In brief: Bleeding during breastfeeding can originate from the vagina (lochia, return of menstruation) or the breast (cracked nipples, rusty pipe syndrome). While lochia and some cracked nipples are often benign, other situations such as heavy or painful bleeding require medical advice to rule out complications and ensure the mother’s peace of mind.
Postpartum Vaginal Bleeding: Lochia and Return of Period
Lochia are the completely normal vaginal bleedings that follow childbirth. They correspond to the shedding of uterine lining debris and the healing of the placental wound. Their presence is a sign that your uterus is returning to its normal size and gradually healing. Therefore, there’s no need to worry about them initially.
These discharges change over time. Initially very heavy and bright red in the first few days, they then become pinker, then brownish. After a few weeks, they lighten to become yellowish or whitish before disappearing completely. This progressive evolution is a key indicator of proper internal healing.
The return of period refers to the appearance of the first menstrual period after childbirth. In breastfeeding women, its arrival is often delayed by several months, as lactation hormones can block ovulation. This phenomenon varies greatly from woman to woman and should not be a source of concern.
When periods reappear, it is common for the first cycles to be irregular. You might observe bleeding that is heavier or lighter than usual, or intermittent bleeding (spotting). This irregularity is normal until your body has regained its complete hormonal balance.
Identifying Your Vaginal Bleeding: Lochia, Period Return, or Warning Sign?
| Criterion | Lochia (Postpartum Bleeding) | Return of Period | Abnormal Bleeding (To Watch For) |
|---|---|---|---|
| Color | Bright red initially, then pinkish, and finally brownish to yellowish. The color evolves. | Bright red, similar to a typical menstrual period. | Persistent bright red, presence of large clots (larger than a golf ball). |
| Heaviness | Very heavy in the first few days, then gradually decreases over several weeks. | Moderate to heavy flow, but consistent throughout the duration of the period. | Hemorrhagic (soaking a pad in less than an hour), does not lessen or suddenly increases. |
| Duration | 3 to 6 weeks on average. | 3 to 7 days, like a classic menstrual cycle. | Bleeding that resumes intensely after calming down or persists beyond 6-8 weeks. |
| Associated Signs | Neutral odor. Sometimes accompanied by “afterpains” (uterine contractions) in the first few days. | May be preceded by premenstrual symptoms (mild cramps, fatigue…). | Fever, intense pelvic pain, dizziness, foul odor. Requires urgent medical consultation. For more information on postpartum recovery, you might find this article helpful: Breastfeeding and Libido. |
Nipple Bleeding: Cracked Nipples as the Main Cause
Bleeding from the nipple is often a sign of cracked nipples. These painful fissures primarily result from a poor baby position or an incorrect latch. The delicate skin of the nipple is then put under severe strain, which can lead to lesions and bleeding. It is crucial to quickly identify the cause to correct the situation and allow for effective healing for the mother’s comfort.
An improperly positioned suckle exerts friction and excessive pressure on the nipple instead of the areola. This repeated rubbing eventually damages the skin, creating cracked nipples that can bleed. This phenomenon, though common, is not inevitable and signals a necessary adjustment in breastfeeding technique to prevent pain from becoming chronic.
Other Causes of Breast Bleeding to Be Aware Of
Rusty pipe syndrome is a surprising but benign cause of bleeding. It manifests as a pinkish or brownish discoloration of colostrum in the first few days postpartum. This phenomenon is due to increased blood flow in the breasts and the growth of milk ducts. Although impressive, it is painless and temporary, resolving spontaneously in a few days with no danger to the baby.
Mastitis, an often infectious inflammation of the breast, can also cause bloody discharge, sometimes accompanied by pus. It is frequently a complication of a clogged milk duct. More rarely, an intraductal papilloma, a small benign tumor within a duct, can cause bleeding. These situations require medical advice for an accurate diagnosis and appropriate treatment, especially in cases of fever or intense pain.
I repeat to all mothers: breastfeeding should not hurt. Bleeding and cracked nipples are not inevitable, but rather symptoms of a latch that needs adjustment.
—Juliette L., IBCLC Certified Lactation Consultant
Treating Cracked Nipples: Solutions and Preventive Measures
To soothe sore nipples, applying purified lanolin after each feeding creates a protective barrier and promotes healing. You can also use your own breast milk, known for its antibacterial properties. Using moist compresses or breast shells can also alleviate pain and protect the area from clothing friction. These simple steps provide quick relief and help prevent fissures from worsening.
However, the most effective treatment remains prevention. The main cause of cracked nipples is often an improper breastfeeding position. Ensure your baby opens their mouth wide and takes in a large part of the areola. Don’t hesitate to consult a lactation consultant to correct the latch. A correct latch is key to comfortable and pain-free breastfeeding, thus stopping any bleeding.
Warning Signs: When to Consult for Bleeding While Breastfeeding?
While some bleeding is normal, other instances require increased vigilance. Vaginally, an urgent consultation is needed if you soak more than one pad per hour, pass very large clots, or if the discharge has an abnormal odor. These symptoms can signal a postpartum complication and should not be ignored. Your midwife or doctor will be able to guide you.
In the breasts, acute and continuous pain is a warning sign. If the bleeding is accompanied by fever, chills, a red and warm area on the breast, or pus, consult without delay. This could be a sign of mastitis. Similarly, a persistent and painful milk lump warrants medical advice to prevent any infectious complications.
Bleeding and Breastfeeding: Your Questions, Our Answers
Is it dangerous for the baby to drink milk containing blood?
No, in the vast majority of cases, it is absolutely not dangerous for your baby. Whether it comes from a cracked nipple or rusty pipe syndrome, the ingested blood is yours and will be digested by the baby. You might notice their stools are a bit darker or they spit up brownish liquid. As long as the baby is well and the bleeding is minimal, there’s no need to worry. If bleeding is heavy or the baby seems uncomfortable or vomits, consult a healthcare professional.
Can my contraception cause bleeding?
Yes, this is a possible cause of vaginal bleeding (spotting) during breastfeeding. Hormonal contraceptives compatible with breastfeeding, such as the progestin-only pill or hormonal IUD, can cause irregular bleeding, especially during the first few months of use. It’s crucial to distinguish this uterine bleeding from nipple bleeding. If these vaginal bleedings are heavy, painful, or concern you, speak to your doctor or midwife.
How to differentiate a cracked nipple from an infection?
The distinction is based on location and associated symptoms. A cracked nipple is a visible lesion on the nipple, causing sharp, localized pain, especially at the beginning of a feeding. The bleeding comes directly from this fissure. For more information on identifying them, you can refer to this article on cracked nipples breastfeeding pictures. An infection, like mastitis, involves broader symptoms: the breast is red, warm, swollen, and painful to the touch, and you may have a fever and chills. The pain is deeper and constant. If in doubt, and especially if you have a fever, a medical consultation is essential.
