Postpartum bleeding is not a terribly fun topic to talk about but it needs to be talked about. I am on the eve of my 5th delivery and thinking about all of the things I need to prepare for after the baby is here. One of the things is postpartum bleeding. Here’s what you need to know and what you should expect:
Fundal Massage – Don’t let the name fool you. It should be called fundal manipulation. Really there is nothing relaxing about it. Immediately after you deliver, your nurse will begin digging her bony hands into the top of your uterus. The top of your uterus is called the fundus. By doing this, they are helping the uterus return to its normal size (below your pubic bone) from its super inflated watermelon size. While doing this, they are likely to pull your pad back and take a peek at the volume of blood coming from your vagina. It’s not glamorous. It is not comfortable. But they are keeping you safe and healthy. This will likely continue until your uterus is an ideal size and firm or bleeding slows when they do it. Usually a couple of hours post birth. Just as a note, the more babies you have, the slower your uterus is to return to its normal state – it is boggy, soft, and worn out – just like the mom that it is inside of!
Post Birth Contractions – I gave birth, why am I still contracting? There are a few reasons. First, your uterus needs to return to its normal size. By contracting, it is able to achieve that. Here is a great secret that no one ever told me as I sat to nurse my sweet little angel, that my uterus would cramp down and I would feel blood pouring out of me. How can such a sweet moment be tainted like that? When you are nursing and bonding with your new baby, oxytocin is being released – the same hormone that makes you have contractions. Nature made us perfect. At least now you have a baby to look at while dealing with this familiar post birth discomfort.
Heavy or Light Flow? – This varies from mother to mother and pregnancy to pregnancy. My first pregnancy, I walked out of the hospital barely spotting. The nursing students who (with embarrassment) asked to see my pristine white pad were flabbergasted. How did I have a baby 24 hours before and have no bleeding? This last delivery, I bled for all 6 miserable weeks. Normal flow after a baby is like a heavy period for several days and should progressively get less. It can be anywhere from a week to six weeks. All variations of normal.
Cesarean Birth – Theoretically it sounds like you shouldn’t bleed as much if you have a cesarean birth but that is not the case. You have to remember that when the placenta detaches from the wall of your uterus, this organ has been a blood supply between you and your baby. This means that you now have an open bleeding wound in your uterus about the size of a saucer. Ultimately, cesarean birth moms will still have the same amount of bleeding and should expect discomfort from fundal massages (maybe even more so since you have an abdominal wound) and post-birth contractions.
Sweet Relief – Remember those breathing techniques you used during labor? You might need to remember those when getting these fundal massages and post birth contractions – especially for those who had a surgical birth. Heating pads hot water bottles on your lower back may help while you are nursing or experiencing uterine contractions. Avoid baths with doctors parameters – With your cervix not completely closed and an open wound in your uterus, baths may expose bacteria to your uterus. This might be the best news I am going to give you – Ibuprofen is finally allowed again! If your doctor has prescribed you Ibuprofen, stay on top of it! Take it before you think you need it. Staying in front of the pain is better than trying to catch up to it.
Feminine Products – If you don’t typically use pads, you may want to start with small packs of various different brands. During your postpartum transition period, nothing is to go into the vagina so pads and adult incontinence undergarments are your only option for feminine products. You may want to consider purchasing different flow products including medium, heavy, and super long ones for night time use. Also, I always recommend purchasing pads with wings – They just seem to stay put better while you are sitting cross-legged nursing. Also consider asking other mom friends – There are SO many options on the market and standing there in the store with a basketball sized belly can be daunting. See what other moms like and try that brand or style. There are also more natural reusable/cloth pads you can purchase from places like Etsy and Amazon.
Reasons for Concern — Sometimes the postpartum period doesn’t go exactly as planned. When should you begin to get concerned about bleeding? These are reasons to contact your provider:
- If you are bleeding through a pad in less than 2 hours.
- If you are passing clots larger than a golf ball.
- If you are running a fever.
- If your bleeding gets better then substantially worse.
- If you have substantial abdominal pain outside of cramping during nursing or let down.
- If you have foul smelling discharge or blood coming from your vagina.
- If you get dizzy or lightheaded or bleed significantly when changing positions.
- If anything in your gut tells you that something is not normal.
As always, your Labor or Postpartum doula is here to answer your questions. The majority of mothers will transition to motherhood seamlessly but we are with you every step of the way when you need us!
Written by: Melanie Binversie, Owner | Lead Doula for Stars and Stripes Doulas of Washington DC