Here’s everything you need to know about postpartum bleeding, including what’s normal and not normal at week 4.
If you’re a first time mom you may wonder, “Why am I still bleeding a month after giving birth?”
Unfortunately, there are lots of surprising and less-than-pleasant things that may happen after the birth of your baby.
For one thing, you’ll still have contractions.
And you’ll likely bleed for several weeks.
While these are normal parts of healing, there are some red flags new moms should look out for.
Here’s what postpartum bleeding is, why it happens, what’s normal for week 4, and when to be concerned.
What is postpartum bleeding?
Before we discuss 4 week postpartum bleeding, it’s important to understand what it is and why it occurs.
Postpartum bleeding is referred to as lochia. It consists of blood and vaginal discharge like mucus, uterine tissue, and other materials from the lining of the uterus.
It’s the body’s way of ridding itself of the excess blood and tissue required during gestation and delivery.
This is why vaginal bleeding occurs for all new mothers whether they have a vaginal birth or cesarean delivery.
For the first few days, bleeding may feel like a heavy period but should taper off as time goes on.
How long does postpartum bleeding last?
Nursing your baby releases hormones that trigger uterine contractions. So breastfeeding may reduce the time that postpartum bleeding lasts.
These contractions help the uterus shrink to normal size and encourage the release of excess blood and body fluids from pregnancy and birth.
What should bleeding look like 4 weeks postpartum?
Normal postpartum bleeding goes through stages. It starts with a dark red discharge with a heavy flow and lightens in color and volume as time passes.
The different stages of lochia can help indicate where you are in your postpartum recovery:
- Stage one is Lochia rubra. This blood is dark red, similar to a very heavy period, and typically lasts about 4 days. You may experience cramping and even pass some blood clots. This is normal and nothing to worry about, as long as the clots are smaller than an egg.
- Then, there’s Lochia serosa. Blood will be a pinkish shade and your flow will likely be lighter. This lasts about 2 weeks.
- The last stage is Lochia alba. Your discharge will be a yellowish or brown color with a little bit of blood. This stage expels those white blood cells responsible for repairing the uterus.
So, at week 4, postpartum bleeding should be light in both color and volume.
If bleeding lightens over time and then gets dark and heavy again, this may be a sign of postpartum hemorrhage.
Or, it could be the emergence of your first postpartum period.
Mothers who choose not to, or who are unable to breastfeed may start their first menstrual period as soon as two weeks after delivery.
Menstrual blood starts bright red and gets darker over time.
So, this is a good way to determine whether you’re experiencing postpartum bleeding vs. a period.
If you have postpartum bleeding that stopped and started again and you also experience any of the symptoms of postpartum hemorrhage, below, seek medical care immediately!
When to Be Concerned
If you’re 4 weeks postpartum, or at any stage during the postpartum period, you should always look out for symptoms of postpartum hemorrhage.
Postpartum hemorrhage is extreme blood loss after birth, and it affects up to 5% of women.
Hemorrhage can happen any time within the first 12 weeks but usually occurs within the first 24 hours.
Look for warning signs like:
- Bright red blood beyond the third day
- Large clots (larger than a golf ball)
- Severe pain, especially abdominal pain
- Excessive bleeding (soaking through more than one pad in an hour)
- Bleeding that gets heavier instead of lighter
- Feeling dizzy or lightheaded
- Increased heart rate
- Decreased blood pressure
- A fever higher than 100.4 degrees Fahrenheit (which may indicate an infection in the uterus)
What causes postpartum hemorrhage?
The most common cause of postpartum hemorrhage is uterine atony. This is when the uterus fails to contract after birth to close off exposed blood vessels from the site of the placenta.
Risk factors for uterine atony are:
- Giving birth to multiple babies
- Having a baby bigger than 8 pounds 13 ounces
- Being in labor for a short or very long period
- Having several previous births
Other conditions that increase the risk for postpartum hemorrhage are:
- Preeclampsia (high blood pressure accompanied by protein in the urine during pregnancy)
- Previous c-section
- Previous hemorrhage
- Use of pitocin during labor
- Issues that affect the placenta like placenta previa (low-lying placenta) and placental abruption (placenta coming away early during labor)
- Blood clotting problems
- Taking blood thinning medications
- Uterine fibroids
- Vaginal tears or an episiotomy
Treatments for Postpartum Hemorrhage
Postpartum hemorrhage always requires medical attention. So, If you experience any symptoms you should seek emergency care as soon as possible.
If you don’t seek medical help, your condition could become life-threatening very quickly.
When you arrive at the medical facility, your healthcare provider will assess the severity of your condition and perform one or more of the following treatments:
- Give you medicine to help your uterus contract and/or stop the bleeding.
- Remove any pieces of placenta left in the uterus.
- Perform a uterine artery embolization to reduce blood flow to the uterus.
- Use a Bakri balloon to put pressure on the uterus and stem heavy bleeding.
- Perform a hysterectomy.
- Perform a uterine massage.
If you’ve had too much blood loss, you may require a blood transfusion. Or, your doctor may have you take extra iron supplements.
How to Manage Postpartum Bleeding
Whether you’re 1 week or 4 weeks postpartum, here are some helpful tips to manage bleeding.
First, don’t use tampons!
Tampons make it easy to introduce bacteria into the healing uterus which may cause severe infection.
Instead use adult diapers (great for the first few days), hospital maxi pads, or regular sanitary pads.
Here’s a list of other must-haves for your postpartum recovery:
- Tucks pads
- Ice packs
- Peri bottle
- Dermoplast spray
- Inflatable donut cushion
- Stool softeners
If your hospital provides these items, make sure to stock up before you head home. Otherwise, you can purchase them yourself, and pack them in your postpartum care kit.
Here are some other important ways to avoid infection:
- Thoroughly wash your hands before and after going to the bathroom and changing maternity pads.
- Keep your fingernails cut short.
- Don’t wear jewelry on your hands or wrists during this period.
- Avoid touching any stitches or dressings.
Postpartum bleeding can fluctuate depending on the time of day and according to your physical activity. Bleeding tends to be heavier in the morning. And you may see an increased output of blood after moving around more than usual.
If you experience bright red blood after around 3 days postpartum, or bleeding that gets heavier instead of lighter, this could be a sign of postpartum hemorrhage or the start of your first postpartum period.
Women who do not breastfeed may get their first period as soon as 2 weeks postpartum. This blood will start bright and get darker over time.
If you experience bright red bleeding after 3 days along with severe pain, dizziness, nausea, or increased heart rate, this may be a sign of postpartum hemorrhage.
If you notice any of these symptoms, you should seek medical attention right away.
Postpartum bleeding is different for every woman and may last up to 6 weeks. Breastfeeding may speed up the process by triggering uterine contractions. But the timeframe ultimately depends on each woman’s unique body.
If you experience bright red blood after day 3 or any of the following symptoms, you should seek medical care as soon as possible:
– Severe pain
– Blood clots larger than a golf ball
– Dizziness or lightheadedness
– Rapid heartbeat
– Low blood pressure
– Bleeding through more than one pad in an hour
If this post was helpful, be sure to check out more tips for first time mothers including:
- 10 Postpartum body changes new moms should know
- Proven newborn sleep tips
- 15+ Newborn baby hacks
- The ultimate list of mom hacks
- 8 Baby essentials for the first 3 months
- 3 First time mom books worth a read
Did we answer all your questions about 4 weeks postpartum bleeding? Let us know if we missed anything in the comments!