Vaginal delivery - discharge

What to Expect at Home

You may have bleeding from the vagina for up to 6 weeks. Early on, you may pass some small clots when you first get up. Bleeding will slowly become less red, then pink, and then you will have more of a yellow or white discharge. The pink discharge is called lochia. 

Bleeding usually decreases in amount during the first week, though it may not stop completely for several weeks. It is not uncommon to have an increase in red bleeding around 7 - 14 days when the scab formed over the spot where your placenta was shed. 

Your menstrual period is likely to return in:

• Four to 9 weeks after your delivery if you're not breastfeeding
• Three to 4 months if you are breastfeeding, and perhaps not for several weeks after you completely stop breastfeeding 

You may lose up to 20 pounds over the first 2 weeks after having a baby. After that, weight loss of around 1/2 pound per week is best. Your health care provider can explain more about losing weight after pregnancy. 

Your uterus will be hard and round, and can most often be felt around the navel. You may feel contractions for a few days. They are most often mild, but they can be stronger the more babies you have had. Sometimes, they can feel like labor contractions. 

If you are not breastfeeding, breast engorgement may continue for a few days.

• Wear a supportive bra 24 hours a day for the first 1 - 2 weeks.
• Avoid any nipple stimulation.
• Use ice packs to help with the discomfort.
• Take ibuprofen to decrease pain and inflammation. 

You will need a follow-up appointment with your health care provider in 4 - 6 weeks. 

Take tub baths or showers, using only plain water. Avoid a bubble bath or oils.

Episiotomy Care

Most women heal without problems, although it may take many weeks. Your stitches do not need to be removed. Your body will absorb them.

You can return to normal activities, such as light office work or house cleaning, when you feel ready. Wait 6 weeks before you:

• Use tampons
• Have sex
• Do any other activity that might rupture (break) the stitches

To avoid constipation (hard stools):

• Eat a high fiber diet with plenty of fruits and vegetables
• Drink 8 cups of water a day to keep from getting constipated and prevent bladder infections
• Use a stool softener (not enemas or laxatives)

Ask your health care provider about what you can do to relieve the discomfort and speed the healing of your episiotomy.

Other Self-care

Try eating smaller meals than normal and have healthy snacks in between. 

Any hemorrhoids you develop should slowly decrease in size. Some may go away. Methods that may help the symptoms include:

• Warm tub baths
• Cold compresses over the area
• Over-the-counter pain relievers
• Over-the-counter hemorrhoid ointments or suppositories (ALWAYS talk to your health care provider before using any suppositories) 

Exercise can help your muscles and your energy level, but don't start until you feel ready and slowly increase the amount. And still get plenty of rest. 

Lovemaking can begin around 6 weeks after delivery, assuming the discharge or lochia has stopped. Check with your doctor.

• You may have some discomfort at first, but this should improve with time.
• KY jelly or some other product that does not have petroleum jelly may help.
• Also, be sure to talk with your health care provider about contraception after pregnancy. 

In the days or even months after delivery, some moms feel sad, disappointed, tired, or withdrawn. Many of these feelings are normal, and they often will go away.

• Try talking with your partner, family, or friends about your feelings.
• If these feelings do not go away or become worse, seek help from your health care provider. 

Pee often and drink plenty of fluids to avoid bladder infections.

When to Call the Doctor

Call your health care provider if you have vaginal bleeding that:

• Is heavier than one pad per hour or clots bigger than a golf ball
• Is still heavy (like your menstrual period flow) after more than 4 days, except for the expected increase around 7 - 14 days for a day or so
• Involves passing large clots
• Spotting or bleeding that returns after going away for more than a few days

Also call your health care provider if you have:

• Swelling or pain in one of your legs (it will be red and warmer than the other way)
• Any fever
• Increased pain in your belly
• Increased pain over you episiotomy or in that area
• Discharge from the vagina that becomes heavier or develops a foul odor
• Notice you are very sad, depressed, withdrawn, or are having feelings of harming yourself or your baby, or find that you are not able to care for yourself or your baby
• A tender, reddened, or warm area on one breast (may be a sign of infection)

References

Katz VL. Postpartum care. In: Gabbe SG, Niebyl JR, Simpson JL, et al, eds. Obstetrics: Normal and Problem Pregnancies. 6th ed. Philadelphia, Pa: Saunders Elsevier; 2012:chap 22.

Update Date: 9/18/2012

Updated by: Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Bellevue, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.