Postpartum Bleeding: What You Need to Know About Lochia
Unfortunately, your body doesn’t bounce back immediately after giving birth. When the nine months of pregnancy are over, you’ll face an array of postpartum unpleasantries—and one of the biggest is lochia, a vaginal discharge consisting of blood, mucus, and uterine tissue.
"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 the uterine lining sheds."
This shedding (lochia) 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 during pregnancy. The discharge after birth also lasts a lot longer than a normal period, and it goes through a few changes before finally stopping.
If you’ve just had a baby—or your due date is quickly approaching—here's a guide to everything you can expect from postpartum bleeding.
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 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 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 for longer."
How Long Do You Bleed After Birth?
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. "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.
What Else Causes Bleeding After Birth?
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.
Is My Postpartum Bleeding Normal? When to Call the Doctor
You can always ask your doctor about your lochia during your six-week postpartum checkup if you have any concerns. There are some red flags, though: Passing clots after birth, for example, is completely normal. But extra-large blood clots after birth (the size of a grapefruit) 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. For this reason, Dr. Magneson 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.