Bloody colostrum (rusty pipes)

Why is my colostrum bloody?

Many mothers, perhaps as many as 14%, have blood in their colostrum. This may be upsetting, but the blood will not harm the baby and will disappear within the first week after delivery. There is generally no need to stop breastfeeding. The blood is most likely leaking from small blood vessels in the breast. This condition is also known as “rusty pipes” because it resembles the short-term flow of coloured water through a rusty pipe.

A) Describing rusty pipes

Some mothers have blood in their colostrum, making it appear red or brown in colour. This condition is commonly called “rusty pipes” because it resembles the flow of water through a rusty pipe. The water in the pipe may have an orange tinge when it starts flowing, but it will look normal after a few minutes. Similarly, the red colour in the colostrum and later in the milk goes away on its own.

Mothers may notice this when they are pregnant and leak colostrum (Guèye 2013), if they express, or when the baby spits.

It is not common but more likely with a mother's first baby (Barco 2014; Cizmeci 2013; Merlob 1990; Silva 2014).  

The cause is unknown but is most likely blood leaking from the small blood vessels (capillaries) in the breast.

This can be upsetting, but it is unlikely the blood will harm the baby. It will disappear within ten days after delivery (Kural 2020).

This phenomenon always affects both breasts. If only one breast produces bloody colostrum or milk or if the bleeding continues for more than one week after the baby’s birth, mothers should consult their health-care providers.

B) Breastfeeding with bloody colostrum

Taking in large amounts of blood can upset the baby’s stomach however, colostrum is only present in small amounts. If necessary, this can be managed by removing red blood cells from breast milk. Taking in blood is unlikely to cause any other problems if the mother is otherwise healthy.

Mothers should also ensure the blood is not coming from inside the baby. 

References

Barco I, Vidal MC, Barco J, et al. Blood-stained colostrum and human milk during pregnancy and early lactation. J Hum Lact. 2014 Nov;30(4):413-5
 
Cizmeci MN, Kanburoglu MK, Akelma AZ, et al. Rusty-pipe syndrome: A rare cause of change in the color of breastmilk. Breastfeed Med 2013;8:340–341
 
Guèye M, Kane-Guèye SM, Mbaye M, et al. Rusty pipe syndrome in a 22-year-old primigravida at 26 weeks’ gestation. SAJOG. 2013;19(1):17-18

Kural B, Sapmaz S. Rusty Pipe Syndrome and Review of Literature [published online ahead of print, 2020 Jun 3]. Breastfeed Med. 2020;10.1089/bfm.2020.0055

Merlob P, Aloni R, Prager H, Mor N, Litwin A. Blood-stained maternal milk: prevalence, characteristics and counselling. Eur J Obstet Gynecol Reprod Biol. 1990 May-Jun;35(2-3):153-7

Silva JR, Carvalho R, Maia C, et al. Rusty pipe syndrome, a cause of bloody nipple discharge: case report. Breastfeed Med. 2014 Oct;9(8):411-2