Bleeding After Childbirth: What You Need to Know About Lochia
Why you're bleeding after delivery—and how to know what's normal (or not).
When the nine months of pregnancy are over, you basically just give birth and then your body goes back to normal...right? Not exactly. There's a bunch of postpartum unpleasantries to look forward to after you deliver your baby, and lochia (i.e. the bleeding that happens after childbirth) is one of the biggest ones.
"When you're pregnant, hormones cause the uterine lining to thicken to support the placenta," says Ob-Gyn Christine Masterson, M.D., chief of the women and children's service line at Summit Medical Group in New Jersey. "After delivery, the uterus begins to contract and shrink back down to its usual size, and that uterine lining sheds."
This shedding is called lochia and it's not totally unlike menstruation, notes Dr. Masterson, because it's made up of the same kind of blood and tissue. But lochia happens on a much larger scale because of how big the uterus grows to accommodate the pregnancy. It also lasts a lot longer than a normal period and goes through a few changes before finally stopping.
If you're newly postpartum—or about to be—here's a guide to everything you can expect when it comes to lochia.
What does lochia look like?
In the first days and weeks after delivery, lochia looks very similar to period blood; it's bright red in color and the flow can be fairly heavy. You might need to wear thicker maternity pads, and it's possible you may pass a small piece of placenta or what looks like tissue along with the blood.
After the first two weeks, Masterson says the color of your lochia will change from red to dark brown and will 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.
Will I have lochia if I had a C-section?
Yes, but it won't be the same as if you had a vaginal delivery.
"Typically women who have had a cesarean section will have less lochia because we manually clean the uterus out with a swab to make sure we removed all of the placenta and membranes," says Amy Magneson, M.D., an Ob-Gyn with CareMount Medical in New York. "That doesn't occur during a vaginal delivery, so [those] women will likely notice more bleeding and for longer."
How do I know if my bleeding is normal?
Usually, lochia lasts for about six to eight weeks, so as long as you're within that window and your lochia is gradually decreasing in volume, it's probably normal. You can always ask your doctor about your lochia during your six-week postpartum checkup if you have any concerns.
How do I know if my bleeding isn't normal?
That said, there are some things to look out for—passing clots, for example, are common during postpartum bleeding, but large ones (i.e. grapefruit-sized) should be monitored. Fever, severe pain or cramping that lasts more than a few days after delivery, and foul-smelling lochia are warning signs of infection, says Dr. Masterson. You should also contact your doctor if you have to change your pad more than once per hour because it's soaked through with blood.
What else can cause postpartum bleeding?
If you're bleeding abnormally after delivery, there's 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, there could be an issue with the overall contraction of your uterus.
"When women have heavy lochia and the uterine fundus is not firm, the mom has what's called uterine atony," Dr. Magneson says. "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 your doctor is probably in order, since he or she will be able to massage the uterus, expel any clots, and prescribe medication—if necessary—to help your uterus contract.
When should I call my doctor?
Any fever, severe pain, or foul odor accompanied with lochia should prompt a call, and—depending on how far along you are in the postpartum period—your volume of lochia may also require a check-in with your doctor.
"When a mom is discharged from the hospital, she should expect the bleeding to gradually decrease over the next two weeks; if it's getting stronger, she should call her doctor immediately," says Dr. Magneson, who also notes that it's important to pay attention to how many sanitary pads you are changing throughout the day, as well as how much bleeding you notice each time you use the bathroom.