Vaginal bleeding following childbirth, known as lochia, is an expected part of the body’s recovery process. This discharge is composed of blood, mucus, and uterine tissue, representing the natural healing of the site where the placenta was attached. Lochia is a sign that the uterus is actively shedding its lining and contracting back to its pre-pregnancy size, a process that occurs regardless of whether the delivery was vaginal or via cesarean section. This temporary biological function typically continues for several weeks.
The Expected Progression of Postpartum Bleeding
The discharge progresses through three distinct phases, each defined by changes in color and consistency. The first stage, known as lochia rubra, lasts for approximately the first three to four days after delivery, characterized by a bright or dark red, heavy flow that may contain small clots. Following this is lochia serosa, which typically occurs between days five and twelve postpartum, where the discharge transitions to a pinkish-brown color and becomes thinner and more watery in volume. By the two-week mark, the bleeding usually enters the final phase, lochia alba, a light, yellowish-white discharge that can continue for several more weeks until it completely subsides.
It is common for the flow to temporarily increase or even revert to a brighter red color around the 10-to-14-day period. This temporary resurgence frequently coincides with an increase in physical activity, such as returning to light household chores or taking longer walks. Increased exertion signals the body to expel more uterine lining, leading to a brief, heavier discharge. Breastfeeding also causes temporary increases in lochia flow, as oxytocin stimulates uterine contractions that help the uterus shrink and expel remaining material. This “rebound” bleeding is normal, provided it quickly subsides back to the lighter, serosa or alba stage within a few hours.
Identifying Symptoms That Require Immediate Medical Attention
Certain symptoms indicate a need for medical evaluation as they may signal a serious complication like delayed Postpartum Hemorrhage (PPH) or infection. The most urgent sign is excessive bleeding that does not slow down, defined as soaking through more than one standard maxi pad per hour for two consecutive hours. Any passage of large blood clots, particularly those larger than a golf ball or a plum, also requires prompt contact with a healthcare provider.
Beyond the quantity of blood, a sudden return to heavy, bright red bleeding after the lochia had already lightened is a warning sign. Signs of infection, such as a fever of 100.4°F (38°C) or higher, chills, or a foul-smelling vaginal discharge, necessitate urgent medical attention. The normal odor of lochia is often described as stale or musty, similar to menstrual discharge; therefore, any distinctly offensive smell is concerning. Systemic symptoms indicating significant blood loss or shock, like sudden dizziness, feeling faint, or a rapid or irregular heartbeat, are also red flags.
Severe, persistent pain or cramping that is not relieved by standard medication may point to an underlying issue. These symptoms warrant immediate contact with your healthcare team or seeking emergency care.
Medical Reasons for Late Postpartum Hemorrhage
The symptoms requiring medical attention are often caused by conditions that prevent the uterus from completing its natural healing process. Delayed or secondary PPH occurs between 24 hours and up to 12 weeks postpartum.
Retention of Placental Fragments
One primary cause is the retention of placental fragments, where small pieces of the placenta or membranes remain attached to the uterine wall. These retained tissues prevent the uterus from fully contracting and closing off the blood vessels at the placental site, leading to continued or renewed bleeding.
Subinvolution
Another potential cause is subinvolution of the placental site, which means the uterus fails to shrink back to its non-pregnant size at the expected rate. This failure results in the blood vessels at the site of placental attachment remaining open, causing excessive or prolonged bleeding.
Endometritis
Infection of the uterine lining, known as endometritis, can also lead to secondary PPH. Endometritis causes inflammation that interferes with the healing of the placental site, often presenting with fever, lower abdominal pain, and foul-smelling lochia.