Postpartum bleeding, medically known as lochia, is a normal discharge of blood, mucus, and tissue that occurs after childbirth. This process is the body’s natural way of cleaning out the uterus as it returns to its pre-pregnancy size, a process called involution. Lochia occurs following every delivery, including Cesarean sections, and begins immediately after birth.
The Typical Timeline and Stages of Postpartum Bleeding
The total duration of lochia typically lasts for about four to six weeks, though some individuals may experience traces of discharge for up to eight weeks. While the overall timeline is similar to a vaginal birth, the initial volume of bleeding immediately following a C-section may be lighter because the uterine cavity is cleaned out during surgery. The discharge progresses through three distinct stages, changing in color, consistency, and flow over time.
Lochia Rubra
The first stage is lochia rubra, lasting approximately three to four days after delivery. This discharge is bright or dark red with a heavy flow, similar to a heavy menstrual period. It is normal to pass small blood clots during this initial phase, typically smaller than a quarter.
Lochia Serosa
Around day four postpartum, the discharge transitions to lochia serosa. The lochia becomes pinkish-brown, thinner, and more watery. This flow is generally lighter than lochia rubra and contains fewer or no blood clots, lasting until about the tenth to twelfth day postpartum.
Lochia Alba
The final stage is lochia alba, beginning around day 12 and often continuing until the six-week mark. This discharge is yellowish-white or creamy in color and appears as spotting or a very light flow. Lochia alba contains little to no blood and is mostly made up of white blood cells, mucus, and uterine tissue.
Distinguishing Normal Bleeding from Concerning Symptoms
While lochia is a normal part of recovery, certain symptoms indicate a complication requiring prompt medical attention. Excessive blood loss is signaled by saturating a large sanitary pad completely in one hour for several consecutive hours. Passing blood clots consistently larger than a golf ball or a plum also warrants concern, as this may signal the uterus is not contracting adequately.
Signs of potential infection often accompany complications like endometritis or retained tissue. A foul odor emanating from the lochia is a key warning sign, as normal lochia generally has a stale, metallic, or musty smell.
Immediate medical review is necessary if you experience any of the following:
- A sudden increase in body temperature or high fever and chills.
- Feeling dizzy, faint, or weak, which can indicate significant blood loss.
- An increased heart rate.
- Persistent, worsening abdominal pain that is localized or severe.
- Any increase in bleeding, or a return to bright red, heavy bleeding after the lochia had already lightened.
Factors Influencing Lochia Duration and Flow
The duration and heaviness of lochia vary significantly, influenced by several physiological and behavioral factors.
Physical Activity
Overexertion or engaging in strenuous activities too soon can cause a temporary increase in the flow or a return to bright red bleeding. Limiting physical activity during recovery is important for managing lochia flow.
Breastfeeding
Breastfeeding impacts the uterus and lochia flow. The hormones released during nursing, particularly oxytocin, trigger uterine contractions, often called “afterpains.” These contractions help the uterus shrink down more quickly, which can sometimes speed up the overall process or cause a brief surge in bleeding volume.
Complications
Underlying complications can prolong lochia or cause an abnormal flow pattern. Retained tissue, such as small pieces of the placenta, prevents the uterus from contracting fully. This lack of proper contraction, known as subinvolution, leads to persistent or heavier bleeding beyond the typical six-week period. Infections like endometritis can also cause prolonged discharge, often accompanied by a foul odor.