Recovery after childbirth involves the body shedding the uterine lining and healing the site where the placenta was attached. When the placenta detaches from the inner wall of the uterus, it leaves a raw wound, often referred to as the “placenta scab.” The subsequent vaginal bleeding and discharge, known medically as lochia, is a normal part of the postpartum healing period. Lochia consists of blood, mucus, and uterine tissue, and it occurs regardless of whether delivery was vaginal or via C-section.
The Phases of Postpartum Bleeding
The discharge from the uterus follows a predictable pattern of color and consistency as the placental wound heals over several weeks. The first stage is called Lochia Rubra, which begins immediately after delivery and typically lasts for about three to five days. During this initial phase, the flow is heavy, similar to a very heavy menstrual period, and the color is bright to dark red. Passing small blood clots is common as the uterus contracts to close off blood vessels at the placental site.
This heavy red flow gradually transitions into the second stage, known as Lochia Serosa, which usually starts around day four or five and can last for up to two weeks. The discharge becomes noticeably lighter in volume and changes color to a pinkish-brown or watery-brown hue. This shift signals that the amount of blood is decreasing and that the discharge now contains more serum, white blood cells, and wound exudate.
The final stage is Lochia Alba, which begins around the second or third week postpartum and may continue as light spotting for up six to eight weeks. During Lochia Alba, the discharge is minimal and changes to a creamy, yellowish-white color. This change indicates that the healing process is nearing completion, and the discharge is primarily made up of white blood cells and epithelial cells.
Identifying the Healing Surge
During the period of lighter bleeding, typically between one and two weeks postpartum, a temporary surge of brighter, heavier bleeding often occurs. This event signifies the moment the protective layer, or eschar, over the placental wound detaches and sheds. The eschar is the medical term for the “scab” that forms over the blood vessels exposed after the placenta’s separation.
When this protective layer sloughs off, it can cause a sudden gush of blood that may be bright red, temporarily mimicking the heavy flow seen in the first few days after birth. This temporary increase may also involve passing a few larger clots than the body has recently shed. Some accounts suggest this localized bleeding event can release up to a cup of blood.
This specific surge is a normal part of the healing timeline, unlike a true complication. The key characteristic of this healing surge is its temporary nature; the flow should quickly subside, usually within an hour or two. It should return to the lighter, pinkish-brown discharge of the Lochia Serosa phase. If the heavier bleeding persists beyond a couple of hours or if the flow does not return to its previous lighter level, it may indicate excessive physical activity or signal a problem.
Urgent Signs of Complication
While the progression of lochia is normal, certain signs indicate abnormal bleeding that requires immediate medical attention. One frequently cited warning sign is blood loss that soaks through more than one full-sized sanitary pad in a single hour for two or more hours consecutively. This level of bleeding suggests a postpartum hemorrhage, which can occur up to twelve weeks after delivery.
The size of blood clots is another important red flag to monitor during the postpartum period. While small clots are common in the first few days, passing any clot larger than a golf ball or a lemon is considered abnormal and warrants emergency contact with a healthcare provider. A sudden and sustained reversal of the bleeding pattern is also concerning, such as a return to bright red, heavy flow after the discharge had already lightened to pink or brown.
Other symptoms that accompany bleeding can signal a serious infection or systemic issue. These include:
- A high fever, usually defined as 100.4°F or higher.
- A foul odor to the discharge.
- Increasing and severe abdominal pain.
- Symptoms of shock, such as feeling dizzy, faint, or lightheaded.
- Experiencing a racing heart or having sudden shortness of breath.