Heavy bleeding after normal delivery

Some vaginal bleeding is expected after birth as the uterus sheds tissue and gradually contracts. It should generally become lighter and change in colour over time. Bleeding that suddenly becomes much heavier, returns after easing, or includes large clots can signal that the uterus is not contracting well, tissue remains inside the uterus, or an injury is bleeding. Infection can also cause heavier bleeding, often with fever, worsening pelvic pain, or an unpleasant smell.

The amount can be difficult to judge at home, so do not rely on appearance alone. A midwife, obstetrician, or emergency clinician can check your pulse, blood pressure, abdomen, uterus, and the source of bleeding.

Stop strenuous activity and sit or lie down while arranging help. Use a maternity pad so the amount and clots can be described; do not use tampons or put anything in the vagina. Ask someone to stay with you, and take your maternity notes and medicines list if you attend a facility. If you feel faint, do not drive yourself. Treatment may include medicines that help the uterus contract, fluids, examination, blood tests, or a procedure depending on the cause. Oxytocin may be used to encourage uterine contraction.

Seek emergency help immediately for bleeding that is rapidly soaking pads, a feeling that blood is running out, faintness, confusion, breathlessness, a racing heartbeat, pale or clammy skin, severe abdominal pain, or large clots. Contact your maternity unit urgently even if the bleeding is not dramatic when it is increasing, has returned after becoming lighter, or comes with fever or a bad-smelling discharge. These warning signs need assessment rather than watchful waiting.

Ask: Could the bleeding be from the uterus, placenta tissue, or a tear? Do I need an examination, blood tests, or an ultrasound? Which symptoms should make me return immediately? Is it safe to breastfeed while receiving treatment? When can I resume activity and vaginal sex?