Postpartum Bleeding and the Return of Menstruation After Childbirth

After childbirth, women experience natural bleeding that lasts for 6-8 weeks, whether the delivery was vaginal or cesarean. This bleeding is known as lochia, but it is not considered a menstrual period. During this period, the body expels blood and remaining tissues from the uterine lining after pregnancy, which is entirely different from menstrual bleeding. In this article, we will discuss the stages of lochia and the changes it undergoes, as well as when and how menstruation returns after childbirth, and the impact of breastfeeding on its regularity. We will also clarify the difference between normal and abnormal postpartum bleeding, and the signs that warrant consulting a doctor to ensure the mother's safety.

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Stages of Lochia:

Postpartum lochia goes through several stages, with its color and amount gradually changing as the body heals. The bleeding pattern varies from woman to woman, but there is a general trend that can be observed in the first few weeks after delivery. Here’s what to expect in each stage:

• From Delivery to 10 Days Postpartum
  Immediately after delivery, the bleeding is heavy and bright or dark red, then gradually decreases. By around the seventh to tenth day, the woman may notice the lochia (postpartum vaginal discharge) changing from bright red to dark reddish-brown. She may also notice small clots, requiring frequent changes of postpartum sanitary pads every few hours.
• After 4 Weeks Postpartum
  By the fourth week, the bleeding is likely to lighten. At this stage, it will no longer be bright red but light pink. Additionally, the number of postpartum pads used should decrease, and she may switch to regular sanitary pads.
• After 6 Weeks Postpartum
  For most mothers, the bleeding will have significantly slowed by the sixth week and should now be yellow or white discharge rather than blood. However, some may still experience light spotting or minimal bleeding for up to ten weeks postpartum.

When Will Menstruation Return After Childbirth?

The return of menstruation after childbirth depends on the method of feeding. Mothers who exclusively breastfeed may not resume menstruation until they stop breastfeeding or reduce its frequency, especially by decreasing nighttime feedings. Mothers who use formula feeding or combine breastfeeding with formula may notice the return of menstruation within four to five weeks after delivery. However, the absence of menstruation, especially for mothers who rely on formula or mixed feeding, does not necessarily mean ovulation is not occurring, meaning there is still a possibility of pregnancy even without menstruation. Light bleeding can typically last for a month or more. By the way, mothers who deliver via cesarean section may experience less lochia compared to those who deliver vaginally.

Impact of Breastfeeding on Menstruation

Breastfeeding delays the return of menstruation compared to non-breastfeeding mothers due to the effect of prolactin. This hormone plays a key role in stimulating milk production in the breasts and suppresses the secretion of sex hormones like estrogen and progesterone. When prolactin levels rise due to breastfeeding, they affect the hormonal system responsible for regulating menstruation. These hormonal effects prevent the release of eggs from the ovaries, thereby preventing ovulation, which is necessary for menstruation. Consequently, without ovulation, menstruation does not occur.

First Period After Childbirth

As postpartum discharge continues and the rate of lochia slows, the body will continue to expel lochia, which is the vaginal discharge resulting from uterine cleansing. It may be white, yellow, or mixed with some blood. If the lochia stops for several days and then bleeding resumes, this is likely the menstrual period. The first period may differ from pre-pregnancy periods, potentially becoming heavier than usual or accompanied by changes in cramp intensity. To confirm, check for the following signs:

• The blood is bright red.
• Blood discharge increases with movement.
• The odor is somewhat unpleasant.

Irregular Menstruation After Childbirth

Irregular menstruation after childbirth is normal. There are no guarantees when it comes to menstruation after delivery. Your period may start after two to seven days of bleeding and repeat every 28 days on average. Postpartum menstruation can vary, meaning the length or duration of your cycle may change from what you’re used to, and breastfeeding may play a role in this. Even if your period returns, it may remain irregular due to continued breastfeeding. Over time, your cycle should return to its normal state. However, if your period is absent for several months or if you have any questions or concerns about your postpartum health, it’s best to consult your doctor.

Normal vs. Abnormal Bleeding

Research indicates that about three to five percent of mothers experience postpartum hemorrhage. This occurs when you lose more than half a liter of blood within the first 24 hours after delivery. Additionally, it’s important to know that bleeding can occur at any time during the first six weeks postpartum. When it comes to postpartum hemorrhage or abnormal levels of bleeding, which means heavy bleeding, the main signs to watch for include:

• Heavy bleeding that does not slow or stop, such as changing pads more than once an hour for several consecutive hours.
• Passing large blood clots.
• Blurred vision.
• Chills.
• Clammy skin, where the skin appears wet or damp without an obvious cause.
• Rapid heartbeat.
• Dizziness, fainting, or confusion.
• Nausea.

If you notice any of these signs, it’s essential to consult your doctor to determine if it’s normal or requires medical intervention. If left untreated, postpartum hemorrhage can be life-threatening. Therefore, it’s best to contact your doctor and act as quickly as possible.

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In conclusion, women undergo numerous physical and emotional changes after childbirth, and lochia is a natural process that helps the body return to its pre-pregnancy state. It’s important to be aware of the stages of this bleeding, when your period will return, and how breastfeeding affects its regularity. Additionally, recognizing the signs of abnormal bleeding can save your life in emergencies. Never hesitate to seek medical help if you notice anything unusual, as your physical and mental health is a top priority for you and your baby.