Bleeding After Caesarean Delivery: All You Need to Know

Blood loss is unavoidable during and after childbirth, more so during a C-section. However, although some bleeding is normal, it helps to know what to expect, and when the bleeding after C-section requires a doctor’s attention.

Post C-Section Bleeding: Is It Normal?

Some bleeding is normal after a C-section, as well as after a vaginal delivery. Here is what you need to know about bleeding after a C-section:

• After the procedure, you will experience heavy bleeding for the first few days along with some clotting. This may be heavier than your periods.
• This bleeding is a type of vaginal discharge, known as lochia and is bright red in colour.
• There may be some clotting along with the bleeding which is also normal during this time.
• This discharge will last for around a fortnight (6 weeks). Post that it will become more watery and the colour will turn from pink-brown to yellow-white.
• The bleeding occurs because the body needs to expel the extra tissue and blood stored for nourishing the baby. Bleeding occurs irrespective of the kind of delivery.

In case the bleeding does not reduce after the first few weeks you should consult the doctor.

What Are the Causes of Bleeding After Caesarean Delivery?

1. Severed Blood Vessels – During C-section there are lacerations made which cause bleeding. In some cases, the initial incision is not wide enough for the baby to exit, and this causes the tissues and blood vessels around this area to get severed while the baby is being taken out. Sometimes bleeding occurs because some of the arteries and veins around the uterus are accidentally cut during the procedure.

2. Uterine Atony – Uterine atony is another cause of bleeding after C-section. It occurs when the woman’s uterus does not contract after the placenta is expelled following the birth of the baby. The blood vessels are closed by the uterine contractions which prevent the area around the placenta from bleeding, once the placenta is expelled through the vagina. When the uterus does not contract after delivery it remains open resulting in heavy bleeding.

3. Placenta Fragments – Some women experience heavy bleeding when the fragments from the placenta remain inside the uterus. This is common in women who have had multiple C-sections.

4. Placenta Accreta – This is a common cause of bleeding. In this case, the bleeding happens because the placenta does not separate naturally from the uterus as it is deeply embedded. Woman who have placenta accreta have the risk of haemorrhaging because the doctor has to manually remove the placenta.

How Long Does Post Caesarean Bleeding Lasts?

After a Caesarean delivery, the bleeding will last for about 6 weeks.

Signs of internal bleeding after C-section – There may be various reasons for bleeding after a C-section. Even if it is accompanied by small clots, bleeding is not a cause for worry. However, it must be remembered that the woman might have lost a lot of blood during the C-section, and heavy bleeding after the procedure may become life-threatening. Hence, it is important to keep a lookout for signs of internal bleeding.

Some Common Signs Are

• Rapid heartbeat and difficulty breathing

A rapid heartbeat and gasping breathing are a sign of internal bleeding.

• A boggy uterus

Post C-section if the uterus loses its form and becomes boggy or flabby then internal bleeding may be the cause for it.

• Weakness and severe anxiety

A lot of women experiencing internal bleeding may complain of weakness and severe anxiety.

• Pale and cold

Internal bleeding can make the woman’s face pale and her hands and feet cold.

• Heavy vaginal bleeding

If your bleeding continues to be heavy even after the initial few weeks, it could be due to internal bleeding.

• Reduced urine output

If the blood reaching the kidneys is less, then it affects the urine output. Thus reduced urine output may be a sign of internal bleeding

How Much Bleeding Merits Medical Attention?

If your bleeding becomes heavy again after tapering off and the colour turns red it may be due to overexertion. However, if clotting continues even after resting for few days then it might be due to some complication.

You should consult your doctor immediately if:

• The lochia has a foul smell and is still bright red after few days
• You have fever
• You are using up a pad or more every hour
• Clotting continues

How to Manage Bleeding Post C-section?

Simple ways to manage the heavy flow post C-section are:

Use Pads – Not Tampons

• During the initial weeks, when the flow is heavy, you should use thick pads similar to the thickness of baby diapers.
• Tampons can cause bacterial infection so they should be completely avoided.

Wear Old Clothes

During this time you should use old panties and clothes which can be disposed of later. You might get stains from bleeding which are difficult to remove.

Changing Pads

You should keep a stock of maternity pads because you will need lots of them after the delivery.

• Good quality maternity pads should be used. Folds of cloth should not be used at all.
• 3 packs of 12 pads can suffice. Initially you will have to change hourly and thereafter every 3-4 hours.
• Hands should be washed and disinfected every time you change the pad.

Rest is Best

Since you are bleeding heavily complete bed rest is advised in the initial weeks.

• You should avoid any physically strenuous activity because it can affect the recovery process and increase bleeding.
• Since the body is recuperating from the change, it is important that you co-operate in the process.

Get Help Around the House

You may ask for support from your family members or hire professional help.

Treatment Options

If there is still heavy bleeding after C-section then you need to consult your doctor. The treatment will depend on the source of the bleeding, at which stage it started and the seriousness. Hence it is important to give a complete medical history to your doctor.

If your uterus has not begun to contract after the delivery, then your doctor may give you medication to stimulate contractions.

If bleeding does not stop you may go for some additional surgery.

In some cases, hysterectomy is done to prevent blood loss.

Conclusion – Adequate post-natal care is important, not only to make sure that you get back to a normal life as soon as possible, but also because your baby needs your care and complete attention in the first few months of her life. Make sure you take it easy and avoid overexerting to avoid complications, and do see a doctor if you notice any signs of ill-health.