Postpartum bleeding tracker

Bleeding after birth is normal. Knowing when it stops being normal is the hard part

Every woman who has given birth bleeds afterwards. The blood comes mainly from the raw area inside the womb where the placenta was attached, and partly from any cuts or tears made during the birth. It is called lochia, it is heaviest in the first few hours, and it fades over weeks from red to brown to a creamy white. RCOG puts the outer limit simply: it will usually have stopped by the time your baby is 12 weeks old.

What almost nobody is told with the same clarity is the other half. Bleeding that gets heavier instead of lighter, or that fades and then turns red again, or that arrives with a smell or a temperature, is not the tail end of something ordinary. It is the presentation of secondary postpartum haemorrhage, and it usually happens after you have gone home, when there is no midwife in the room to notice.

The two definitions worth knowing

Postpartum haemorrhage comes in two kinds and the distinction is about timing. Primary postpartum haemorrhage is a loss of 500 ml or more within the first 24 hours after birth; RCOG calls 500 to 1000 ml minor and anything above 1000 ml major. That one almost always happens with staff present. Secondary postpartum haemorrhage is abnormal or heavy bleeding at any point between 24 hours and 12 weeks after the birth, and RCOG notes that it usually occurs after you have left hospital.

Its two usual causes are both treatable. The most common is infection in the womb, which responds to antibiotics. The other is a small piece of placental tissue that has stayed behind, which occasionally needs a short operation to remove. Neither is a reason to wait and see whether it settles, and RCOG is explicit about why: prompt treatment is what stops a minor haemorrhage becoming a major one.

The numbers to ring about

The CDC, with the Alliance for Innovation on Maternal Health, publishes a list of urgent maternal warning signs. Two of them are about bleeding after pregnancy, and they are numbers you can check yourself at three in the morning: heavy bleeding that soaks through one or more pads in an hour, and clots bigger than an egg, or passing tissue. ACOG puts the same idea slightly differently: soaking two pads an hour for more than one to two hours. A discharge that smells bad is on the same list.

NICE, writing for clinicians rather than for you, tells maternity staff to advise women to seek medical advice if the bleeding is sudden or very heavy, if it increases, if you pass clots or placental tissue or membranes, if there are signs of infection such as abdominal or pelvic pain, fever, shivering or an unpleasant smell, or simply if you have concerns about the bleeding. That last clause is doing real work. You are allowed to ring because something feels wrong.

Add feeling faint, dizzy, breathless, or a racing heart. Those can mean you have lost more blood than the pad suggests, and they change a phone call into an emergency.

Why pad counting is a rough measure, and why we use it anyway

Pads differ in absorbency. A pad soaked in the middle is not the same as one soaked edge to edge. Nobody pretends this is precise. It is used because it is the only measure available in a bathroom, and because “how fast are you going through pads?” is the first question the person on the phone will ask. If you are near the line, keep the pad, take a photograph, and ring anyway. Nobody in maternity triage thinks that is a waste of their time.

What the usual course actually looks like

Bleeding is heaviest just after birth and eases over the following hours, then further over the following days. The colour changes from bright red to brown over a few weeks. It is normal for it to be redder and heavier while you feed — breastfeeding makes the womb contract, which is also why you may get period-like cramps during a feed. That contracting is the point: the womb weighs around 1000 g straight after birth, about 500 g by the end of the first week, and 50 to 100 g by roughly six weeks, and it is that shrinking that closes the placental site.

How long it lasts varies more than most people expect. In a diary study of 236 women who recorded the colour and duration of their own lochia for up to 60 days, the median total duration was 33 days, and 13% still had some lochia at 60 days. So still bleeding lightly at seven weeks is not automatically a problem. Bleeding that has started getting heavier at seven weeks is.

Practical things

Use maternity or period pads rather than tampons or menstrual cups until after your 6 to 8 week postnatal check. The placental site is still a wound, and internal products before it has healed raise the risk of infection. Change pads regularly and wash your hands before and after.

Bleeding is not contraception. You can get pregnant three weeks after giving birth, before any period returns and whether or not you are breastfeeding, which is why NHS advice is to have contraception in place within 21 days.

What this tracker is, and what it is not

It restates published thresholds against your dates so you can act on them, and it will not tell you that anything is normal — the strongest thing it says is that today matches the usual course, which is a description of a pattern and not an examination of you. It cannot see the pad, does not know your notes, and has no idea what your birth was like. If your instinct says something is wrong, that outranks everything on this page. Ring.