“I Passed a Clot the Size of a Golf Ball”: Secondary Postpartum Haemorrhage and Retained Placenta
In this article
Bleeding that comes back days or weeks after you go home can be a secondary postpartum haemorrhage (PPH), often caused by infection or a piece of placenta left behind. Many women are told on the phone that a big clot is “just the placental scab”. This article explains what is normal and what isn’t, what assessment you are entitled to, how retained placenta is found and treated, and what to do if you were sent away.
Quick answer · updated November 2026
Some bleeding for up to six weeks after birth is normal. Soaking a pad every hour or two, passing large clots, bleeding that turns bright red again, fever, bad-smelling discharge or feeling dizzy are not. These can mean a secondary PPH, usually from infection or retained placenta. Get assessed the same day.
Bleeding after you go home
- 1Normal lochiaRed, then pink-brown, then pale. Up to about 6 weeks.
- 2Warning signsSoaked pads, large clots, bright red again, fever.
- 3AssessmentExamination, bloods, swabs, often an ultrasound.
- 4TreatmentAntibiotics, drugs to contract, or removing tissue.
- 5AfterwardsRecovery, answers, and what to ask.
At any point: if you are bleeding heavily, feel faint, or your heart is racing, call 000. Don’t drive yourself, and don’t wait for a call back.
Eight days after. I stood up from feeding him on the couch and felt something give, and I made it to the bathroom, and it fell out of me onto the tiles with a sound I still hear. A clot. Dark red, shiny, about the size of a golf ball. Then fresh blood, bright, running down my leg.
I rang the number on the discharge sheet with my phone in one hand and a towel between my legs. The midwife on the line was kind. She said, “Sounds like the placental scab coming away, love. Watch it. If you soak a pad in an hour, or pass another big one, come in.”
I didn’t soak a pad in an hour. I soaked one in about an hour and a half. Then it slowed. Then two days later it started again. Every time I rang, I was told the same thing, and every time it slowed down just enough that I felt silly for worrying.
By three and a half weeks I was grey and I couldn’t walk to the letterbox. My mum drove me in. The ultrasound took four minutes. “There’s something still in there,” the doctor said, and I started crying, not because it was bad news but because it was news at all.
A composite story, drawn from the experiences of many families I have worked with, combined and changed so that no one can be identified. It does not describe any individual client.
If you have passed a big clot and are sitting on the bathroom floor wondering whether to ring someone, ring someone. If you already did and were told it was normal, and it didn’t feel normal, this article is for you. A secondary haemorrhage is less common and less talked about than bleeding at the birth, but it is real, it can be serious, and women describe being dismissed again and again before anyone looks.
This is part of a series that begins with “I thought I was going to die”: postpartum haemorrhage, what happened and what you can do.
Why I can write this
I have been a medical negligence lawyer since 2013 and have worked on many hundreds of claims, many involving birth. My doctorate studied patterns of failure in medical negligence. I am not medically qualified. The clinical information here comes from the NSW Health postpartum haemorrhage guideline (GL2025_013), the RANZCOG statement on PPH, Pregnancy, Birth and Baby and the Queensland Ambulance Service guideline on secondary PPH, all listed below.
Start with your question
- “How much bleeding after birth is normal?” Normal lochia
- “Is a golf ball sized clot normal?” Warning signs
- “Was it just the placental scab?” The “placental scab”
- “How do they know if placenta was left behind?” Assessment and ultrasound
- “Do I need a D&C?” Treatment
- “I was told it was normal, more than once.” When you are sent away
What normal bleeding after birth looks like
Pregnancy, Birth and Baby explains that bleeding after birth, called lochia, is normal. It usually changes from bright red to pinkish-brown and then whitish-yellow, and typically lasts up to six weeks, though this varies. It can get heavier for a while when you first get up, after feeding, or if you have been very active. Small clots, especially in the first days, are common.
Definition
Secondary postpartum haemorrhage: abnormal or heavy bleeding from the genital tract that starts more than 24 hours after birth. NSW Health defines it as blood loss of 500 mL or more between 24 hours and six weeks; the Queensland Ambulance Service guideline uses up to 12 weeks and notes there is no standard volume for diagnosing it.
