What is it?
Whether you’ve had a vaginal or cesarean birth, you can expect a lot of vaginal discharge and bleeding in the days and weeks after birth. This discharge, called lochia, is a mix of mucus, blood and the uterine lining.
While often characterized as similar to a menstrual period, there is actually a lot more bloody fluid being discharged from your body postpartum than in a typical period, and that’s completely normal.
Immediately after birth, lochia is bright red, has an odor similar to that of menstrual blood, and can be significant in volume. It can also appear in the form of clumps or clots about the size of a prune or smaller.
Lochia will become less heavy after a week or so, and the color will become a more watery-pink or brown. If you are breastfeeding, you may notice that you pass more lochia while feeding, since the uterus is contracting in response to hormone shifts activated by nursing or pumping.
How common is it?
Everyone who gives birth expels lochia.
How long does it last?
Everyone’s postpartum lochia is slightly different. On average, bleeding lasts a little over 30 days, although it is also normal for it to last longer than six weeks. Some women experience a shorter lochia period with subsequent births.
First few days
There will be a significant amount of bright red or brownish-red blood in the days after delivery, and it may include small clots. Expect to soak through a super-absorbency maternity pad every few hours.
About seven to 10 days postpartum, the discharge changes to a brown or brown-pink color (called lochia serosa), and the consistency is more watery. This type of discharge can last a few weeks.
Lochia will decrease in volume over time and will change from a yellowish discharge to a whitish discharge. By the time you visit your midwife or doctor at six weeks postpartum, you'll have just completed this process or will be in the final stages. A small percentage of women will still be spotting at the six-week postpartum visit, and scant bleeding can even last up to eight to 10 weeks postpartum.
What can I do about it?
Maternity pads are the best products to use during this time. They can feel diaper-like, yes, but they catch and hold a lot more volume than an overnight or heavy-flow maxi pad. Maternity pads are also softer — most hospitals and birthing facilities provide them.
Note: It is not recommended to use any type of inserted blood collector (such as tampons) due to the possible risk of infection or damage to sutures.
When should I be worried?
While lochia is absolutely normal, severe or abnormal bleeding is not and could be an indication of postpartum hemorrhage. Postpartum hemorrhage is a rare but potentially life-threatening condition where there’s excessive bleeding following delivery. It usually happens within one day of giving birth, but it can also happen up to 12 weeks after having a baby. About 1-5% of women experience postpartum hemorrhage.
Postpartum hemorrhage is one of the leading causes of preventable maternal death in the United States, which has the highest rate among other high-income countries. The rate is even higher for black women at 3.3 times that of white women, and 2.5 times for Native American and Alaskan Native women.
Signs of postpartum hemorrhage include bleeding through one to two maxi pads per hour, pale skin, shakiness and chills. If you or your partner notices these symptoms, at the hospital or in the first 45 days after delivery, you should seek medical attention immediately.
Within the first 24 hours after birth:
What to look for
Passing large clots of blood or soaking through two pads an hour for more than an hour. Symptoms such as blurred vision, chills, or feeling weak or faint while bleeding are all signs of postpartum hemorrhage.
What to do
Get medical attention immediately if you are experiencing any of the symptoms above. If possible, save your bloody pads, which will help measure blood loss. If you’re passing large clots, be sure to let your doctor know.
Why this happens
Postpartum hemorrhage right after birth happens because the uterus is not contracting well after delivery. Other reasons include tears in the vagina, cervix or uterus, as well as small pieces of the placenta or membranes that remain inside the uterus after the baby is born.
From 24 hours to 12 weeks postpartum:
Though less common, it’s possible that postpartum hemorrhage will occur in the days and weeks following delivery. This is called secondary postpartum hemorrhage and studies indicate that it occurs in 0.23 - 2% of postpartum women in high-income countries, and incidence peaks at one to two weeks postpartum.
What to look for
The main symptom is abnormal or heavy bleeding that increases rather than decreases. This may also be accompanied by pain in the pelvis or lower abdomen, feeling feverish and uterine tenderness.
What to do
Get medical attention immediately if you are experiencing any of the symptoms above. If possible, save your bloody pads, which will help measure blood loss. If you’ve been passing large clots, be sure to let your doctor know.
Why this happens
The most common cause at this stage is an infection, retained placenta or membranes, or the uterus not returning to its normal size.
Unsure if your bleeding is normal? Trust your gut, advocate for yourself or designate an advocate for you, and always err on the side of caution and contact a medical provider.