Does postpartum breastfeeding cause bleeding?

Written by Zhang Yin Xing
Obstetrics
Updated on April 02, 2025
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Bleeding caused by postpartum breastfeeding generally occurs within 42 days after delivery, during which the mother has lochia secretion. Breastfeeding promotes the secretion of oxytocin, which acts on the uterus and causes it to contract, facilitating the expulsion of lochia and aiding in the recovery of the uterus. Typically, by 42 days postpartum, the uterus has returned to its non-pregnant size and the expulsion of lochia is essentially complete. Subsequent breastfeeding is not directly related to vaginal bleeding. Another situation is due to the increase in prolactin during lactation; menstrual periods may not have fully resumed in women who are breastfeeding, and abnormal uterine bleeding may occur. As long as the amount and duration of bleeding do not exceed normal menstrual flow, no special treatment is needed.

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Written by Du Rui Xia
Obstetrics
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How many days of postpartum bleeding are normal?

Postpartum hemorrhage typically stops around three weeks. Lochia can be classified into bloody lochia, serous lochia, and white lochia. Another type is abnormal bleeding, which is pathological bleeding. It occurs postpartum, for instance, due to soft birth canal injuries, cervical lacerations, uterine atony, or pre-existing blood disorders, which may extend the bleeding duration even beyond a month. This abnormal condition requires prompt medical attention. Normal lochia during the initial three to four days is bloody. As the bleeding from the uterus gradually decreases, it transitions to serous lochia, which can last about ten days. Finally, it becomes white lochia, which clears up after about three weeks.

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Written by Yue Hua
Obstetrics and Gynecology
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Late postpartum hemorrhage clinical symptoms

Late postpartum hemorrhage occurs when significant uterine bleeding happens after the first 24 hours following the delivery of the fetus, commonly seen from one to two weeks postpartum. At this time, patients may experience sudden heavy vaginal bleeding, and some may even develop hemorrhagic shock. A minority of patients might not bleed profusely but may experience recurrent bleeding. Additionally, this bleeding is often accompanied by lower abdominal pain, fever, and symptoms of anemia, so it is critical to seek immediate medical treatment upon noticing these symptoms.

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Written by Tang Mei Xiang
Obstetrics and Gynecology
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Postpartum hemorrhage causes

Postpartum hemorrhage (PPH) has four primary causes: 1. Lacerations from difficult labor; 2. Placental factors; 3. Uterine atony; 4. Coagulopathy. Immediately after childbirth, if there is bright red bleeding that includes blood clots, this is considered to be caused by soft birth canal lacerations. Approximately 10 to 15 minutes after delivery of the fetus, if significant bleeding occurs, placental factors should be considered. After the placenta is delivered, if the placenta and membranes are found to be intact and there is still vaginal bleeding, or if there is intermittent heavy vaginal bleeding, and the uterus feels soft and poorly defined upon light palpation, uterine atony should be considered as a likely cause of the heavy bleeding. Lastly, coagulopathy, which leads to continuous, dark red bleeding without clots, can also cause severe postpartum hemorrhage.

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Written by Zhang Lu
Obstetrics
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Symptoms of Postpartum Hemorrhage

Postpartum hemorrhage is the leading cause of death in pregnant women. The symptoms of postpartum hemorrhage include the following aspects: First, it initially presents as significant vaginal bleeding, where the bleeding may exceed 500 milliliters in a short period or 800-1000 milliliters within 24 hours, predominantly featuring fresh blood. Second, there can be abdominal pain or other symptoms caused by the underlying etiology, such as postpartum hemorrhage due to soft birth canal injuries, which can manifest as tears in the vagina or cervix. Third, there can be signs of shock, such as confusion, lowered blood pressure, and an increased heart rate, all of which are symptoms used to diagnose postpartum hemorrhage.

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Written by Tang Mei Xiang
Obstetrics and Gynecology
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Causes of postpartum hemorrhage

The causes of postpartum hemorrhage can be summarized into four main reasons: First is related to the placenta; second is lacerations in the soft birth canal; third is coagulation dysfunction; fourth is uterine atony, among which uterine atony is the most common cause. So, how can one determine if postpartum hemorrhage is caused by uterine atony? Clinically, after the placenta is delivered, examination of the soft birth canal is conducted. Upon examining the uterus, if it is found that the outline of the uterus is unclear and pressing on it results in a lot of blood and blood clots flowing out from the uterine cavity, then the uterus becomes firm when pressed and softens when not pressed. This situation indicates uterine atony. Other injuries, such as lacerations in the soft birth canal, are generally detected during an examination. There are also factors related to the placenta and coagulation dysfunction, which are the four main causes of postpartum hemorrhage.