Lochia: What You Need to Know About Postpartum Bleeding

Despite what the media may have us believe, the truth is that your body won't "bounce back" to its pre-pregnancy state immediately after giving birth. In fact, when the long months of pregnancy are over, you'll face an array of postpartum symptoms. One of the biggest is lochia, a vaginal discharge consisting of blood, mucus, and uterine tissue.

If you've just had a baby, or your due date is quickly approaching, read on for a guide to everything you can expect from lochia and postpartum bleeding.

What Is Lochia?

Lochia is vaginal discharge that follows childbirth. It contains blood and leftover uterine tissue from pregnancy. According to Colorado Women's Health at the University of Colorado, lochia lasts about six weeks.

This shedding is not totally unlike menstruation, says OB-GYN Christine Masterson, M.D., chief of the women and children's service line at Summit Medical Group in New Jersey. That's because it's made up of the same blood and tissue.

But lochia happens on a much larger scale than a period because of how big the uterus grows during pregnancy. As a result, the discharge after birth also lasts much longer than a normal period and goes through a few changes before finally stopping.

What Causes Lochia?

"When you're pregnant, hormones cause the uterine lining to thicken to support the placenta," says Dr. Masterson. "After delivery, the uterus begins to contract and shrink back down to its usual size, and the uterine lining sheds."

Oxytocin is the hormone that facilitates these changes. This hormone causes uterine contractions during labor and after you give birth. Breastfeeding and chestfeeding release oxytocin, which is why you might be encouraged to nurse immediately after birth to help jump-start the process.

Lochia tends to be heaviest in the first week after birth, and then it gradually tapers down. In addition, it may be heavier in the morning when you first get out of bed, whenever you stand up after reclining, and after increased physical activity.

What Does Lochia Look Like?

In the first days and weeks after delivery, lochia looks very similar to period blood; it's bright red, and the flow can be fairly heavy. You might need to wear thicker postpartum pads, and you may pass a small piece of the placenta or what looks like tissue along with the blood.

After the first two weeks, Dr. Masterson says the color of your lochia will change from red to dark brown and decrease in volume; eventually, it may become yellow and watery. You may also begin bleeding more irregularly rather than having a consistent flow all the time.

In addition, lochia smells like a menstrual period. It may smell metallic or musty, but it should not smell foul. A fishy or foul odor may indicate an infection.

The 3 Types of Lochia

Lochia occurs in three distinct stages, including lochia rubra, lochia serosa, and lochia alba. Exactly how long these stages last varies from person to person, but the following is a guide.

Lochia rubra

The first stage of lochia is known as lochia rubra, begins right after birth and usually lasts about three to four days. It is typically the stage with the heaviest flow (like a very heavy period). The discharge is typically dark or bright red and bloody and small clots are normal.

Lochia serosa

Lochia serosa is the second stage of lochia, and it lasts for four to 12 days. At this point, the discharge typically turns pinkish-brown and is less bloody and more watery. The flow can remain heavy to moderate and there is usually less clotting, if any.

Locha alba

The third and final stage of lochia is known as lochia alba, and it lasts about 12 days to six weeks. The discharge changes from pinkish-brown into yellowish-white with little to no blood and no clots. The flow is light and will eventually turn into spotting.

Will I Have Lochia After a C-Section?

Yes, you'll experience bleeding after birth with a C-section, but it won't be the same as with a vaginal delivery.

Typically those who have had a cesarean section will have less lochia because, during surgery, doctors manually clean the uterus out with a swab to ensure they've removed all of the placenta and membranes, says Amy Magneson, M.D., an OB-GYN with CareMount Medical in New York.

Dr. Magneson points out that manual "cleaning" doesn't occur during a typical vaginal delivery, so those who've given birth vaginally will likely notice more postpartum bleeding for a longer period of time.

How Long Does Lochia Last?

Usually, lochia lasts for about six to eight weeks after birth, so as long as you're within that window and your lochia gradually decreases in volume, it's probably normal.

You should expect the bleeding to decrease gradually over the first two weeks following delivery. If, on the other hand, it's getting heavier, you should call a health care provider immediately, says Dr. Magneson.

What Else Causes Bleeding After Birth?

If you're bleeding abnormally after delivery, there are several possible reasons. You could have a vaginal tear or bladder hemorrhage (meaning the blood isn't actually coming from your uterus), or even a previously undiagnosed bleeding disorder, says Dr. Masterson.

Additionally, when people have heavy lochia and the uterine fundus (the top of the uterus) is not firm, they may have what's called uterine atony, she adds. "This can occur because the uterus isn't contracting enough; there are placenta or membranes left inside the uterus; or there is some other anatomical problem keeping the uterus from contracting, like a fibroid that is inside the lining of the uterus."

In these cases, a visit to a health care provider is probably in order as they can massage the uterus, expel any clots, and prescribe necessary medication to help your uterus contract.

Is My Postpartum Bleeding Normal?

You can always ask the doctor about your lochia during your six-week postpartum checkup if you have any concerns. There are some red flags, however, that warrant a call before then.

Passing clots after birth, for example, is entirely normal. But you should tell a health care provider about extra-large blood clots (the size of a grapefruit) after birth.

Dr. Masterson says that fever, severe pain or cramping that lasts more than a few days after delivery, and foul-smelling lochia are warning signs of infection. You should also contact a health care provider if you have to change your pad more than once per hour because it's soaked through with blood.

For this reason, Dr. Magneson notes that it's important to pay attention to how many sanitary pads you change throughout the day and how much bleeding you notice each time you use the bathroom.