What is lochia
Lochia is a vaginal discharge after having a baby consisting of superficial mucous membrane that lined your uterus during pregnancy and blood. The flow of lochia is not dependent on the type of delivery – normal vaginal childbirth or C-section. The amount and duration is the same in both cases. Lochia will be bright red and heavy for the first few days. Then it will taper, become increasingly watery and change from pinkish brown to yellowish white until it goes away after 4 to 6 weeks. Contact your health care provider if you have heavy vaginal bleeding — soaking a pad in less than an hour — especially if it’s accompanied by pelvic pain, fever or uterine tenderness.
Some women have after-birth pains or cramps for the first few days after the birth sometimes called afterpains, as the uterus starts to contract to its pre-pregnancy size. After-birth pains can feel like labor pains or mild to moderate period pain. If you’re having your second or third baby, they’ll probably be stronger than the after-birth pains from your first baby. A warm pack on your back or belly may help. You can also ask your doctor or midwife for pain relief. Take an over-the-counter pain medicine, such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin). Read and follow all instructions on the label. Do not take aspirin. It can cause more bleeding. Do not take two or more pain medicines at the same time unless the doctor told you to. Many pain medicines have acetaminophen, which is Tylenol. Too much acetaminophen (Tylenol) can be harmful.
Your uterus will be hard and round and can most often be felt near the navel shortly after birth. It will get smaller very quickly, and after a week will be difficult to feel abdominally. You may feel contractions for a few days. They are most often mild but can be stronger if you have already had several babies. Sometimes, they can feel like labor contractions.
Your perineum may be swollen in the first 24 hours after giving birth. You can manage this with the RICE program.
- Rest – lie down to help reduce pain and swelling
- Ice – apply an ice pack for 20 minutes every 2 to 4 hours to reduce the swelling
- Compression – wear firm-fitting underwear and 2 to 3 maternity pads for extra support
- Exercise – start pelvic floor exercises as soon as you comfortably can, but certainly within the first few days
If your perineum is painful, ask your midwife for pain relief. If you have stitches in your perineum, they will dissolve in 1 to 2 weeks. Wash the area normally in the shower and gently pat dry. Eat plenty of fiber and drink a lot of water so your stools are soft. Avoid straining on the toilet. Ask for laxatives if you become constipated.
Your breasts will produce colostrum to feed your baby. Normally a small amount is produced. Remember that your baby’s tummy is just the size of a marble.
If you are not breastfeeding, breast engorgement may continue for a few days.
- Wear a supportive bra 24 hours a day for the first 1 to 2 weeks.
- Avoid any nipple stimulation.
- Use ice packs to help with the discomfort.
- Take ibuprofen to decrease pain and inflammation.
Take tub baths or showers, using only plain water. Avoid bubble baths or oils.
If you have a straightforward vaginal birth in a public hospital or birthing center, you’ll probably go home within 24 hours. A midwife might visit you at home. If you have your baby in a private hospital, you might be able to stay longer, if you want to. Ask your hospital what to expect for your length of stay.
If you have a caesarean section, your experience will be different and you can expect to stay in hospital for a few days.
You will need a checkup with your provider in 4 to 6 weeks.
Call your local emergency services number anytime you think you may need emergency care. For example, call if:
- You have sudden, severe pain in your belly.
- You passed out (lost consciousness).
Also call your doctor or seek immediate medical care if:
- You have severe vaginal bleeding. This means you are soaking through a pad each hour for 2 or more hours or passing blood clots.
- You have bloody discharge that continues beyond 4 to 6 weeks.
- You pass blood clots larger than a golf ball over several hours.
- You are dizzy or light-headed, or you feel like you may faint.
- You are vomiting or cannot keep fluids down.
- You have a fever of more than 100°F (37.8°C) that persists (swollen breasts may cause a mild elevation of temperature).
- You have new or more belly or pelvic pain.
- You pass tissue (not just blood).
- You have swelling or pain in one of your legs (it will be slightly redder and warmer than the other leg).
- Increased pain in your belly.
- Increased pain over your episiotomy/laceration or in that area.
- Discharge from your vagina that becomes heavier or develops a foul odor.
- Sadness, depression, withdrawn feeling, feelings of harming yourself or your baby, or inability to care for yourself or your baby.
- A tender, reddened, or warm area on one breast. This may be a sign of infection.
Watch closely for changes in your health, and be sure to contact your doctor if:
- You are not getting better after 2 days (48 hours).
- You have vaginal discharge that smells bad.
Postpartum preeclampsia, while rare, can occur after delivery, even if you did not have preeclampsia during your pregnancy. Call your provider right away if you:
- Have swelling in your hands, face, or eyes (edema).
- Suddenly gain weight over 1 or 2 days, or you gain more than 2 pounds (1 kilogram) in a week.
- Have a headache that does not go away or becomes worse.
- Have vision changes, such as you cannot see for a short time, see flashing lights or spots, are sensitive to light, or have blurry vision.
- Body pain and achiness (similar to body pain with a high fever).
Abnormalities of lochia
The lochia may be abnormal if infection occurs at this time. Infection can be suspected when :
- The lochia continues to remain bright red even after the first week from childbirth.
- The lochia becomes bright red again after having become paler over the previous days.
- There is abnormally heavy bleeding causing a sanitary pad to soak through within 1 hour or less or there is passage of blood clots larger than a golf ball. This is a sign of secondary postpartum hemorrhage and needs emergency treatment.
- It has an unpleasant smell.
- There is fever with chills.
- There is pain in the lower abdomen which increases over the days.
Types of lochia
Depending on the color, lochia can be of three types:
Lochia rubra
Lochia rubra the discharge is red in color (rubra) and lasts from 1st postpartum day to 4th day and sometimes 7th day. It is made up of mainly blood, bits of fetal membranes, decidua, meconium and cervical discharge.
Lochia serosa
Lochia rubra gradually changes color to brown and then yellow over a period of about 1 week. It is called lochia serosa at this stage. Lochia serosa is a pink yellow discharge containing less blood blood and more serum, and extends for another 3 to 4 days. The lochia serosa contains less red blood cells but more white blood cells, wound discharge from the placental and other sites, and mucus from the cervix.
Lochia alba
Lochia alba is a creamy or whitish colored discharge contaning leucocytes and mucus. It remains for the 10 to 14 day postpartum. Lochia alba mainly consists of decidual cells, mucus, white blood cells, and epithelial cells.
How long does postpartum bleeding last?
For the first 24 hours, lochia is similar to a very heavy period and you might also pass some lochia clots. If some clots are bigger, such as the size of a 50 cent piece, tell your midwife. In less than a week, the lochia will be pink in color. After about 10 days, the lochia will be white or yellow. Lochia may last up to 6 weeks or longer, until your uterus heals. Lochia can come and go for about 2 months. In most cases, bleeding decreases the most during the first week. It may not stop completely for several weeks. It is not uncommon to have an increase in red bleeding around 7 to 14 days, when the scab forms over the spot where your placenta was shed. Don’t worry if you also pass some blood clots, as long as they are smaller than a golf ball.
Do not use tampons until you see your doctor for your 6-week checkup.
Use pads, rather than tampons, during this time. If you have a tear next to the vagina (perineal tear) or an episiotomy that is healing, change the pad at least every 4 hours to prevent irritation and infection.
Your menstrual period is likely to return in:
- 4 to 9 weeks after your delivery if you’re not breastfeeding.
- 3 to 12 months if you are breastfeeding, and perhaps not for several weeks after you completely stop breastfeeding.
- If you choose to use a contraceptive, ask your provider the effect of the contraceptive on the return of your menses.