In plain terms: if your bleeding gets heavier or comes back after the first day, rather than slowly tapering off, that can be a haemorrhage, even weeks later.
The Queensland Ambulance guideline estimates secondary PPH affects about 1 to 3% of births, that most cases present before day 14, and that around one in ten are massive. It also warns that blood loss is often underestimated and that a soft uterus can hide a lot of blood and clots inside it.
Warning signs: when it isn’t normal
Expected after birth
Bleeding that is slowly getting lighter. Colour moving from red to brown to pale. Small clots, mostly in the first days. A brief increase when you first stand or after feeding, which then settles.
In plain terms: messy, but heading in the right direction.
Not normal
Soaking a pad every hour or two. Large clots, or one sudden very large clot. Bleeding that turns bright red again. Fever, chills or bad-smelling discharge. Increasing pain. Feeling tired, dizzy or short of breath.
In plain terms: going the wrong way, or making you unwell.
Signs from Pregnancy, Birth and Baby and the Queensland Ambulance Service secondary PPH guideline. If in doubt, get checked.
The Queensland Ambulance guideline treats more than one heavily soaked pad per hour as excessive, and lists bright red loss, a bad smell, fever over 38°C and a tender uterus among the common signs. Pregnancy, Birth and Baby adds feeling tired, dizzy or short of breath.
The “placental scab”
Women are very often told that a sudden clot and a gush of fresh blood a week or two after birth is the “placental scab” coming away from where the placenta was attached. Sometimes it is, and the bleeding settles. But the same symptoms can also be the first sign of retained tissue or infection. The difference usually shows in what happens next: whether the bleeding settles and stays settled, or keeps coming back, and whether you start to feel unwell.
NSW Health says women must be told the signs of secondary PPH as part of routine postnatal care, and know how to get reviewed if they are worried. If you were never told, that is worth noting.
What to say when you ring
- “I gave birth on [date]. I think I may be having a secondary postpartum haemorrhage.”
- “I have soaked [number] pads in [time] and passed a clot about the size of [a golf ball / my palm].”
- “The bleeding had settled and is now bright red again.” (if true)
- “I feel dizzy / my heart is racing / I have a fever / it smells bad.” (if true)
- “I had a PPH at the birth / my placenta was noted as incomplete.” (if true)
- “I would like to be seen today.”
Afterwards: write down the date, time, who you spoke to and what you were told. If you are told to wait and you are still worried, you are allowed to go in anyway.
Why it happens
NSW Health lists the most common causes of secondary PPH as endometritis (infection of the lining of the uterus), retained products of conception (pieces of placenta or membrane left inside), and subinvolution (the placental site not healing and the uterus not shrinking back as it should). Pregnancy, Birth and Baby notes that infection in the uterus, which can follow retained placenta, is the most common cause, and that fibroids occasionally play a part. The Queensland Ambulance guideline adds infected tears or caesarean wounds and bleeding disorders as less common causes.
The same guideline lists risk factors including a long labour or long time with ruptured membranes, emergency caesarean, ragged membranes or an incomplete placenta at the birth, and manual removal of the placenta. If any of these were in your birth notes, a secondary bleed should have been taken especially seriously. My article “Nobody ever told me why” explains how the placenta check at birth works, and Pregnancy, Birth and Baby on retained placenta explains how retained tissue can cause infection or serious bleeding.
Assessment: what should happen when you present
NSW Health’s guideline says care for a woman presenting with secondary PPH must include a structured assessment, an estimate of blood loss, an assessment of whether she is in shock, and “full consideration of the woman’s concerns”. That last phrase matters. Your account of how much you have bled and how you feel is part of the assessment.
Depending on what is found, you might have:
- Observations: pulse, blood pressure, temperature.
- An examination of your abdomen and, often, an internal examination.
- Blood tests for haemoglobin, infection and sometimes clotting.
- Vaginal swabs if infection is suspected.
- A pelvic ultrasound to look for retained tissue.
