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How do you tell the difference between lochia and postpartum hemorrhage?

Last post 09-19-2010 9:40 AM by midwifea. 3 replies.
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  • 09-17-2010 8:09 AM

    • minkajane
    • Top 150 Contributor
    • Joined on 02-18-2009
    • Franklin, OH
    • Posts 7

    How do you tell the difference between lochia and postpartum hemorrhage?

    This is a totally random question. I know that it's normal for lochia to be bright red and heavy for a week for so. What I can't seem to figure out is when it starts. Does it take a bit of time after the birth for it to start or is it immediate? If a woman is having bleeding in the first few hours after birth, how do you tell if it's lochia or postpartum hemorrhage?

    Mandy, childbirth educator, lactation educator, and aspiring midwife.
  • 09-17-2010 9:52 AM In reply to

    Re: How do you tell the difference between lochia and postpartum hemorrhage?

    It starts right after birth and normal bleeding is very different to pph.  Differentiating between the two depends on amount, duration, and how the woman is tolerating the loss.

  • 09-18-2010 10:31 PM In reply to

    • minkajane
    • Top 150 Contributor
    • Joined on 02-18-2009
    • Franklin, OH
    • Posts 7

    Re: How do you tell the difference between lochia and postpartum hemorrhage?

    I've heard of women having a slow hemorrhage - a trickle of bleeding that doesn't stop. So if a woman's got ongoing bleeding, how do you tell if it's normal lochia or not? Is it basically ok as long as she's feel ok and isn't soaking more than a pad an hour?

    Mandy, childbirth educator, lactation educator, and aspiring midwife.
  • 09-19-2010 9:40 AM In reply to

    • midwifea
    • Top 10 Contributor
    • Joined on 02-12-2009
    • Kailua Kona, HI
    • Posts 475

    Re: How do you tell the difference between lochia and postpartum hemorrhage?

    minkajane,

    You observe. If you are watching the bleed itself and it's trickling, you'll know this. You ascertain where the blood is coming from, is it a tear or is it uterine?   Normal immediate blood loss, with the separation and birth of the placenta can come in waves and flow heavy for a brief time. Usually a mama is reclined and bonding with baby and the caregiver is checking her bottom frequently. Mama is usually on a sheet of some sorts so you can estimate the blood loss initially. It  is different from post partum bleeding which can be scant or nothing for a short time,  then pool and discharge pretty heavy with movement or urination.  I think this is where experience comes heavily into play, observing the start and stop of the flow, feeling the uterus and how responsive it is, estimating the amount of blood, observing the mama and her tolerance of the blood loss.  It is as much an act of observation and discernment as it is anything else. By the time a couple hours have passed and you've gotten mama cleaned and a pad on her then you can check the blood flow from her pad and time passed since it was new.  Trickle bleeding coming from the uterus, to me, indicates a boggy uterus that needs help contracting or possible retained piece of membrane or placenta.  There are so many factors that come into play.  So much study is given in midwifery to bleeding but until you've had a real hemorrhage on your hands you may not know the difference between heavy bleed and life threatening bleed that you must get under control, urgently.  Trust that you will know when it is the latter and also know that you will have a bleed that scares the bejeesus out of you one day, it is inevitable in midwifery.  Knowing in your head the steps you will take and in what order you take them when that time comes, is very, very important.

    Blessings,
    April
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