Postpartum vaginal discharge, known as lochia, is a natural part of the healing process following childbirth. It consists of blood, mucus, and uterine tissue, as the body expels extra material and the uterus returns to its pre-pregnancy state. This discharge occurs after both vaginal and cesarean deliveries.
What is Lochia Alba?
Lochia alba, the final stage of postpartum discharge, signifies that healing is well underway. It typically appears whitish-yellow, creamy, or pale, with a thinner, mucous-like consistency and no blood clots. Its smell is usually earthy or musty, similar to menstrual fluid, and should not be foul. Composed primarily of white blood cells, decidual cells, epithelial cells, mucus, fat, cholesterol, and various microorganisms, its lighter color is due to the absence of significant red blood cells.
The Postpartum Timeline of Lochia
Lochia progresses through distinct stages as the uterus heals after childbirth, each characterized by changes in color and consistency. The initial stage, lochia rubra, lasts one to four days postpartum, appearing bright or dark red and heavy, sometimes with small blood clots. Lochia then transitions to lochia serosa, which is pinkish-brown and thinner, lasting from day four to ten or twelve postpartum. Lochia alba, the final phase, usually begins around day ten to twelve and can continue for two to six weeks, sometimes longer. While the transition between stages is gradual and durations vary, flow during lochia alba is typically light, often requiring only thin panty liners.
Signs of Concern and When to Contact a Healthcare Provider
While lochia is a normal part of postpartum recovery, certain changes in its appearance, amount, or accompanying symptoms signal a need for medical attention. A sudden increase in bleeding, such as soaking more than one pad per hour or heavy bleeding for two hours, is a concern. Passing large blood clots, especially those larger than a golf ball, also warrants immediate contact. Other warning signs include the return of bright red bleeding after it had lightened, or a foul-smelling odor, which could indicate infection. Seek medical evaluation for fever or chills, severe abdominal pain not relieved by medication, increased heart rate, or feeling dizzy, lightheaded, faint, or unusually weak, as these may suggest complications like infection, retained placental tissue, or excessive blood loss.