What should you know about reason for heavy bleeding after delivery?

Bleeding after birth normally changes from red to brown or pink and gradually becomes lighter. Heavy, sudden or increasing bleeding is different. The womb may stay soft instead of tightening after the placenta is delivered. Small pieces of placenta or membranes may remain inside, or tears of the cervix, vagina or perineum may bleed. Problems with blood clotting can add to the bleeding. A perineal repair may be needed when a tear or an incision is contributing, but the cause must be assessed by the maternity team.

Tell the midwife, obstetric team or emergency service immediately if bleeding feels heavier than expected. Lie down if faint, keep your phone nearby, and do not drive yourself when weak or dizzy. Note how quickly pads become soaked, whether clots are passing, and whether you have pain, breathlessness or palpitations. Do not wait for a routine postnatal appointment. The team may check your pulse and blood pressure, examine the birth canal and womb, and use medicines or a procedure to control bleeding.

Call emergency services for rapidly soaking pads, large clots, faintness, confusion, severe weakness, trouble breathing, chest pain, a racing heartbeat or severe abdominal pain. Fever, worsening pelvic pain or a bad-smelling discharge also needs prompt review. Heavy bleeding can become serious quickly, including after you have left the birth unit.

What is the suspected source of the bleeding? Could a tear, retained tissue or poor womb contraction be involved? Do I need a perineal repair or another procedure? Which symptoms should prompt an emergency call after discharge?