L is for Lochia
Lochia or Postpartum Bleeding (aka the Longest Period of Your Life)
Mothers enter what has been referred to endearingly as “The Fourth Trimester,” a magical time when baby and mama continue almost as one. Baby sleeps and feeds; mama rests and recovers. But you know what isn’t as magical? Having the longest period of your life! This bloody flow is called lochia, which comes from the Greek word lokheíos, meaning “of childbirth.”
What Is Lochia?
Lochia is a combination of blood, placental tissue, mucus, cells, and bacteria coming from the wound that occurred when your placenta tore away from your uterine wall.
Why Does Lochia Happen?
Lochia is part of your postpartum healing process, whether you give birth vaginally or by cesarean section.
During pregnancy, your uterus expands, thickens, and softens to house 500x more than its usual capacity.
It basically goes from a cupboard to a luxury condo; and that’s a lot of building material! Your body also grows an entirely new organ: the placenta.
After all this miraculous growth, the luxury-condo-uterus needs to shed a few pounds and get back into cupboard-shape. Following birth, contractions push out the placenta, shrink the wound where the placenta grew, and begin the process of shedding the extra “padding.”
The uterus returns to its usual size and weight in about six to eight weeks. Congrats, uterus, you fit-tastic female organ! Those six weeks, however, require care and patience as you experience period-like discharge.
What Should I Expect?
Since the lochia stages vary woman to woman, the most important thing to remember is that lochia should taper off in volume and brightness. Volume should go from heavy to light to spotting. Color should go from red with some clots to pink/brown to yellowish white. This process can take anywhere between 4-8 weeks.
(FYI, moms who gave birth to twins or triplets will generally have longer and heavier lochia periods.)
How Long Do You Bleed After You Have a Baby?
You’ll go through three normal stages of lochia:
Stage 1: Lochia rubra — First 2-4 days after delivery
Significant cramping as your uterus starts to shrink in size; this is especially true if you breastfeed since nursing releases oxytocin, the love hormone that also helps to contract the uterus.
Blood will be bright red in color and similar to a very heavy menstrual flow.
You may also see blood clots, mucus, and tissue in the discharge of your vagina. (Contact your provider if you see blood clots bigger than a golf ball or you soak through a large menstrual pad every hour.)
Stage 2: Lochia serosa — Starts about day 4 and lasts a week or two
Blood flow is less.
Discharge lightens from pinkish-brown to yellow for about a week.
The discharge will be red blood cells from the placental wound and white blood cells that is mucus from the cervix.
Stage 3: Lochia alba — From about weeks 4-6 after giving birth
Discharge is light yellow or yellowish-white in color, with the bleeding virtually gone.
It should smell like regular menstrual blood.
The uterus has dried up, and the discharge is mostly white blood cells and cells from the uterus lining.
When Do I Need Medical Attention?
Head to your doctor’s office or the emergency room if:
One pad has been soaked within one hour or less. This may be postpartum bleeding or part of the placenta may be stuck to your uterus.
You’ve passed lots of clots.
You’re passing clots in the lochia alba stage.
Your bleeding has a foul smell instead of smelling like normal menstrual blood.
You have a fever or chills above 100.4˚ F.
Any of the above indicates infection or the beginning of possible postpartum hemorrhaging.
Call your doctor or midwife if:
You don’t see any lochia for the first two weeks.
Your lochia becomes red in the serosa or alba stages.
You’re passing clots in the lochia serosa stage.
One or more clots are sized as large as golf balls.
You feel sharp pains low down in your stomach, which only become worse.
You see infrequent bright red spotting after lochia has already lightened.
What Causes Postpartum Hemorrhage?
Postpartum hemorrhage rarely occurs. You may be at special risk if you’ve birthed a large baby, carried multiples, or gone through induced labor—all of which can bloat your uterus to double its normal size.
Looks Like Postpartum Hemorrhaging. Now What?
Heavy bleeding is to be taken seriously. You may need a minor operation to contract your uterus or to remove the placenta. Treatments include the oxytocin drug called Pitocin, uterine massage to stimulate your uterus, a blood transfusion if there’s massive blood loss, and hysterectomy if there’s damage to your uterus.
What Can I Do to Reduce Lochia Bleeding?
You’re more in charge than you may think, since bleeding slows as the uterus contracts. You can rush that process by:
Have your caregiver or nurse to massage your uterus.
Breastfeed, if you can. It produce oxytocin which contracts your uterus.
Pee as often as you can. It helps your uterus contract.
Don’t overdue activity—this can get in the way of healing.
You can get a shot of Pitocin to help your uterus contract faster, but it isn’t necessary for most moms.
What Else Should I Know About Lochia?
For that same reason, take it slow. Try not to lift anything heavier than your baby, and delegate your tasks if you can. If you notice an uptick in bleeding, it could be because you pushed yourself too much that day. Kick your feet up and rest—your body is still healing.
Can You Take a Bath After Having a Baby?
Your placental area is raw and open during this time, so bacteria can easily infect your vagina. Keep away from tampons, sex, swimming in public pools, or inserting anything in your vagina, for at least six weeks after birth to prevent infection. You’ll want to give that area a chance to rest.
The Bottom Line About Lochia
Lochia is a pain—and a gift.
It will remind you that you just have gone through a tremendous and transformative process—from nurturing the life within for 9 months, to delivering your baby, to now breastfeeding and caring for your young one.
Lochia can also be very cleansing. It’s almost like your uterus is being scraped or scrubbed in some ways. You’ve had a baby plugged up there for almost a year. Now it’s gone, and your vagina’s going to purge its unwanted leftovers.
It’s time for you to rest. Let your visitors and family pamper you. You need all the rest and recovery you can get for the weeks and months that follow.