Lochia is the normal discharge of blood, tissue, and mucus that occurs after childbirth as the uterus begins to heal and return to its pre-pregnancy size. This healing process, known as uterine involution, involves shedding the extra lining and debris that supported the pregnancy. The discharge is a natural part of recovery, whether delivery was vaginal or by cesarean section. Lochia is more complex than a typical menstrual period because it contains cellular debris and wound discharge from where the placenta was attached. This discharge gradually changes in appearance and volume over several weeks.
The Expected Stages of Lochia
The body’s healing process is marked by a predictable progression in the color and consistency of lochia over approximately six weeks. This shift reflects the transition from heavy bleeding to a minimal discharge as the uterine wall repairs itself.
The initial stage, known as lochia rubra, lasts for about the first three to four days after delivery. The discharge is a bright to dark red color, similar to a heavy menstrual flow, and may include small blood clots. This phase is characterized by the expulsion of blood, pieces of the decidua, and other uterine tissue.
Lochia serosa follows, typically beginning around day four and continuing for up to the tenth day postpartum. The color transitions to a pinkish-brown tint as the amount of red blood cells decreases. The discharge becomes thinner and more watery, consisting of serous fluid, white blood cells, and less tissue debris.
The final stage is lochia alba, which starts around the second week and can persist for up to six weeks postpartum. The discharge is significantly lighter in volume and changes to a yellowish-white color. The discharge is primarily made up of white blood cells, epithelial cells, fat, and mucus, signaling that the placental site is largely healed.
Understanding Flow Fluctuation
It is common for the flow of lochia to fluctuate, leading many to wonder if the discharge truly “comes and goes.” Unlike the progression through the color stages, the daily flow can vary significantly based on activity and time of day. This intermittent pattern is a normal characteristic of postpartum bleeding. Periods of rest, such as sleeping overnight, can cause lochia to pool inside the vagina and uterus. When standing up after waking, a gush or heavier flow may be noticed as the collected fluid is released.
Increased physical activity, such as walking or carrying objects, can temporarily increase the flow of lochia. The exertion stimulates the uterine muscles, causing them to contract and expel more discharge. Breastfeeding also commonly triggers a temporary increase in flow due to the release of the hormone oxytocin, which causes the uterus to contract.
Passing small clots, generally no larger than a pea or dime, can occur when the flow momentarily increases. Sometimes, lochia may seem to stop entirely for a short period, perhaps 12 to 24 hours, before resuming its normal flow and color progression.
When to Seek Medical Attention
While fluctuations are normal, certain signs indicate a complication that requires immediate medical attention. Excessive bleeding that soaks more than one maxi pad in an hour for two consecutive hours or more can signal a postpartum hemorrhage. Passage of very large clots is another sign of concern, particularly if they are larger than a golf ball.
If the lochia flow reverts to bright red after progressing to lighter stages, this suggests the uterine healing process has been disrupted. A foul or unpleasant odor, distinctly different from the stale, metallic smell of menstrual blood, can be a sign of a potential uterine infection. Other symptoms that warrant contacting a healthcare provider immediately include:
- Fever, chills, or severe, persistent abdominal pain.
- Feeling faint, dizzy, or experiencing a racing heart rate alongside heavy bleeding.