The placenta is an organ that develops in the uterus during pregnancy, providing oxygen and nutrients to the growing fetus and removing waste products through the umbilical cord. It forms where the fertilized egg implants into the uterine wall. Once the baby is born, the placenta detaches from the uterine wall, leaving an internal wound within the uterus.
The Placental Attachment Site
The placenta attaches to the uterine wall. When it detaches after birth, it leaves a raw, open area inside the uterus, comparable to a large scrape. This site is rich with blood vessels. The body begins to heal this internal wound.
The Healing Journey
The uterus undergoes a process called involution, shrinking back to its pre-pregnancy size. Contractions help compress blood vessels at the placental attachment site to reduce bleeding. As the uterus heals, it sheds remaining tissue and blood, a discharge known as lochia. This shedding allows the uterine lining to regenerate without scarring over several weeks postpartum.
Normal Postpartum Recovery
Lochia is a normal part of postpartum recovery and typically lasts for several weeks, commonly between four to six weeks. Initially, lochia rubra presents as dark or bright red, heavy bleeding, similar to a heavy menstrual period, and may include small blood clots. This heaviest flow usually occurs for the first three to four days after birth.
Over the next few days, lochia transitions to lochia serosa, becoming more watery and pinkish or brownish, usually lasting until about day 10 postpartum. Finally, it becomes lochia alba, a lighter, yellowish-white discharge consisting mainly of white blood cells and mucus. This final stage can continue for up to six weeks or longer. Mild cramping, often called “afterpains,” is common, and these cramps may intensify during breastfeeding due to oxytocin release.
When to Seek Medical Advice
While lochia and cramping are normal, certain signs warrant medical attention. Contact a healthcare provider if you experience:
Excessively heavy bleeding, such as soaking through more than one sanitary pad in an hour, or if bleeding suddenly becomes heavier after it had lightened.
Passing large blood clots, especially those larger than a golf ball.
Foul-smelling vaginal discharge, which can indicate an infection.
A fever greater than 100.4°F (38°C), chills, or severe abdominal pain not relieved by medication or worsening.
Dizziness, feeling faint, or an increased heart rate, which can signal excessive blood loss.