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Bleeding

Bleeding

Pile of sanitary pads and pant liners Some bleeding after birth is normal – this is recorded in your notes as estimated blood loss (EBL). Vaginal bleeding after birth is referred to as lochia, which is a mix of blood and other products from inside the uterus. This can be quite heavy at first, requiring several sanitary pad changes a day. After the first week the lochia slows down and becomes pink/light brown in colour. This loss will normally disappear by four weeks after birth. Any large clots, silky membranes, sudden heavy bleeding or an offensive smell may be a sign that something is wrong and should be discussed with your midwife or GP urgently.

Retained products

You may be aware that when the placenta detaches from the inside of the uterus sometimes small pieces or fragments are left behind. Your midwife will have checked the appearance of the placenta to check whether there are any obvious pieces missing, but it is not always possible to spot fragments that have been left behind. The same is true when a caesarean is performed. Even though the doctors will have checked the inside of the uterus for any remaining placenta, it is not always possible to identify them. For most women, any retained fragments of placenta (sometimes referred to as “retained products”) will pass unnoticed with the normal lochia in the days or weeks following the birth. However, for a small number of women, retained products that do not pass naturally may require medical assistance. It may be that heavy bleeding occurs, or you begin passing blood clots. Or you may develop a temperature and feel shivery and unwell. These are potential signs of retained products that require treatment and if you develop any of these symptoms, you should get in touch with your local maternity Triage, or see your GP. Occasionally the retained products require surgical removal. This will involve a short procedure under a general anaesthetic, but most women can go home the same day.
Contact my maternity unit
Blood loss after birth Postpartum haemorrhage
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Feeling unwell

Feeling unwell

Graphic of three mercury thermometers showing no reading, a mid-range reading and a maximum reading

Infections

Infections following birth are rare; however some women may contract infections which require treatment with antibiotics. Infections may occur in perineal stitches, caesarean section wounds, the uterus, breasts or in urine and can worsen rapidly.

Signs/symptoms:

  • a high temperature (more than 37.5°C)
  • feeling unusually hot or cold/shivery
  • feeling unusually lethargic and sleepy
  • flu-like aches and pains in the body.

Stitches or caesarean wound infection

If your stitches or wound are infected you may notice pus, an offensive smell or an unusual amount of pain or tenderness in the area. You may also notice the skin is red and hot to touch.

Uterine infection

An infection in the uterus may cause symptoms of excessive vaginal bleeding, passing of clots and offensive smelling blood loss. You may also note severe pain and/or heat on touching the lower abdomen.

Breast infection

If breasts become infected (known as mastitis) they may appear red, swollen and be painful/hot to touch. You may notice a burning sensation during feeds. Seek help urgently and read more about this here.
Breast changes

Urinary infections

Symptoms include the increased need to pass urine or pain on passing urine. If you are experiencing any of these symptoms please speak to your midwife or GP urgently, or attend the local maternity triage/assessment unit where you had your baby.

Other infections

If you experience other infections not directly linked to having had a baby, like a severe cold/flu or chest infection, or diarrhoea and vomiting, seek help urgently.

Deep vein thrombosis/Pulmonary embolism

Read more about this here.
Deep vein thrombosis (DVT) and pulmonary embolism (PE)
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Deep vein thrombosis (DVT) and pulmonary embolism (PE)

Deep vein thrombosis (DVT) and pulmonary embolism (PE)

Woman's hand holding her leg below the knee

Are you at increased risk of developing a blood clot?

After giving birth, women are at a slightly increased risk of developing blood clots in the veins in their legs, known as deep vein thrombosis (DVT). This risk is increased for roughly six weeks following birth. On rare occasions, these blood clots can become very large and travel in the body to the lungs. This is known as pulmonary embolism (PE) and can be very serious.

Signs/symptoms:

  • pain/tenderness in the leg behind the knee or in the calf
  • feeling of heat in the affected area or a red discolouration of the skin
  • swelling of the affected area
  • a pulmonary embolism may cause shortness of breath and chest pain, which comes on suddenly and worsens with deep breaths, coughing or chest movement.
If you have any of these symptoms you should speak to a health professional immediately, or attend your local A&E department.

Treatment

These conditions are serious and will require urgent treatment in hospital with medications that prevent the clot from getting bigger and breaking off and travelling to another part of the body.

