Bleeding After C-Section: Causes And How Long It Lasts

Image: Shutterstock

Bleeding after C-section is normal. Also called lochia, this bleeding consists of mucus, tissue, and blood that the uterus sheds as it replaces its lining following the delivery (1) (2). Bleeding after cesarean delivery may be heavy and bright red during the first week after birth and become lighter and brownish over time. It usually continues for 24 to 42 days after birth; however, some women may bleed for a little longer (1). Knowing what to expect with bleeding after a cesarean reduces anxiety and helps new mothers adjust to motherhood. Read this post to learn more about the causes of bleeding after a C-section and ways to manage it.

How Heavy Is The Bleeding After A C-Section?

The amount of blood loss after a C-section depends on several factors (1) (3).

• Bleeding is heavy and bright red after breastfeeding because the oxytocinⁱA hormone secreted by the pituitary gland to stimulate contractions during childbirth and lactation released during the process compresses the uterus, thus producing more blood.
• Any physical activity may cause bleeding during the first two weeks after delivery.
• Heavier bleeding may also be experienced after you wake up in the morning because the blood may accumulate in the vagina while you are sleeping at night.

Quick fact

1% to 5% of women have a postpartum hemorrhageⁱUnusual and uncontrolled blood loss after childbirth , which is more likely with a C-section birth (13).

The following bleeding pattern is commonly seen in women after a C-section. However, it may vary from one person to another (1).

Source: nct

What Causes Bleeding After C-Section?

During delivery, the placentaⁱA temporary organ that develops during pregnancy and provides the fetus with oxygen and nutrients detaches from the uterus lining (endometrium), leaving behind an open wound of around 8.5in in diameter (placental site). This wound takes time to heal. As the uterus heals, the residual tissue slowly comes out in the form of uterine bleeding and vaginal discharge (4). In the case of vaginal delivery, up to a half-quart (500ml) of blood is lost, whereas in the case of cesarean delivery, up to a quart (1000ml) of blood is lost (5).

Bleeding after birth (lochia) can be divided into three stages (4).

1. Lochia rubra

• This stage lasts for the first four days after delivery.
• You may experience regular abdominal cramps as the uterus begins to contract to its original size.
• The lochia is bright red with clots caused due to the pooling of blood.

2. Lochia serosa

• This stage lasts for around ten days.
• You may notice the blood changing from bright red to pink or brown. The color change occurs as the number of white blood cells in the blood increases.
• The placental site continues to heal during this stage.
• If you are not breastfeeding, you may notice the discharge of cervical fluid. However, if you are breastfeeding, the cervical fluid may not be seen yet.

3. Lochia alba

• This is the final and the longest stage.
• The lochia turns yellowish or whitish. It mainly consists of white blood cells, cervical mucusⁱA gel-like discharge produced by the cervix that indicates the most fertile time of your menstrual cycle , and epithelial tissueⁱA major tissue that covers the internal and external surface of the body, body cavities, and hollow organs .
• The placental site continues to heal rapidly.

Besides physical discomfort, bleeding after a cesarean can bring emotional concerns. Seek support from family, fellow mothers, or your gynecologist to manage stress and aid recovery.

How To Manage Bleeding After C-Section?

Postpartum bleeding is normal and taking a few smart precautions can help manage the phase easily and without any adverse reactions. Here are important points to help you manage post C-section bleeding effectively while reducing the risk of infections (3) (6):

• Bleeding after a C-section can be managed by using maternity pads. These pads offer more comfort than regular sanitary pads and allow you to check the amount of blood loss.

Bethany Fontaine, a mother of two and a vlogger, shares a tip about handling postpartum bleeding. She says, “I found a really good tip for recovery.. buying the 10-pack of Walmart underwear—this big, high-waisted cotton underwear that are super like major granny panties, but they work so well. And it’s great because they do come above your incision, which is what you really want to look for. You don’t want underwear to cut right into that because it is painful and it’s very sensitive (i).”

• Avoid the use of tampons or menstrual cups for the first six weeks after childbirth.
• Change the sanitary pads at regular intervals.