Definition
Retained products of conception (RPOC): pieces of placenta, membranes or related tissue left inside the uterus after birth. Subinvolution: when the uterus, and particularly the area where the placenta was attached, doesn’t shrink and heal as expected.
In plain terms: either something was left behind, or the place the placenta came from isn’t healing, or both, often with infection.
Ultrasound is useful but not perfect. NSW Health says diagnosing retained products on ultrasound can be difficult and unreliable after birth. RANZCOG goes further: where bleeding is excessive or continuing, surgical removal of retained products should be considered irrespective of the ultrasound findings. In other words, a “clear” scan shouldn’t on its own be the end of the conversation if you are still bleeding heavily.
Treatment
RANZCOG and NSW Health describe a similar approach:
- Antibiotics where infection is likely, usually broad-spectrum.
- Drugs to help the uterus contract, and sometimes tranexamic acid to help clotting.
- Removal of retained tissue, usually by suction or curettage in theatre (often called a D&C, dilation and curettage), sometimes under ultrasound guidance. NSW Health says this must be done or supervised by an experienced clinician.
- Emergency treatment if bleeding is severe: NSW Health notes a secondary PPH can cause shock and may need the same advanced measures as a haemorrhage at birth, including transfusion and surgery.
Removing tissue from a recently pregnant uterus, which is soft, carries risks, including rarely damage to the uterine wall. That is one reason the guideline wants an experienced clinician involved. Ask what the risks are, and whether ultrasound guidance will be used.
Many women are given oral or IV antibiotics, have a D&C, and go home the same day or the next, and feel dramatically better within days. Others have a longer road, particularly if they have lost a lot of blood. Recovery, anaemia and milk supply are covered in “I lost over two litres”.
Questions to ask
- What do you think is causing the bleeding: infection, retained tissue, or something else?
- What did the ultrasound show? Can I have a copy of the report?
- If the scan is clear but I am still bleeding heavily, what is the plan?
- Will tissue removed be sent to the lab? When will I get the result?
- What are the risks of the procedure, and who will be doing it?
- What should I do if the bleeding comes back?
When you are sent away
Online, women describe the same story with remarkable consistency: a big clot, a phone call, reassurance; more bleeding, another call, more reassurance; an emergency visit where they wait for hours because they “look fine”; and then, sometimes weeks later, an ultrasound or a D&C that finds retained placenta. Some women describe bleeding for many weeks, with a smell they tried to wash away, before anyone looked.
Phone advice has a place, and most clots after birth are not dangerous. But reassurance is only safe if it comes with clear instructions about when to come in, if those instructions take your history into account, and if repeated calls are treated as a pattern rather than as isolated worries. If you were dismissed despite risk factors, repeated bleeding, fever or dizziness, that may be a question about the standard of care. My article on being dismissed by doctors explores this, and “I kept telling them something was wrong” looks at when PPH care falls short.
Afterwards: getting answers
Once you have recovered, you may want to understand why tissue was left behind, and whether it should have been found sooner. The answers are usually in two places: your birth records, especially the placenta check, and the records from each time you sought help afterwards. A debrief can also help; NSW Health says women may need debriefing opportunities after discharge.
What to look for in the records
Ask for your complete birth records and the records from every later contact. My guide to getting and reading your birth records explains how.
| Record | Why it matters |
|---|---|
| Third stage and placenta check (birth) | Whether placenta and membranes were recorded as complete, “ragged”, incomplete, or not checked, and whether anything was done about it. |
| Labour and birth notes | Risk factors such as long labour, long ruptured membranes, manual removal of placenta, or a PPH at birth. |
| Discharge summary and postnatal notes | Whether you were told the signs of secondary PPH and given a number to ring. |
| Phone and maternity assessment line records | Each call: date, time, what you reported, and what you were advised. Some hospitals log these; some don’t. |
| Emergency department or maternity triage notes | Your triage category, waiting time, observations, and what was decided at each visit. |
| Ultrasound reports | What was seen, and whether retained tissue was reported or queried. |
| Pathology and swabs | Infection markers, haemoglobin, and swab results. |
| Operation report and histopathology | What was removed and whether the lab confirmed placental tissue. |
Keep your own record too: dates of calls, texts to family, photos of the pads or clots if you took them (many women do, to show a doctor). These can matter if your records are incomplete.
