A Look At Lochia: The Normal Bleeding and Discharge After Having A Baby

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Many changes happen in your body to support you and your baby through pregnancy, labor and delivery.

One obvious change during pregnancy is the size of your uterus. Considering that it is normally about the size of a lemon, your body has a lot of work to do to return your uterus to its non pregnant state. And this recovery process starts while you are still in the delivery room.

Right after your baby is born your placenta separates and delivers.

Once the placenta delivers your uterus can contracts which helps to block the blood vessels that were attached to the placenta. This is very important part of your labor because problems with delivery of the placenta are a leading cause of postpartum hemorrhage. In addition to controlling your bleeding this initial contraction of the uterus begins the process of returning your uterus to its normal size.

What Is Lochia?

Over the next several weeks your uterus contracts down to its pre-pregnancy or normal size. During this time the lining of your uterus or endometrium has to heal and rebuild especially in the area where the placenta was attached. As the uterus and endometrium returns to normal blood, tissue, and mucous pass through your cervix and create a typical vaginal discharge.

 Lochia is the medical term for this normal vaginal bleeding and discharge that occurs after childbirth. There are three stages of lochia:

  • Lochia rubra -- Lochia rubra appears very bright red and contains a large number of red blood cells.
  • Lochia serosa --  Lochia serosa is thinner than lochia rubra and is brownish or pink.
  • Lochia alba --  Lochia alba is white or yellowish-white.

These stages will vary in length and represent the normal healing of the endometrium as it rebuilds after delivery.

The Stages Of Lochia

The first stage of lochia or lochia rubra is typically the heaviest.

You may pass some blood clots, especially during the first few days after delivery. You will typically have some painful cramping as well. Usually,  lochia rubra lasts for about 7 days but can last a little longer. If your bleeding during this time is excessively heavy or if you are still having heavy bleeding for more than two weeks after you deliver you should talk to your healthcare provider. Abnormally heavy bleeding after delivery can be a sign of retained placental tissue.

The second stage of lochia or lochia serosa is a transition from the heavier bleeding that occurs in the first few days after delivery.

There is still bleeding from the lining of the uterus especially from the area where the placenta was attached, but it is a lighter flow. Lochia serosa typically lasts for about 2 weeks but can last 4 to even 6 weeks postpartum. During this time, especially in the first 2 weeks, you might notice that increasing your physical activity can increase the amount of your lochia. This can be normal. But if the bleeding doesn't slow down again within a day or so or if the bleeding is excessive it could be a sign of a problem.

Also, bleeding that continues for more than 6 weeks after delivery needs to be evaluated by your doctor. This prolonged bleeding could be a sign of a rare pregnancy complication called gestational trophoblastic disease.

The final stage of lochia or lochia alba is the discharge caused by the healing process and initial build up of your menstrual endometrium. It lasts for a few weeks after the blood tinged lochia serosa stops. Typically it lasts until about 6 weeks after delivery but this will vary depending on how may weeks your lochia serosa lasted.

Five Fast Facts About Lochia

1) No Tampons

It is important not to use tampons or a menstrual cup to manage lochia.

The concern is for an increased risk of a uterine infection while your uterus and endometrium are healing. It is only appropriate to use pads.You can use either disposable or reusable ​sanitary pads. Make sure you have a good supply at home.

2) No Sex

Usually, you will be instructed not to have sex until you have your routine postpartum visit 6 weeks after you have your baby about when lochia usually ends. Again the concern is for an increased risk of infection. However, Your healthcare provider might suggest that you start birth control before that visit.

3)Lochia Is Not Your Period

Lochia is not the same as your period. It may take several weeks or even months for your normal menstruation to return after you have a baby. It will take longer for your period to return if you are breastfeeding.

You will ovulate before you get your first period after you have a baby. This is important because that means that you can get pregnant again before you see your first period. Your doctor may suggest that you start birth control before your 6 week postpartum check up.

4) Lochia Should Not Have A Bad Odor

All three stages of lochia have an odor similar to that of normal menstrual flow. If you experience an offensive or abnormal odor during lochia, contact your physician for evaluation.

5) Breastfeeding Doesn't Change Your Lochia

Although breastfeeding is associated with a delay in the return of your periods it does not cause a significant change in the normal progression of postpartum lochia.

Updated by Andrea Chisholm MD

Source:

Viness,C;Kennedy,K;Ramos,R.(1997) The duration and character of postpartum bleeding among breastfeeding women. Obstet Gynecol, 89(2):159-63.

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