• Wash your hands before and after changing the sanitary pads.
• Rest whenever possible to reduce strain and bleeding.
• Stay hydrated and maintain good nutrition to support overall healing.
• Take pain medication as prescribed by your doctor, which can help manage discomfort associated with both the incision and uterine contractions.
• Be attentive to any sudden increase in bleeding, passage of large clots (golf ball-sized or larger), or return to bright red bleeding after it has lightened.
• Breastfeeding may help manage post-C-section bleeding by stimulating the release of oxytocin, a hormone that promotes uterine contractions, which also helps reduce postpartum bleeding (7) (8). As per a study, initiating bilateral breast sucking within the first two hours after delivery decreased the amount of lochia (9). 

When To Call The Doctor?

You should contact your doctor if you notice the following symptoms (3) (10).

• Sudden heavy bleeding (soaking of one pad in one to two hours)
• Large blood clot (bigger than the size of a golf ball)
• Change in the color of the blood (changes to bright red)
• Dizziness and weakness
• Chills with fever lasting more than two days

• Foul-smelling vaginal discharge or blood
• Severe pain and discomfort in the lower abdomen

The presence of large blood clots, especially those bigger than the size of a golf ball, also warrants immediate medical attention. Large blood clots after birth could indicate that the uterus is not contracting properly.

These symptoms may indicate postpartum hemorrhage (PPH), a life-threatening condition causing excessive bleeding after childbirth. Doctors diagnose PPH through blood tests, pelvic examinations, ultrasounds, blood loss measurements, and physical assessments. Treatment depends on the bleeding cause but typically includes medications to help uterine contractions to reduce blood loss (11). 

Taking supplements may help reduce the risk of excessive blood loss after a C-section. During pregnancy, the body increases red blood cell production to compensate for blood loss during childbirth, which raises the need for iron. Following a healthcare provider’s guidance on iron supplementation can support recovery and replenish iron levels (5).

Quick fact

Previous postpartum hemorrhages, a BMI above of 35, twin or triplet pregnancy, placenta previaⁱA condition where the placenta blocks the cervical opening entirely or partially , placental abruption, pre-eclampsiaⁱA pregnancy disorder characterized by high blood pressure, water retention, and protein content in urine , anemia, and fibroidsⁱNon-cancerous tumors that are formed in or on the wall of the uterus may increase the risk of postpartum hemorrhage (1).

Infographic: What Are The Stages Of Bleeding After A C-Section?

After a C-section, many women experience vaginal bleeding (lochia) in various stages that may linger for a few days. Understanding these bleeding stages might help women know when to seek medical attention and ensure a healthy postpartum recovery. The infographic below explains the different types of post-cesarean bleeding stages and their features.

Illustration: Momjunction Design Team

Learn about normal bleeding after birth and labor, and how much is too much in this video. Understand the signs of excessive bleeding and when to seek medical help.

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Dr. Shashwat JaniMS

Dr. Shashwat Jani is a consultant obstetrician & gynecologist in Smt. N.H.L. Municipal Medical College, Ahmedabad. He has 14 years of experience with a special interest in high-risk pregnancy, infertility, and endoscopy.

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Pragya BhargaviMSc, BEd

Pragya Bhargavi has been in the field of content research, writing and editing for over six years. Her passion for academics and science has enabled her to write creative as well as research-based articles. She has completed her Masters in Microbiology from Bangalore University and obtained a Bachelor’s degree in Education (BEd) from Acharya Nagarjuna University, Guntur.

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Rebecca MalachiBSc

Rebecca is a pregnancy writer and editor with a passion for delivering research-based and engaging content in areas of fertility, pregnancy, birth, and post-pregnancy. She did her graduation in Biotechnology and Genetics from Loyola Academy, Osmania University and obtained a certification in ‘Nutrition and Lifestyle in Pregnancy’ from Ludwig Maximilian University of Munich (LMU).

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Reshmi DasMSc

Reshmi Das has over four years of experience as a clinical coordinator, medical content writer and medical conference coordinator. Her continuous interest in medical journals and writing makes her write well-researched articles for MomJunction.

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