Postpartum recovery involves significant physical healing, including vaginal bleeding and discharge known as lochia. This discharge occurs as the uterus returns to its pre-pregnancy state, shedding the extra tissue and blood that supported the pregnancy. Understanding the typical progression of this bleeding helps manage expectations during the weeks following childbirth.
Understanding the Healing Site
The process often described as the shedding of a “placenta scab” is the body’s mechanism for healing the large wound left inside the uterus. When the placenta detaches during the third stage of labor, it leaves behind an open site, roughly the size of a dinner plate, known as the decidua basalis. This area is rich with blood vessels that must heal. The resulting discharge is lochia, consisting of blood, mucus, and sloughed-off uterine tissue. To control bleeding, the uterus begins involution, contracting to shrink down and compress the blood vessels at the placental site, which minimizes blood loss and encourages healing.
The Typical Timeline of Lochia
Lochia typically lasts between four to six weeks, defined by changes in the color, consistency, and volume of the discharge as the uterus heals. The first phase, lochia rubra, is the initial heavy flow occurring for approximately the first three to five days after delivery. This discharge is bright or dark red, similar to a heavy menstrual period, and may include small blood clots no larger than a quarter.
As healing progresses, the lochia transitions to the second phase, lochia serosa, a thinner, more watery discharge. This stage typically begins around day four or five and can last up to about two weeks post-delivery. The color shifts to a pinkish-brown tint. Around seven to fourteen days postpartum, some people notice a temporary, brief increase in bright red bleeding, which is thought to be the shedding of the healing layer, or eschar, from the placental site.
The final stage is lochia alba, characterized by a yellowish-white or creamy discharge with a minimal flow. This phase begins around the second week and can persist until the recovery period ends, often at the six-week mark. It is comprised mainly of white blood cells and decidual cells, signifying that bleeding from the placental site has stopped and the uterine lining is nearing full restoration. Increased physical activity or oxytocin release from breastfeeding can temporarily increase the flow or cause a return to a slightly redder discharge, but this should subside quickly with rest.
Identifying Abnormal Bleeding
While changes in lochia flow are normal, certain signs indicate a need for immediate medical attention, as they may suggest complications like infection or secondary postpartum hemorrhage. A concerning sign is bleeding that is heavy enough to soak through more than one full-sized sanitary pad in a single hour for two or more consecutive hours. Passing blood clots that are larger than a golf ball also warrants an urgent call to a healthcare provider.
Foul-smelling vaginal discharge, especially when accompanied by a fever higher than 100.4°F or chills, can be a symptom of a postpartum uterine infection, such as endometritis. A sudden return to bright red, heavy bleeding after the lochia had previously lightened and become pink or white is also a warning sign. Other systemic symptoms to monitor include feeling dizzy, lightheaded, faint, or experiencing a rapid heart rate, as these may signal excessive blood loss. Abnormal bleeding is often caused by factors like retained fragments of the placenta or a failure of the uterus to contract sufficiently, which requires prompt medical evaluation and care.