Lochia: Post Childbirth Bleeding

The first thought that comes to mind when you discover that you are pregnant – “For the next 9 months – NO PERIODS!” Your body is a non-stop work in progress during pregnancy; all sorts of changes happen for the next 37-42 weeks. Finally, the baby arrives, but the changes in your body continue to occur. One of these changes is that you will have several weeks of extended postpartum bleeding – known as lochia. This bleeding post-birth is a natural process where your body sheds the remaining tissue and blood from the uterus. It can last for several weeks, varying from woman to woman, and may change in colour and flow over time. Understanding lochia helps you feel more prepared for postpartum recovery and reassures you that this phase is normal.

Is Post Delivery Bleeding Normal?

Post-delivery bleeding or lochia is a required healing process the body goes through post-delivery. Immediately after your baby is born, the placenta which nourished him in the womb will pull away and separate from the lining of the uterus. Some of the blood vessels where the placenta was attached to the uterus would remain open. These blood vessels within the uterus will start bleeding. This blood will go through the birth canal to the vagina. It is accompanied by tissues from the lining of the uterus.

What Is Lochia?

Lochia discharge is just like periods; the only difference is that it lasts longer and is heavier. The bleeding will be heavy for the first 2-3 days post-delivery and may include blood clots. The flow will eventually decrease to spotting after a few days before completely stopping. The colour of the flow will change from dark red to brown and finally yellowish-white as the uterus heals in a few weeks.

Lochia mostly consists of: 

• The sloughed-off endometrium (mucus membrane lining the inside of the uterus) which considerably thickens during pregnancy
• Blood and discharge from the uterus wall to which the placenta was attached
• Dead and necrotic tissues
• Mucus and blood from the healing cervix
• Foetal membrane and epithelial cells

If you had a vaginal birth, lochia would exit your body through the birth canal. A few contractions will push it down through and out of the vagina. If you had a caesarean section, the placenta would be removed surgically. In any case, you will experience bleeding post-delivery.

Please note that lochia is not a period. After delivery, it can take a while for your menses to return. For breastfeeding mothers, the first period may start about 6 months postpartum. If you are formula feeding, you may see it as soon as 6 weeks after delivery.

Types of Lochia

Depending on the colour of the discharge, postnatal lochia can be classified into three types or stages. The length of time in each stage will vary across individuals.

1. Lochia rubra

This is a stage with heavy blood flow that will last for about 3-4 days post-delivery. The blood discharge is deep reddish in colour. It mainly consists of thick blood clots of large size, foetal membrane, meconium, decidua and cervical discharge. You may experience painful cramps similar to menstrual cramps, as the uterus will contract a lot to shed the clots. If the heavy discharge lasts for more than 7 days or you have abnormally heavy bleeding or large size of clots, it could be a sign of some placenta remaining inside the uterus. This could lead to an infection or haemorrhage and needs immediate medical attention.

2. Lochia serosa

The consistency of blood will start getting thinner, and the colour of the blood discharge will change from deep red to brown and eventually turn yellow in about 7-10 days post-delivery. The discharge will contain fewer red blood cells and more white blood cells, mucus from the cervix, and some fluid from the placenta. This stage will last for about three to four weeks. If it continues for more than six weeks, consult your doctor for an evaluation to discuss the possible complications.

3. Lochia alba

After another week or so, you will notice that the discharge will turn whitish and the amount of blood discharge will reduce to spotting. This will last for about a fortnight. It mostly consists of mucus, white blood cells, decidua and epithelial cells. This is the last stage of lochia and represents the complete healing of the uterus.​ The spotting will completely stop post this stage.

Causes of Lochia

Lochia is a normal occurrence post-childbirth in every woman. It is not a disease or a complication of pregnancy. As discussed earlier, it is caused by the shedding of the uterine lining after delivery. The body needs to heal post-delivery, and the uterus has to shrink back to its pre-pregnancy state.

• The length and quantity of lochia will vary for every individual.
• Some women may experience painful contractions post-delivery. This may lead to heavy bleeding accompanied with large clots and then the flow will reduce spontaneously.
• In case of premature birth, lochia may be lesser, and in case of twin pregnancy, it may be excessive.

However, if you experience abnormal amounts or a prolonged period of lochia, it will need immediate medical attention.

Symptoms of Lochia

You may experience the following symptoms during lochia:

• Sometimes, the blood collected in the vagina will drain with a huge rush or flow when getting up or sitting down or while spreading your legs. This is normal and is not a cause for concern.
• Though the lochia is sterile, bacteria colonising in the area will give off menstrual blood odour. If it is bad-smelling or has a foul odour, it could be a sign of infection.
• Breastfeeding causes the womb to contract and leads to a period of cramps called ‘after-pains’. The bleeding can get heavier during breastfeeding.
• You may experience a heavy flow of blood after physical activities or exercise. You will need to take adequate rest.

