What Is Lochia?

Lochia, also known as postpartum bleeding, is a normal discharge of blood and mucus from the uterus after childbirth. It begins right after delivery and can continue for four to six weeks postpartum, with the heaviest flow occurring for the first 10 to 14 days. For some people, lochia may disappear more quickly, while others may have lochia for slightly longer than four to six weeks.

Characteristics of Lochia 

Lochia is similar to menstrual blood, but is typically heavier and lasts quite a bit longer than a normal period. It also contains elements not found in menstrual blood, like remnants from the placenta. As the lochia passes, it may look pink, brown, yellow, or watery.

It’s possible that you may see small clots of blood contained in the lochia. As long as these are no larger than a plum and you don’t pass several of them in a 24-hour period, this is normal. If you’re worried at all about a clot you have passed, don’t hesitate to call your provider.

Causes of Lochia

For nine months, your uterus has not only housed your baby but your placenta and lots of excess uterine tissue and blood (remember, you weren’t getting a monthly period!). When your baby is born, the uterus sheds all this extra material through postpartum uterine contractions, which are also normal—they help your uterine shrink back down to its normal size.

Types of Lochia

Lochia changes in appearance over time, as the uterus clears out the excess blood and tissue. Typically, you will notice the following pattern:

• At first, lochia will look dark red and the flow may be heavy.
• After about four to 10 days, the lochia should lighten and look pinkish or brownish in appearance.
• After 10 to 14 days, the lochia should become similar to spotting, like what you may notice just before or after your period.
• For the remaining days or weeks, the lochia will look more like watery mucus and will be white or yellow in color. It may also become very irregular.

If you had a cesarean section, you will still have lochia, though it’s possible you may have less of it than if you had a vaginal delivery. After a cesarean procedure, doctors inspect the uterine cavity to be sure all of the placenta has been removed; some of what would traditionally pass later as lochia is often removed as well.

Treatment of Lochia 

Nothing needs to be done to treat lochia. You should not do anything to prevent lochia or stop it from happening—it’s a normal part of your body’s postpartum healing process. By the time your uterus has returned to its normal size, you won’t be passing much lochia anymore (if at all). But it’s important to keep an eye on the lochia and make sure it’s staying within the range of normal.

When to Seek Help

While it's normal to pass a heavy flow of fluid, excessive bleeding, also called postpartum hemorrhage or (PPH) is a cause for concern and should be immediately reported to your doctor. PPH, which is defined as losing over 500 ml of fluid within 24 hours, is a rare but serious condition that occurs in approximately 2% of postpartum women. It primarily happens in the day or so after birth but may occur any time in the first weeks postpartum.

Signs of PPH include the following:

• Blurred vision
• Chills or fever
• Feeling lightheaded, sleepy, or confused
• Heavy bleeding that doesn't slow or stop
• Nausea
• Pale or clammy skin
• Pain, cramping, or swelling in the vagina, abdomen, or perineum
• Rapid heartbeat
• Repeatedly soaking back-to-back menstrual pads
• You notice your lochia has a foul-smelling odor
• You pass a large blood clot or pass several clots in one day
• Your bleeding increases or gets lighter and then suddenly gets heavy again

These may be signs of infection or hemorrhage, which can be dangerous and should be treated immediately. You should also call your provider if your lochia remains heavy for more than two weeks postpartum, or if you are still having any lochia at all after about eight weeks postpartum.

Coping With Lochia 

Unfortunately, you can’t make your lochia go away any sooner, but you can do a few things to make life easier while you wait it out.

• Wear pads, not tampons, after birth to avoid infection (and irritation of the vagina after a vaginal birth). You may need heavy-duty pads at first, and it may be easier to continue wearing the mesh underwear from the hospital to keep everything in place.
• Wear comfortable undergarments and loose-fitting clothes.
• Take over-the-counter pain relievers (unless otherwise directed by your doctor) to reduce the pain of postpartum cramping.
• Get plenty of rest. If you overdo it, you may notice an increase in lochia—that’s your body’s way of telling you to take it easy!