How to Know if It's Postpartum Bleeding or a Period

Postpartum bleeding naturally occurs in all pregnant women after giving birth, and it can last for as long as 6 to 8 weeks. Thereafter, the normal menstrual cycle resumes, but only if the mother is not breastfeeding. Sometimes it can be difficult to tell when postpartum bleeding has ended and normal menstruation has begun, however there are several telltale signs you can watch out for.

Method 1 of 3: Identifying Differences Between The Two

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   Take note of the timing. In general, a woman doesn't get her period back for about a year if she decides to breastfeed. Breastfeeding can delay menstruation as it triggers the body to release the prolactin hormones which keeps the progesterone and estrogen levels low.
   • However, even if the women decides not to breastfeed, they will not start menstruating for a couple of weeks after childbirth. In fact, approximately 70% of women have their normal menstrual period around 6 to 12 weeks after giving birth. The period should only last for 3 to 6 days.
   • Postpartum bleeding, on the other hand, starts almost immediately after the childbirth and can last for several weeks before tapering off.
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   Look at the color of the blood. The color of the blood will be slightly different in postpartum bleeding than in menstruation, so it's important take note of this.
   • With postpartum bleeding, the color of the blood appears bright red for the first three days. Then from day 4 to 10, the discharge changes its color from pinkish red to reddish brownish with varying components such as old blood, white blood cells and tissue debris.
   • After day 10, a whitish discharge may be observed, which is medically referred to as lochia. This discharge consists of leukocytes (white blood cells), mucus, and epithelial cells. Lochia may be discharged for a maximum of 8 weeks.
   • Although menstrual blood may also start as bright red, the color will change to dark red, black or brown towards the end of menstruation.
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   Pay attention to the heaviness of the flow. The flow of blood is heavier in postpartum bleeding than in menstruation. In general, postpartum bleeding will be heavy for the first 4 days, then gradually reduce in quantity over the next few days/weeks.
   • To quantify it more exactly, the average amount of postpartum blood loss is about 500 ml in vaginal deliveries or 1000 ml in case of cesarean deliveries. If the blood loss is heavier than this, it could be a sign of postpartum hemorrhage and you should seek medical advice.
   • With menstruation on the other hand, blood flow is also heaviest in the first 3 to 4 days, however the average blood loss is only 10 ml to 80 ml.
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   Watch out for additional symptoms of severe blood loss. Another way to tell the difference between a normal period and heavy postpartum bleeding is the presence of additional symptoms which often accompany heavy blood loss. If you experience any of the symptoms listed below, you should seek immediate medical assistance:
• Dizziness
• Excessive sweating
• Tachycardia (rapid heart rate)
• Loss of color (becoming pale)
• Oliguria (low urine output)
• Shallow breathing

Method 2 of 3: Understanding the Physiological Processes

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   Understand what causes normal postpartum bleeding. If everything goes according to plan, the uterus will continue to contract after childbirth in order to expel any residue leftover from the placenta. This residue is what constitutes postpartum bleeding.
   • This bleeding occurs while the uterus undergoes what's called the "stage of involution" — a normal physiologic response in which the uterus returns to non-pregnant state. This bleeding is controlled and should not produce any adverse side effects.
   • As time goes on, the superficial layer of the endometrium (the mucous membrane which lines the uterus) becomes necrotic and slowly sloughs off in the form of lochia.
   • These processes are completely normal and expected. The uterus will normally heal on its own and the bleeding/lochia will stop within six weeks.
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   Be aware of what causes abnormal postpartum bleeding or hemorrhage. In some instances, postpartum bleeding becomes excessive and poses serious health risks. This may occur due to a number of different issues, such as the following:
   • Uterine atony: This is the most common cause of excessive postpartum bleeding. It occurs when the uterus is unable to continue contracting — due to prolonged labor, exhaustion, or the use of certain drugs (NSAIDs, nitrates) — allow the blood to leak freely out of the body.
   • Placenta retention or incomplete detachment: When the placenta is retained or fails to detach completely from the uterus, it may lead to the incomplete occlusion of the uterine blood vessels at the site of the attachment, resulting in postpartum bleeding.
   • Uterine trauma: Uterine trauma can happen due to several reasons, such as vigorous labor, birthing twins, attempting to remove the retained placenta (either manually,with special instruments or with drugs that induce labor as Oxytocin). All of these things can cause injuries to the genital tract or uterus lining, causing excessive bleeding.
   • Other causes: Other potential causes of postpartum hemorrhage include an over-distended uterus, preeclampsia, infections or obesity.
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   Know what causes menstrual bleeding. During a woman's normal menstrual cycle; the uterus is lined with a nutrient-rich coating to prepare for the arrival of a fertilized egg.
• When no fertilization occurs, this lining shrinks and begins to slough off and is expelled from the body, along with the unfertilized egg. Once the old lining is removed, a new lining forms and the cycle begins again.
• Each menstrual period lasts for 2 to 7 days, and occurs approximately every 28 days, though this varies from woman to woman.

Method 3 of 3: Treating Postpartum Bleeding

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   Take iron supplements for normal postpartum bleeding. For normal or mild postpartum bleeding, there is no need for any drugs to be taken as the bleeding will stop naturally after a maximum of six weeks to two months. However; your doctor may suggest or prescribe some iron supplements for you to treat any signs of anemia as a result of the blood loss.
   • Many forms of iron supplements are available at pharmacies, such as Sandoz Iron chewable tablets, or iron injections such as Hydroferrin, Haemojet or Ferrosac.
   • These supplements are usually taken once a day. They should be taken after meals to avoid constipation, however; some other gastric disturbances may be felt, such as nausea or vomiting.
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   Allow your doctor to administer oxytocin in the case of heavy bleeding. For severe postpartum cases, oxytocin is the drug of choice for treatment. Oxytocin is administrated through an intravenous infusion containing 20 units of oxytocin in one liter of normal saline.
   • Oxytocin acts mainly by stimulating strong uterine contractions by acting on specific receptors located at the lining of the smooth uterus muscles. It also increases the calcium levels in the intracellular space to induce more vasoconstriction.
   • If oxytocin is not available for any reason, some doctors use misoprostol (a similar drug) to induce uterine muscle contractions.
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   Receive emergency care in case of life-threatening bleeding. In very severe and potentially life-threatening cases of postpartum bleeding, the woman will need immediate medical attention.
• The emergency care team will use an ABC (airway, breathing, circulation ) assessment to ensure all vital signs of the patient are present. External oxygen support may be required in case of respiratory collapse or severe shock signs.
• A blood transfusion may be necessary to support vital organs such as the brain, heart, kidneys and liver and to prevent end organ damage. This blood transfusion will try to compensate for the excessive loss of blood.
• Oxytocin will be administered through an IV to stimulate uterine contractions and control the bleeding.

Source: www.wikihow.com