Prevention:

  • keep mobile and rotate your ankles regularly
  • wear compression stockings if your midwife or doctor have advised you to do so
  • consider taking short walks when you feel up to it
  • stay well hydrated
  • avoid sitting/lying down for prolonged periods i.e. in a car/on a train.
Some women will be prescribed injections to self-administer at home to reduce the risk of blood clots if they are considered to be at a higher risk of developing them. Staff use a venous thromboembolism risk scoring system to determine each women’s risk. These include caesarean section, postpartum haemorrhage, pre-eclampsia and preterm birth, or any family or medical history that makes the risk higher. Before you are discharged you will be shown how to administer the pre-filled syringe and safely dispose of the sharp into a sharps container. If you have been prescribed injections it is very important to complete the course – and to dispose of the needles safely. Your midwife will explain this to you before you go home.
Blood clots in pregnancy Reducing the risk of DVT
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Recovery from caesarean birth

Recovery from caesarean birth

Close up of woman's tummy showing a caesarean scar Following a caesarean you may feel sore and swollen for a few days. To help with pain, regular pain relief is recommended in combination with early and gentle movement. Always wash your hands before caring for your caesarean wound. Your scar will take up to six weeks to heal, and to assist with healing you should:
  • look out for any signs of infection such as severe pain, parting of the wound, redness, oozing of pus and bleeding
  • bath or shower daily and clean your incision site gently with warm water and pat dry
  • keep the scar dry and exposed to the air when possible
  • wear loose, comfortable clothing and cotton underwear
  • avoid lifting anything heavier than your baby.
Gentle activity such as a daily walk is recommended to prevent the formation of blood clots. Advice on resuming exercise can be found elsewhere in this section.
Recovery from caesarean
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Perineal after-care

Perineal after-care

Close up of hands covered in soap lather being rinsed under a running tap
  • Always wash your hands before caring for your stitches or changing your sanitary towels. This is particularly important if anyone in your household has a cough or cold
  • Shower or bath daily, if possible, for the first two weeks. Prolonged bathing can cause the stitches to dissolve too quickly. Rinse with warm water and avoid soaps and perfumed products. Dry with a clean towel and avoid rubbing the area
  • Do not apply any creams, salts, oils or lotions to the stitches
  • Sanitary towels should be changed frequently, and leaving the stitches exposed to the air can assist with healing
  • When passing urine, some mild stinging can be expected in the first few days. Avoid dehydration which can worsen this sensation. Rinsing with plain water during or after urination may reduce this discomfort
  • When opening your bowels the stitches won’t come apart. Avoid constipation or excessive straining and ensure good personal hygiene is maintained to reduce the risk of infection
  • Mild/moderate discomfort is to be expected in the first few days after birth and can be relieved with common pain relief medications such as paracetamol and/or ibuprofen. Please speak to your midwife regarding the recommended dose and other methods to relieve discomfort of your stitches
  • Using ice can reduce inflammation and pain. You can use ice wrapped in a clean towel or use a sanitary pad that has been placed in the freezer for couple of hours. Place over the tender part of your perineum for 10 minutes. Repeat the process three to four times each day for the first few days
  • If your stitches are gaping, oozing, severely painful, offensive in smell or unusually hot, please contact your GP, midwife or local maternity triage/assessment unit urgently.
Recovering from tearing
Understanding perineal tears
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Intrahepatic cholestasis of pregnancy (obstetric cholestasis) after birth

Intrahepatic cholestasis of pregnancy (obstetric cholestasis) after birth

Close up of a pair of bare feet with a hand scratching an itchy rash on the sole of one of the feet Intrahepatic cholestasis usually gets better after birth.  Rarely, women may have persistently elevated liver enzymes after birth which may indicate a separate underlying liver problem, requiring investigation by your GP in conjunction with a liver specialist. Your GP should check that your liver function has returned to normal at your six week postnatal check. There is a high chance that intrahepatic cholestasis may happen again in a future pregnancy. Up to 90 per cent of women who have had intrahepatic cholestasis will develop it again in future pregnancies. If you have had intrahepatic cholestasis in your pregnancy, it is recommended to have your liver function checked before taking a hormone based contraceptive. For more information see the related link below ‘ICP and contraception advice’.
Intrahepatic cholestasis ICP support ICP and contraception advice Obstetric cholestasis
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Gestational diabetes after birth

