Lochia is the term for the vaginal discharge experienced after childbirth, representing a normal and necessary part of the body’s postpartum healing process. This discharge is comprised of a mixture of blood, mucus, and tissue shed from the lining of the uterus. The body uses this process to clear out the uterine lining that was built up to support the pregnancy, allowing the uterus to return to its pre-pregnancy size. While sometimes referred to as postpartum bleeding, lochia is distinctly different from a menstrual period because of its composition and gradual changes.
The Timeline of Normal Lochia
Lochia typically lasts between four and six weeks, though some people may experience traces of discharge for up to eight weeks. The process is characterized by three distinct stages, each marked by a change in color, consistency, and volume as the uterus heals.
The heaviest bleeding, known as Lochia Rubra, is the first stage. It begins immediately after delivery and lasts for about three to four days. Lochia Rubra is bright or dark red, resembling a heavy menstrual period, and may contain small blood clots. The bright red color indicates the presence of fresh blood being shed from the area where the placenta was attached.
As the flow lessens, the discharge transitions to the second stage, called Lochia Serosa. This stage typically begins around day four and can last until about the twelfth day postpartum. During this phase, the discharge becomes thinner and more watery, changing color to a pinkish-brown. This shift in color is due to the discharge containing more white blood cells, wound exudate, and less red blood cells.
The final and longest stage is Lochia Alba, which usually starts around two to four weeks after birth and continues until the process stops completely. This discharge is minimal in flow and appears yellowish-white or pale. Lochia Alba is primarily composed of leukocytes, epithelial cells, and mucus, signaling that the uterine lining has largely regenerated.
Factors That Influence Flow
While lochia follows a predictable overall timeline, several common factors can cause temporary fluctuations in the flow volume. A frequent observation is a temporary increase in bleeding when first getting out of bed in the morning. This happens because lochia can pool in the vagina while lying down, leading to a sudden gush when standing.
Physical activity or overexertion can also cause a temporary surge in lochia. Increased movement can lead to a heavier flow or a brief return to a redder color.
Breastfeeding is another factor that commonly influences discharge, often causing mild cramping and a temporary increase in flow. Suckling stimulates the release of oxytocin, a hormone that causes the uterus to contract. These contractions help the uterus shrink back to its pre-pregnancy size, a process called involution, and this action can expel collected blood, resulting in a temporary heavier discharge.
The method of delivery, whether vaginal or Cesarean section, may affect the initial amount of lochia. C-section deliveries sometimes have less initial flow, but this generally does not change the total expected duration.
When to Seek Medical Advice
Monitor lochia closely, as certain changes indicate a potential complication requiring immediate medical attention. Excessive bleeding is a serious warning sign, defined as soaking through more than one full-sized sanitary pad in a single hour for several consecutive hours. Passing very large blood clots, especially those larger than a golf ball, is also a sign that the uterus may not be contracting properly to stop the bleeding.
A foul odor from the lochia, unlike the typical metallic or menstrual-like smell, can signal a uterine infection, such as endometritis. This is often accompanied by other signs of infection, including a high fever, chills, or persistent abdominal pain that does not improve. A sudden return of bright red, heavy bleeding after the lochia had already lightened to pink or white is another concerning sign.
Other symptoms warranting an immediate call to a healthcare provider include dizziness, lightheadedness, a racing heart, or feeling faint. These may be symptoms of significant blood loss or postpartum hemorrhage. While mild cramping is normal, severe, unmanageable pain or tenderness in the abdomen should also be reported promptly.