Bleeding After Childbirth (Lochia)

From the beginning of your pregnancy until the very end, when your baby finally arrives, your body is a non-stop work in progress.

All sorts of changes will take place over the course of the 40 or so weeks you're expecting. This doesn't end when you give birth, of course; your body will go through a series of other physical transformations in order to get back to a non-pregnant state. 

One of these changes is an extended period of bleeding called lochia, in which the lining of the uterus, or the endometrium, is sloughed off and the uterus shrinks down to its pre-pregnancy state—the size and shape of a pear.

Below are some important things to know about this normal and necessary part of healing after childbirth.

A Timeline of Lochia

Almost immediately after your baby is born, the placenta that nourished them while they were in your womb pulls away from the lining of the uterus.

If you had a vaginal birth, it will exit your body in the same way your baby did: A few contractions will push it down through and out of the birth canal. You may not even notice when this happens; you'll be too busy getting to know your newborn. If you had a cesarean section, your healthcare provider will remove the placenta surgically.

Once the placenta is out of your body, your uterus will continue to contract—this time to help seal off the blood vessels where the placenta implanted itself into the endometrium. This is a very important part of childbirth because problems with the delivery of the placenta are a leading cause of postpartum hemorrhage. These initial contractions also are part of the process of returning your uterus to its normal size.

While the uterus contracts following childbirth, it also sloughs off the blood, tissue, and mucus of the endometrium. This happens in three stages that will vary in length and represent the normal healing of the endometrium as it rebuilds itself after delivery. The three stages are as follows:

​​Lochia Rubra

This is the first and heaviest stage of lochia. The blood expelled during lochia rubra will be bright red. Expect to pass blood clots as well—these are just clumps of red blood cells. In order for the uterus to shed these clots, it will have to contract a lot, so you can expect to experience cramping that may be painful at times.

Abnormally heavy bleeding after delivery can be a sign that not all of the placenta was delivered—and that could be a medical emergency, leading to complications such as hemorrhage and infection.

​​Lochia Serosa

The blood during this second stage of postpartum bleeding is thinner in consistency and brownish or pink in color. Most of the blood expelled during this period will still come from the area where the placenta was attached as the uterus works to fully heal it.

You might notice that the flow will be heavier when you've been physically active. If the bleeding doesn't return to normal within a day or so, or if the amount of blood seems excessive, see your caregiver.

Any bleeding that continues for more than six weeks after delivery needs to be evaluated by your healthcare provider. While prolonged postpartum bleeding may have simple causes, it could be a sign of a rare pregnancy complication called gestational trophoblastic disease.

Lochia Alba

In this final stage of lochia, rather than blood, you'll see a white or yellowish discharge that's generated during the healing process and the initial reconstruction of your endometrium.

Need-to-Know Facts About Postpartum Bleeding

• Don't use tampons or a menstrual cup. You could put yourself at risk of infection as your uterus and endometrium heal. While you're stocking up on diapers for your baby before you give birth, be sure to lay in a good supply of sanitary pads for yourself.
• Take a time-out from sex. Most healthcare providers tell new moms to avoid intercourse until at least six weeks, which is typically when the routine postpartum visit takes place. As with tampon use, the concern is an increased risk of infection.
• Use birth control. As soon as you're given the green light to have sex, be sure to use birth control. You will ovulate before you get your first period after you have a baby, which means you can get pregnant again even if you haven't had a period.
• Don't mistake post-partum bleeding for a menstrual period. It may take several weeks or even months for normal menstruations to start back up after you have a baby. If you are breastfeeding, it will take longer. However, breastfeeding will not cause a significant change in the normal progression of postpartum lochia.
• Sniff out signs of infection. During all three stages of lochia, your bleeding should have an odor similar to that of a normal menstrual flow. If you notice an offensive or unusual smell, see your healthcare provider.