How Long Does Lochia Last?

On an average, postpartum lochia lasts for about six weeks post-childbirth. The flow and consistency will gradually reduce from the heavy flow of thick consistency in the initial stage to regular menstrual consistency after 1 week to spotting after a fortnight. In any case, it should completely stop after six weeks of delivery.

How to Manage the Bleeding After Delivery?

Lochia is perfectly normal post-delivery and essential for healing. You just need to ensure basic hygiene and take essential care to sail through this time.

• Stock up on sanitary napkins and change them at regular intervals. In the initial few days, you will need large pads with a heavy absorption capacity.
• Avoid using tampons or menstrual cups to keep away any infection.
• Avoid sexual intercourse during this period to stop bacteria from spreading.
• Avoid heavy exercises and strenuous physical activities. Get enough rest.
• Keep away from swimming in public pools.
• Keep your private parts clean.
• Empty your bladder frequently. Urinate often even if you don’t feel the need to relieve yourself.
• Herbal bath with Epsom salt can speed up the recovery process.
• Avoid blood-thinning medications like aspirin and ibuprofen.
• Increase the intake of iron in your diet.

How to Tell If You Are Bleeding

Lochia will be deep red in colour and eventually turn brown and yellowish before completely stopping. You will be able to see the lochia on your sanitary napkin. With a reduction in flow over time, it will reduce to spotting. You can use panty liners in the last few days.

Is Post-Delivery Bleeding Different for Women Who Have a C-Section?

Whether you give birth vaginally or through a c-section, your body will have to get rid of the extra blood and tissues. Bleeding after c-section will be for the same duration and amount as in the case of normal delivery.

When to Call Your Doctor

You will have to consult your medical practitioner immediately if you experience any of the following symptoms. It is likely that you are suffering from an infection in the uterus, postpartum haemorrhage or have retained a piece of the placenta which is still attached to the uterine wall.

• If the blood discharge is bright red after the first week of delivery.
• The lochia discharge increases instead of reducing with time.
• If you experience abnormally heavy bleeding with large-sized blood clots, it could be a sign of postpartum haemorrhage and needs immediate medical attention.
• Lochia with an unpleasant odour is a sign of bacterial infection.
• If you have a fever accompanied by chills.
• Increasing pain in the lower abdomen continued for many days.
• Excessive tiredness, dizziness, and fatigue.
• Tenderness of stomach
• Fainting

FAQs

1. Can lochia stop and then restart?

Yes, lochia can sometimes appear to stop and then restart after a few days, especially if you have increased physical activity or resumed daily chores too soon. This is typically not a concern unless the flow becomes unusually heavy or bright red.

2. Is it normal to pass tissue-like clumps during lochia?

Passing small, tissue-like clumps can be a normal part of lochia, as they may include remnants of the uterine lining. However, passing large clots (larger than a golf ball) should be reported to your doctor immediately.

3. Can the colour of lochia temporarily darken?

Yes, lochia can temporarily darken in colour, especially if you’ve been lying down for an extended period. When you stand up, blood that pooled in the vagina may appear darker or thicker, which is generally normal unless accompanied by other symptoms like fever or severe pain.

Lochia is normal in the postpartum stage. It isn’t a disease that one needs to watch out for but the natural shedding process that takes place after every pregnancy. There are certain do’s and don’ts that can help you with the postpartum recovery process. Once this process is over, it will only take place again if you have another delivery.

References/Resources:

1. Lochia; Cleveland Clinic; https://my.clevelandclinic.org/health/symptoms/22485-lochia

2. Pregnancy: Physical Changes After Delivery; Cleveland Clinic; https://my.clevelandclinic.org/health/articles/9682-pregnancy-physical-changes-after-delivery

3. Sherman. D, Lurie. S, Frenkel. E, et al.; Characteristics of normal lochia (American Journal of Perinatology); National Library of Medicine; https://pubmed.ncbi.nlm.nih.gov/10772198/

4. Your body after the birth; NHS; https://www.nhs.uk/pregnancy/labour-and-birth/after-the-birth/your-body/

5. Visness. C, Kennedy. K, Ramos. R; The duration and character of postpartum bleeding among breast-feeding women (Obstetrics & Gynecology); National Library of Medicine; https://pubmed.ncbi.nlm.nih.gov/9015013/; February 1997

6. 3 Conditions to Watch for After Childbirth; American College of Obstetricians and Gynecologists; https://www.acog.org/womens-health/experts-and-stories/the-latest/3-conditions-to-watch-for-after-childbirth

7. Lopez-Gonzalez. D, Kopparapu. A; Postpartum Care of the New Mother; National Library of Medicine; https://www.ncbi.nlm.nih.gov/books/NBK565875/

Also Read:

Tips to Recover From Postpartum Pain
Important Precautions to Take After Delivery
How Your Body Changes After Delivery of the Baby
Common Postpartum Complications & Their Solutions