Lochia is the lining of the uterus that is shed after giving birth. It is a normal part of the healing process and not a cause for concern. The lochia is made of blood, tissue, and mucous similar to a menstrual period. The bleeding is heaviest right after birth and slowly decreases over the following 3 or 4 days. For the first few days, you may notice heavier bleeding when you stand up after you have been sitting or lying down for a while. Standing up does not cause the heavier flow. The heavier flow comes from the release of blood that collects in the vagina while you are sitting or lying down.
Protect your furniture and bedding from accidents by using plastic-covered pads under your hips. Until the lochia stops completely wear sanitary pads, not tampons. Tampons increase the risk of infection in the uterus. It is important for you to recognize when bleeding is a normal part of the lochia and when bleeding is a possible sign of hemorrhage. Most hemorrhages happen right after delivery when the uterus does not begin shrinking right away. However, hemorrhaging can happen anytime during the postpartum period.
Hemorrhage during this time can be caused by infection in the uterus or a piece of placenta can stick to the uterus and keep the uterus from healing in that spot. The spot that doesn't heal keeps bleeding. Since the unhealed area is small, you probably won't see a "gush" of blood. Instead, you would see a steady drip, drip, drip which can become a serious problem—just think how fast a cup fills in the sink if you let the faucet drip, drip, drip.
If you have bleeding that soaks a pad in 15 minutes or less, call your doctor immediately. If you cannot get in touch with your doctor have someone take you to the emergency room, or call 911 if you are alone.
Too much activity, like going up and down stairs, can cause a heavier blood flow. If you have been active and notice a heavier flow of lochia, it's a signal to slow down or rest. So try not to lift anything heavier than your baby. Don't be going up and down stairs often, and when you must, then go up and down slowly. If you normally need to use stairs at home, then while you recover, set up a recovery area for you and your baby so you only have to go up and down stairs once in the morning and once again at night. Dining rooms make great recovery areas because they aren't used much. If your bleeding starts to get heavier, get off your feet and rest. Small blood clots, up to the size of a plum are normal. However, clots and heavy bleeding that doesn't stop with rest aren't normal—if this happens call your doctor.
There are 3 normal stages of lochia. It is important for you to know the stages so you can tell whether something may be wrong. How many days each stage lasts isn't as important as whether the amount of lochia keeps getting less and less as the color gets lighter as it changes from red to pink to creamy or white.
These are the normal stages of lochia.
1. Lochia rubra — first 2 to 3 days after delivery
• the lochia is mostly blood
• the blood looks bright red
• the blood flow can be heavy to moderate
• you may see small blood clots
2. Lochia serosa — starts about day 4 and lasts until day 10
• the color changes to pink or pinkish-brown
• the flow is much less
• blood clots or bright red blood during this time may be signs of a problem.
3. Lochia alba — from about day 10 until day 21
• the color is light yellow to a cream color
• the flow has almost stopped and does not smell
• the presence of clots, a bad smell, or bright red blood may be signs of a problem.
The progression from lochia rubra to lochia serosa to lochia alba should not reverse. The color should always turn from red to pink to white as the amount of discharge gets less and less. If you see a red flow after the flow has turned pink or white, call your doctor right away.
Also, call your doctor right away:
☎ if you have heavy bleeding that soaks more than 1 pad per hour for 3 hours
☎ if you see blood clots or bright red blood after the 4th day
☎ if the lochia smells bad (it should smell like your normal menstrual f low)
☎ if you do not see any lochia during the first 2 weeks
☎ if you have bad cramps and heavy bleeding
☎ if you have a fever over 100.4˚ F
☎ if you have severe pain in your lower abdomen
If you are not breastfeeding, you can expect to have your periods return within 4 to 8 weeks. The first menstrual flow tends to be heavy and contain blood clots; your period may start, stop, start again. The second period should be more or less normal. As long as you are breastfeeding, your period will not ordinarily appear. If it does, it won't interfere with breastfeeding.
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