When the records arrived there was nothing from either phone call. Not a line. The first entry after I went home was the emergency department, three and a half weeks later: “Triage category 4. Woman reports ongoing PV bleeding post partum. Appears well.” I’d waited four hours.
Then, back in the birth notes, a page I’d never seen. Third stage: “Placenta adherent. Manual removal in theatre. Removed piecemeal.” Piecemeal. In pieces. Nobody had ever told me it came out in pieces, and nobody had told me what to watch for because of it.
The histopathology report from the D&C said “decidua and chorionic villi with necrosis”. I had to look up every word. It meant what the doctor had said: placenta, left behind, and dying.
I didn’t feel vindicated. I felt sad that the word “piecemeal” had sat there for three and a half weeks while I rang, and was reassured, and rang again. But for the first time the story on paper matched the story in my body. It wasn’t the placental scab. It never was.
A composite story, drawn from the experiences of many families I have worked with, combined and changed so that no one can be identified. It does not describe any individual client.
How the law looks at it
Standard of care
Under section 5O of the Civil Liability Act 2002 (NSW), a health professional isn’t negligent if they acted in a way widely accepted in Australia by peer professional opinion as competent practice, unless that opinion is irrational. Guidelines are evidence of competent practice, not the law itself. In secondary PPH, the questions are often about follow-up of a placenta recorded as incomplete, whether you were told the warning signs, whether phone advice took account of your history, whether repeated presentations were joined up, and whether a reassuring ultrasound was relied on despite continuing heavy bleeding.
Causation
You must show, more likely than not, that proper care would have made a real difference: less blood lost, no transfusion, earlier removal of tissue, less infection. In Tabet v Gett [2010] HCA 12, the High Court confirmed that losing only a chance of a better outcome isn’t enough on its own.
Consent and information
Under Rogers v Whitaker [1992] HCA 58, you are entitled to be told material risks, including the risks of a D&C and the alternatives.
Time limits
NSW claims generally must be started within three years of when you knew, or ought to have known, enough to claim, and within twelve years of the birth. With secondary PPH, the relevant events may span several weeks; note the dates. If your baby was also injured, don’t assume their claim can wait until they turn 18. Read “Is it too late?” and medical negligence time limits in NSW.
In my practice
Secondary haemorrhage files are where the chain of small failures is easiest to see, because it stretches across weeks and across different parts of the health system. A question mark at the placenta check that no one follows up. A discharge sheet with a phone number but no list of warning signs. A call to a maternity line that isn’t written down. A second call answered by someone else, who doesn’t know about the first. An emergency triage nurse who sees a well-looking woman and a long waiting room. A scan reported as “possible small RPOC” and a plan to “review in two weeks”. Each person acts reasonably on what is in front of them. No one holds the whole story except the woman, and she is the one being told it is normal. My doctoral research was about precisely these chains.
Holding two truths
Most big clots after birth are harmless, and the midwife who reassured you may have been right nine times out of ten. And you were the tenth, and you knew something was wrong. Both are true. You were not being dramatic. Advocating for yourself was not your job alone; listening was theirs too.
The bigger picture
NSW Health’s 2025 guideline added explicit requirements that women be taught the signs of secondary PPH and that their concerns be fully considered when they present. Safer Care Victoria’s PPH collaborative focused on primary PPH; postnatal and community care after discharge has received far less attention. The NSW Birth Trauma inquiry heard from women about not being listened to after birth. If you want the hospital to learn from what happened, a complaint is one route; see making a complaint after a traumatic birth and the Health Care Complaints Commission.
Support
- Pregnancy, Birth and Baby: 1800 882 436. Maternal child health nurses, 7am to midnight. For heavy bleeding, call 000.
- PANDA National Helpline: 1300 726 306. Support for parents, including partners.
- Gidget Foundation Australia: 1300 851 758. Free psychological sessions, including after birth trauma.
- Birth Trauma Australia: online peer support for mothers and partners.
- Health Care Complaints Commission (NSW): 1800 043 159.
