expect it to recommence reasonably quickly. It takes about 6 weeks for your body to be in a 'non-pregnant' state, so I would say monthly after that," she explains.

"If you are breastfeeding it can vary," Dr. Stamatopoulos continues. "Some will have it re-start within 6 months, even if they are breastfeeding around the clock. For others, it can take 2 or so years, even if they are only breastfeeding once a day," she adds.

Other factors like hormonal fluctuations, diet and even stress can also play a part in when your regular period will return post-birth. Have a chat to your Doctor if you're concerned.

(If you're wondering what the link between breast/chest feeding and supressed periods is, it's is because the hormone used to produce milk, prolactin, can supress reproductive hormones).

YOUR FIRST MENSTRUAL PERIOD POST-BIRTH

A lot has changed since your last period, Moxette, so don't be alarmed if your menstrual period has changed, too. Your first period post-birth may be different to how it was before. You may experience:

• irregular periods (especially if it returns while you're breast/chest feeding)
• cramping – this may be worse or better (hopefully the latter!) than before you were pregnant
• heavier periods
• small blood clots* in your period flow

Beyond your first menstrual period post-birth, don't be alarmed if it takes a little while for your cycle to re-regulate. Your periods may fluctuate in length, intensity of cramping and/or flow, and their frequency may not even be regular (i.e. monthly).

This isn't a one-size-fits all though, Moxette, and everyone will experience things differently. If anything seems particularly unusual for you, check in with your Doctor.

*if clots in your flow are becoming frequent, are larger than an Aussie $1 coin and are accompanied by a heavy or dark period, make an appointment to see your Doctor.

MY PERIOD HASN'T COME BACK AFTER PREGNANCY - WHEN SHOULD I WORRY?

First up, try not to worry (that may actually exacerbate the issue - nore on that in a sec). Experiencing what feels like a delay in the return of your period after pregnancy can be concerning for some. Whilst it's not uncommon for your menstrual cycle to take time to regulate postpartum, it's important to address any lingering concerns in case there's anything underlying going on that requies treatment.

Hormonal changes, breast/chest feeding, stress and even pregnancy are just some of the things that may be supressing your period. "If your period doesn't restart after 3 - 6 months from ceasing breastfeeding completely, then it is reasonable to see your Doctor," says Dr. Stamatopoulos.

So if it's been a few months post-birth and your period hasn't made it's (re)entrance yet, make an appointment to see your GP or OBGYN. They will be the best ones to evaluate your individual situation, address any underlying concerns you have and provide guidance and support that's tailored to your specific needs.

Remember, that everyone's experience with postpartum bleeding and the return of menstruation can and will be unique. As always, if anything seems unusual to you about your body or your flow post-birth (or otherwise), check in with your Doctor.

IMPORTANT PSA: The information posted here and on @MoxieHQ Instagram, TikTok and Facebook channels is intended to inform only, and does not nor should it constitute or replace a personalised medical diagnosis or treatment plan from a medical professional. If you're ever concerned about anything relating to your own intimate health, please make an appointment to see your Doctor or health practitioner.