Is Lochia or Bleeding After Pregnancy Normal?

Lochia is a normal part of involution, the body returning to its prepregnant state. In part, lochia results from the layers of the endometrium sloughing away after delivery to heal the placental site. Involution is a complex process that also includes the uterus contracting and returning to a smaller size and the return of ovarian function. There are many changes at the cellular level, as well.

Lochia originates in the uterus, cervix, and vagina. The characteristics change over time, as the body heals. For the first three to four days following birth, lochia is bloody and red, known as lochia rubia. It then becomes pale brown —  lochia serosa — until changing to yellowish-white or lochia alba as time passes.

Lochia is normal and can last for weeks postpartum. Heavy bleeding should last no longer than ten days, but light bleeding and increased vaginal discharge may persist for as long as six weeks. This progression varies from woman to woman, and one woman may have a different experience with subsequent pregnancies.

In addition to endometrial sloughing during involution, the body is also eliminating extra tissue and blood the baby needed during gestation. Women who have experienced a C-section also have lochia. Even though they did not have a vaginal birth, their bodies are healing from pregnancy, which is what causes the discharge.

One way to cope with lochia is to use sanitary pads. Women must avoid putting anything, including tampons, into the vagina in the weeks following childbirth, until cleared by their doctor. Tampons may introduce bacteria and lead to an infection. Women should also avoid intercourse in the postpartum period for this reason.

Blood red lochia typically lasts anywhere from a week to ten days. Any red lochia beyond this point may be a sign of uterine subinvolution, meaning the uterus is having trouble returning to a pre-pregnancy state. Other things to look for are foul odors, blood clots that are larger than a quarter, and large pieces of tissue, as these can be signs of infection. The absence of lochia might also signify a problem.

Perineal care is important during the postpartum period. When a woman is still having bloody lochia, it is particularly vital. Always wipe from front to back, and gently pat the area dry. Change sanitary pads often to avoid infection and care for any stitches as directed by the physician.

Giving birth is physically hard on a woman's body, and proper rest is essential for recovery. It may take as many as eight weeks after giving birth to start to feel closer to normal. Limiting visitors and physical activity during this time and giving the body time to heal should be priorities. If lochia increases or begins to redden again, it could indicate problems with recovery.

Postpartum hemorrhage is rare, but it does occur. Monitoring the amount and characteristics of lochia is essential for identifying it. If postpartum bleeding fills more than one sanitary pad every hour, call the doctor immediately or go to the emergency room. This amount of bleeding is a sign of postpartum hemorrhage, and urgent treatment is required.

There are other signs that should be reported to the doctor right away. If vaginal bleeding increases and the flow does not slow down with rest, call the doctor right away. Women should also let their physicians know if they are worried about the color, characteristics, or amount of lochia or feel that it has been going on for too long.