- Lifeline: 13 11 14, 24 hours. In an emergency, call 000.
More options are in finding support after birth trauma in Australia. If the fear of bleeding has stayed with you, “I still wake up back in that room” may help.
She keeps the histopathology report in the folder with her son’s birth certificate. Not because she wants to remember, but because when her sister had her baby last year, she pulled it out and said, “If anyone tells you it’s just the scab, ring me.”
With care, Rosemary
Frequently asked questions
Is passing a golf ball sized clot after birth normal?
A single clot that is followed by settling bleeding can happen. Large or repeated clots, soaking a pad every hour or two, fever or dizziness are not normal and need same-day review.
How long after birth can you have a haemorrhage?
A secondary PPH can happen from 24 hours to six weeks after birth, and some guidelines say up to 12 weeks. Most occur within the first two weeks.
What causes a secondary postpartum haemorrhage?
Most often infection of the uterus, retained placenta or membranes, or the placental site not healing. Less commonly, an infected tear or wound, fibroids or a bleeding disorder.
Can an ultrasound miss retained placenta?
Yes. NSW Health says ultrasound diagnosis after birth can be difficult and unreliable. RANZCOG says removal should be considered for heavy ongoing bleeding even if the scan is reassuring.
What is the placental scab?
A common term for the healing site where the placenta was attached. A clot as it comes away can be normal, but it can also look like the start of a secondary haemorrhage.
Do I need a D&C for retained placenta?
Often, if tissue is causing bleeding or infection. It is usually done in theatre by an experienced clinician, sometimes with ultrasound guidance. Antibiotics and medicines may be used too.
Questions about bleeding after you went home?
When you’re ready, and not before, I can look at what happened with you, from the placenta check to the last phone call. A free case review means I listen, read the records in order, and tell you honestly what I see, with no obligation.
The series: After a postpartum haemorrhage
- “I Thought I Was Going to Die”: Postpartum Haemorrhage (PPH), What Happened and What You Can Do
- “Is It Too Late?” PPH: Time Limits and What a Claim Can Cover
- “Nobody Ever Told Me Why”: Why Did I Bleed So Much?
- “Their Arm Was Inside Me and No One Explained”: What Happens During a PPH
- “I Lost Over Two Litres”: Recovery, Anaemia and Milk Supply After a PPH
- “I Passed a Clot the Size of a Golf Ball”: Secondary PPH and Retained Placenta (you are here)
- “I Kept Telling Them Something Was Wrong”: When PPH Care Falls Short
- “He Was Left Holding Our Baby in the Corner”: When Your Family Saw the Haemorrhage
- “I Still Wake Up Back in That Room”: PTSD After a PPH
- “Can It Happen Again?” Pregnancy and Birth After a PPH
- “They Had to Take My Uterus”: Emergency Hysterectomy After Birth
This series is part of my work on birth trauma and obstetric negligence. If infection followed a tear or stitches, see “My stitches smell, came apart or feel open”, and explore the birth injury map.
References
- NSW Health. Postpartum Haemorrhage, Guideline GL2025_013, section 8 (secondary PPH). August 2025.
- RANZCOG. Management of Postpartum Haemorrhage (C-Obs 43), section 4.3.
- Queensland Ambulance Service. Clinical practice guideline: secondary post-partum haemorrhage. February 2021.
- Pregnancy, Birth and Baby. Postpartum haemorrhage. Reviewed June 2026.
- Pregnancy, Birth and Baby. Retained placenta. Reviewed May 2026.
- Safer Care Victoria. Postpartum Haemorrhage Collaborative: evaluation report. 2024.
- NSW Legislative Council Select Committee on Birth Trauma. Birth trauma, Report 1. May 2024.
- Civil Liability Act 2002 (NSW), s 5O.
- Tabet v Gett [2010] HCA 12.
- Rogers v Whitaker [1992] HCA 58; (1992) 175 CLR 479.
- Health Care Complaints Commission. What can I make a complaint about?
A composite story, drawn from the experiences of many families I have worked with, combined and changed so that no one can be identified. It does not describe any individual client.