Gestational diabetes after birth

Close up of woman taking a blood sugar fingerprick test If you had diabetes before becoming pregnant, you should refer back to your diabetes team for appropriate advice about managing your blood sugars following your baby’s birth. If you have had gestational diabetes, any medication you have been taking in pregnancy to control your blood sugars can usually be stopped after the birth. Your maternity team may check your blood sugars to ensure they are returning to normal prior to you going home from your maternity unit. You do not need to check your blood sugars once home unless you’ve been told to do so. It is important that you arrange to have a blood test at your GP practice to exclude continued problems with your blood sugar between six and 13 weeks after the birth. Your GP should offer to repeat this blood test every year thereafter, as women who have had gestational diabetes are more likely to be diagnosed with diabetes later in life than those who have not. Research suggests that breastfeeding your baby for more than 3 months may delay the onset of diabetes in the future, or reduce your chance of developing it at all. You can ask your midwife for support with feeding if you need it. After you have had gestational diabetes once, the chance is higher that you will have it again in any future pregnancy, therefore it is important to plan your pregnancy and ensure you have access to maternity care early on. Babies born to mothers with gestational diabetes are at a higher risk of obesity and type 2 diabetes later in life. Use the lifestyle information gained during your pregnancy to make healthy life choices for your whole family and the future.
Portal: Gestational diabetes (Related link)
Gestational diabetes More on gestational diabetes
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Pre-eclampsia (PET) after birth

Pre-eclampsia (PET) after birth

Medic takes woman's blood pressure reading Most women who are diagnosed with pre-eclampsia [PET] had normal blood pressure and no protein in their urine before pregnancy. By six weeks after birth, your blood pressure and protein urinary levels will have usually returned to normal. However, a few women may need tablets to control their blood pressure on a long-term basis, this is one of the reasons that it is important to measure your blood pressure in the weeks after birth. Women who have had PET are more likely than other women to have it again in a future pregnancy, and thus you should seek advice about how to manage this, either at the eight week GP postnatal check, or at a pre-pregnancy appointment. The occurance of hypertension during pregnancy is known to predispose women to hypertension in the future. According to the National Institute for Health and Care Excellence, based on your diagnosis of hypertension during this pregnancy, there is an approximate 1 in 5 risk of hypertension during future pregnancies. There is also an increased risk that you may develop hypertension or cardiac disease in later life. Please be reassured that you can help reduce this risk by maintaining a healthy lifestyle and body weight and avoid smoking. Please consult your General Practitioner or specialist to see how you can reduce your future risks. If you are known to have chronic hypertension you have:
  • 17% (1 in 7 women) risk of pre-eclampsia in a future pregnancy
  • 1.7 times increased risk of a major adverse cardiac event in later life
  • 1.8 times increased risk of a stroke in later life
If you have pre-eclampsia you have:
  • 20% (1 in 5 women) risk of any hypertension in a future pregnancy
Of these: Up to 16% (1 in 6 women) risk of pre-eclampsia in a future pregnancy: – if this birth was at 28-34 weeks, this is increased to 33% (1 in 3 women) – if this birth was at 34-37 weeks, this is increased to 23% (1 in 4 women) 6-12% (up to 1 in 8 women) risk of gestational hypertension in a future pregnancy
  • 2% (up 1 to 50 women) chance of developing chronic hypertension
  • 1.5-3 times increased risk of a major adverse cardiac event in later life
  • 2 times increased risk of a cardiovascular mortality in later life
  • 2-3 times increased risk of a stroke in later life
  • 2-5 times increased risk of developing hypertension
If you have gestational hypertension (high blood pressure with no protein in the urine) you have:
  • 22% (1 in 5 women) risk of any hypertension in a future pregnancy
Of these: 7% (1 in 14 women)risk of pre-eclampsia in a future pregnancy 11-15% (up to 1 in 7 women) risk of gestational hypertension in a future pregnancy
  • 3% (up 1 to 50 women)chance of developing chronic hypertension
  • 1.5-3 times increased risk of a major adverse cardiac event in later life
  • 2 times increased risk of a cardiovascular mortality in later life
  • 2-4 times increased risk of developing hypertension
  • Potential increased risk of a stroke in later life
Postnatal recovery from pre-eclampsia More on pre-eclampsia