Lochia
Lochia is the postpartum bleeding and discharge. Following the birth of a baby, continued uterine contractions, often called afterpains, help to peel the placenta off of the inside wall of the uterus, and once it is fully detached, the placenta is born, usually within 30 minutes after the baby. The placenta site is rich in blood vessels that connected the uterus, and the pregnant person’s blood supply, to the placenta, and the baby’s blood supply. Once the placenta begins to detach from the uterus, the blood vessels are open and begin to bleed. This blood flows out of the uterus and vagina, along with other fluids and tissues, for several weeks following the birth. Afterpains help to tighten the uterine muscle fibers around those blood vessels to slow postpartum bleeding to normal levels. Because the bleeding comes from the placenta site, people experience lochia following vaginal births and Cesarean births.
In the first 2 hours or so following childbirth, losing up to 1000cc (1 liter) of blood is considered normal, while losing more than 1000cc is called postpartum hemorrhage. You can also be diagnosed with postpartum hemorrhage if you lose less than 1000cc of blood but have symptoms of excessive blood loss.
1000cc or 1 liter and a typical postpartum sized pad with ruler for scale
The lochia in the first 3 or 4 days following the birth is typically bright red in color, and called lochia rubra. Lochia rubra is typically very heavy, filling as much as an entire postpartum pad in as little as 1-4 hours. Clots are common in lochia rubra, and clots as large as an egg are considered normal. Lochia rubra should smell like nothing, or like menstrual blood. Over these few days, lochia rubra should decrease in quantity, from heavy flow, to moderate, perhaps to light. Lochia should never go backwards in volume or color, if it does increase again, it is a sign that you have done too strenuous activity for your stage of recovery.
Following lochia rubra is lochia serosa, which may begin as early as 4 days postpartum and lasts for about a week, or as long as a month. Lochia serosa is pink, darker red, or brown in color, and clots are not normal anymore. Over the days and weeks you have lochia serosa, it should decrease in quantity, and never go backwards in volume or to lochia rubra, if it does increase again, it is a sign that you have done too strenuous activity for your stage of recovery.
Finally, comes lochia alba, which can begin as early as 10 days postpartum, and may continue into the 6th or even the 12th week postpartum. Lochia alba is yellow or white in color, and is typically very light or scant in flow. Over the days and weeks you have lochia alba, it should decrease in quantity, and never go backwards in volume or to lochia serosa or rubra, if it does increase again, it is often a sign that you have done too strenuous activity for your stage of recovery. Clots are not normal for lochia alba either. Some people will experience their first postpartum period as early as 6 weeks postpartum, if you experience a return to bright red discharge from lochia alba, it may be your first menstrual cycle, but you should still mention it to your caregiver.
Overall, lochia may increase with exertion, may look like it has increased when getting up after resting, and it can increase temporarily at around 10 days postpartum due to the wound healing process. There should never be a bad or foul odor, and any clots larger than an egg should be reported to your caregiver. Pads should be worn, never tampons, menstrual cups, discs, or other internal menstrual options. Lochia may last as little as 2 weeks from start to finish, or as long as 12 weeks. At any time, if you fill a pad in less than an hour, call your caregiver or even 911 if that feels appropriate. Pads should be changed regularly, about every 1-4 hours as needed. Any time you are concerned with your lochia, contact your caregiver.
