Lochia

What is lochia?

Lochia is the vaginal discharge you have after giving birth. It contains a mix of blood, mucus and uterine tissue. It has a stale, musty odor like menstrual period discharge, and can last several weeks. Lochia is heavy at first but gradually subsides to a lighter flow until it goes away.

Between pregnancy and childbirth, you’ve been through a lot. And so has your body. Now that your baby is here, bleeding may be the last thing on your mind. But your body needs time to recover. Lochia is part of the postpartum healing process.

Lochia stages

Lochia has three stages:

1. Lochia rubra
2. Lochia serosa
3. Lochia alba

The duration of each stage and the way the lochia looks vary.

Lochia rubra

Lochia rubra is the first stage. You can expect the discharge to:

• Be dark or bright red blood
• Flow like a heavy period
• Contain small clots (smaller than a quarter)

You may also experience mild, period-like cramping. You may especially feel this cramping if you’re breastfeeding or pumping.

Lochia rubra typically lasts at least three to four days after childbirth. You can expect to soak one thick maxi pad every two to three hours.

Lochia serosa

Lochia serosa is the second stage. You can expect the discharge to:

• Be pinkish brown and less bloody-looking
• Be thinner and more watery than lochia rubra
• Have a moderate flow
• Contain fewer clots than lochia rubra or no clots

You typically have lochia serosa for the fourth through 12th day after childbirth.

Lochia alba

Lochia alba is the last stage. You can expect the discharge to:

• Be yellowish white
• Contain little to no blood
• Have a light flow or spotting
• Contain no clots

Lochia alba typically starts around day 12 and can last up to six weeks after delivery. At this stage, you may only need to wear thin panty liners to absorb the discharge.

How long does it last?

It can vary, but lochia typically lasts up to six weeks. Some people have traces of lochia for up to eight weeks. It’s important to remember that lochia isn’t just blood or bleeding. The last stage of lochia involves little to no blood.

How long after birth do you bleed?

You can typically expect to have bloody discharge for about two weeks after childbirth. But this can vary. The amount of blood should decrease over that time.

Do you bleed less if you have a C-section?

If you’ve had a cesarean delivery (C-section), you’ll still bleed for multiple weeks. But it’s typically less than the amount of lochia after a vaginal delivery. You should still expect dark red blood that gradually changes from brown to yellow to white over several weeks.

What is the purpose of lochia?

Lochia helps your uterus return to how it was before pregnancy.

During pregnancy, your uterus gets bigger and builds up extra blood and tissue to support the growing fetus. Once your baby is born, your body no longer needs that extra stuff. Lochia is how your body clears it out. It’s a mix of blood, fluid and tissue.

Your uterus is essentially “starting fresh.” It gets rid of blood, tissue and fluids from months of pregnancy.

What is lochia made of?

Lochia is made up of:

• Amniotic fluid
• Any leftover fetal membranes (tissues that surround and protect the fetus)
• Bacteria and microorganisms
• Blood
• Cervical mucus
• The tissue lining of your uterus (endometrium)

What does it look like?

Every person is different. But generally, lochia follows a similar progression in color and volume. It begins as blood before tapering to a whiteish mucus.

Lochia is dark or bright red for at least three or four days. The flow is heavy, and you may also pass small clots. After about a week, lochia is more watery and transitions to a pinkish-brown color. Finally, after about 10 to 14 days, lochia changes to a creamy, yellowish-white color.

How does lochia smell?

Lochia will smell like menstrual blood. Some describe it as musty, metallic, sour or stale. But it shouldn’t smell fishy or foul. This could mean bacteria has caused an infection.

When should I be concerned about lochia?

Lochia usually doesn’t cause problems. The amount of bloody discharge should slowly stop on its own.

But having lochia rubra (red, bloody discharge) for more than one week may be a red flag. It might mean your uterus isn’t shrinking back to its nonpregnant size as it should (subinvolution). Call your healthcare provider if this happens.

You should also watch out for signs of abnormal bleeding or discharge. Contact your healthcare provider if you experience the following symptoms in the weeks after giving birth:

• Greenish vaginal discharge
• Foul-smelling odor (unlike your usual period)
• Too much bleeding or discharge (soaking a pad every hour)
• Large, golf-ball-sized clots or excessive clotting
• Fever, chills or flu-like symptoms
• Swelling or worsening pain around your vaginal area
• Dizziness or feeling like you may faint
• Excessive cramping or pelvic pain

These symptoms may signal complications like:

• Endometritis
• Retained placenta
• Uterine atony

These complications need medical treatment right away.

Can bleeding after birth stop and start again?

There may be times during the stages of lochia when you have more or less discharge. But bloody discharge that’s part of lochia shouldn’t completely stop and then start again. If you start bleeding again, it may be your period or a sign of a complication. Reach out to your healthcare provider for guidance.

What do I do to manage lochia at home?

Here are some tips on how to manage postpartum bleeding:

• Use only sanitary maxi pads or disposable underwear for the first six weeks postpartum. Plan on going through several large, thick pads (or disposable underwear) per day for at least a week.
• Stock up on your sanitary supplies before you come home from the hospital, if possible. It’ll be one fewer thing you need to worry about.
• Don’t use tampons or insert anything into your vagina for at least six weeks. This can introduce bacteria to your uterus and cause infection.
• Wear clothing you don’t mind ruining. Lochia may stain your clothes.

You may notice an increase in discharge:

• During or after physical activity like walking or climbing stairs
• While breastfeeding
• When you stand up out of bed in the morning

Healing after childbirth takes several weeks. Try to rest when you can. Lean on loved ones to help with chores and meals so you can take care of yourself and your baby.

Can you get pregnant when you have lochia discharge?

Yes, it’s possible to get pregnant again just three weeks after giving birth.

It’s best to avoid sexual intercourse for at least six weeks after giving birth. Introducing bacteria and objects into your vagina before it has healed can cause infection. Your healthcare provider will give you the OK for intercourse after your postpartum check-up. This is usually around six weeks after delivery.

When it’s medically OK to have sex again, use contraception if you don’t want to become pregnant. You can get pregnant even if your menstrual period hasn’t returned.

How is lochia different than period blood?

The biggest difference between the two types of discharge is that lochia lasts much longer. A typical period lasts three to seven days. Lochia lasts about six weeks in most women.

Lochia and menstrual bleeding are similar in that the bleeding is heavier at first and then lightens before going away.