Lochia is the normal discharge of blood, tissue, and mucus that occurs after childbirth, regardless of whether the delivery was vaginal or via C-section. This process is a necessary part of postpartum recovery, helping to heal the uterine lining where the placenta was attached. The discharge helps the uterus return to its pre-pregnancy size by shedding the extra blood and tissue it no longer needs.
The Three Stages of Lochia
Lochia follows a predictable progression, marked by changes in color, consistency, and volume. The first stage, known as Lochia Rubra, begins immediately after delivery and generally lasts for the first three to four days. This discharge is typically dark or bright red, similar to a heavy menstrual period, and may contain small blood clots no larger than a quarter. Following this initial heavy flow, the discharge transitions to Lochia Serosa, which usually occurs from day four up to about the twelfth day postpartum. During this stage, the discharge becomes thinner, more watery, and changes color to a pinkish-brown, with blood clots being minimal or absent.
The final stage is Lochia Alba, which begins around day 12 and can continue for up to six weeks after delivery. At this point, the discharge is light, appearing yellowish-white or creamy, and consists primarily of leukocytes, epithelial cells, fat, and mucus. This signals that uterine healing is nearing completion.
Daily Flow Patterns and Intermittency
It is normal for lochia flow to fluctuate daily, meaning it does “come and go” in intensity. A common pattern is a temporary surge in flow when first standing up after a period of rest, such as getting out of bed. This increase occurs because blood and fluid pool in the vagina while lying down, and gravity causes a gush when the position changes.
Physical activity or exertion can also cause a temporary increase in lochia as movement stimulates the flow. Additionally, nursing or pumping often leads to a brief, heavier flow. This is due to the release of oxytocin, which triggers uterine contractions to aid in shrinking the uterus and pushing out collected discharge.
The flow may appear to stop completely when entering the lighter Alba stage, only to briefly return to a pinkish or brownish color (Serosa) before ending. This temporary return of a slightly redder discharge is often triggered by increased activity and is a normal part of the tapering process. As long as the overall trend is a decrease in volume and a lightening of color, these fluctuations are expected.
Warning Signs Requiring Medical Review
While fluctuations are normal, certain signs indicate that lochia may be abnormal and require immediate medical attention. Excessive bleeding is a serious warning sign, defined as soaking through one full-sized maxi pad in less than one hour for several consecutive hours. The passage of large clots is another concern; while small clots are normal during the first stage, any blood clot larger than a golf ball warrants medical review.
Lochia should have an odor similar to a normal menstrual period, so a foul or fishy smell suggests a possible infection. Accompanying systemic symptoms must also be monitored, including a fever over 100.4° Fahrenheit, chills, or persistent, severe abdominal pain. Other symptoms like dizziness, feeling faint, or a rapid heart rate, especially when combined with heavy bleeding, can signal significant blood loss. If bleeding that had previously slowed suddenly becomes bright red and heavy again, this change in pattern should be reported to a healthcare provider.