Postpartum bleeding (lochia)

What is lochia?

Lochia is vaginal discharge during the postpartum period. It consists of blood, tissue shed from the lining of the uterus, and mucus.

For the first few days after birth, lochia contains a fair amount of blood, so it'll be bright red and look like a heavy period. It may come out intermittently in small gushes or flow more evenly. If you've been lying down for a while and blood has collected in your vagina, you may find your bleeding is a bit heavier. It may also be heavier while breastfeeding.

What causes lochia?

Lochia is a very normal part of the postpartum experience. When the placenta separates from the uterus after birth, there are open blood vessels in the area where it was attached, and they begin to bleed into the uterus. After the placenta is delivered, the uterus continues to contract, which closes off those blood vessels, dramatically reducing the bleeding. The contractions also help shed the remaining uterine lining that supported the baby during pregnancy and return your uterus to its normal size. Healing hemorrhoids from pregnancy and vaginal birth may also cause bleeding when you have a bowel movement.

Immediately after delivery, your obstetrician or midwife may massage your uterus and give you synthetic oxytocin (Pitocin) to help your uterus contract and reduce your bleeding. Breastfeeding, which prompts your body to release natural oxytocin, also helps your uterus contract. (That's why you may feel cramps, or afterpains, when you nurse.)

You'll have lochia whether you had a c-section or a vaginal birth. Your placenta is removed no matter how you give birth, and your uterus still needs time to contract down to its pre-pregnancy size. But if you had a c-section, your bleeding may be less than for women who delivered vaginally.

Occasionally, the uterus doesn't contract well after delivery, resulting in excessive blood loss called a postpartum hemorrhage. This is a rare but potentially fatal condition that must be addressed quickly by doctors.

How long does postpartum bleeding last?

Normal postpartum bleeding typically lasts for four to eight weeks in total. The heaviest bleeding, called lochia rubra, lasts for the first two to four days after giving birth. You might also feel some cramping during this time as your uterus continues to contract and shrink. You'll likely have a little less discharge each day, and it will probably get lighter and lighter as the days go by. Around two to four days after you've given birth, the lochia may be more watery and pinkish. (This postpartum bleeding phase is called lochia serosa.) By about 10 days after the birth, you may have only a small amount of white or yellow-white discharge. At this point, the lochia – called lochia alba – is mostly white blood cells and cells from the lining of the uterus.

The lochia will taper off before it stops in another two to four weeks. During that time many women will feel spurts of bleeding a few times a day, usually while breastfeeding or pumping. This is the uterus contracting in response to the oxytocin release associated with your milk letdown. This connection helps expel any collected blood within the uterus and encourages the return to pre-pregnancy uterine size. A small number of women continue to have scant lochia or intermittent spotting for a few more weeks.

If you've started on the progestin-only birth control pill (the "minipill") or gotten the birth control shot (Depo-Provera), you may have spotting for a month or more, and that's perfectly normal. Similarly, intrauterine devices (IUDs) and birth control implants may cause some normal spotting in the first few months of use.

How to manage lochia

In the beginning, use heavy-duty sanitary pads. The hospital will send you home with some, and you can stock up on more if you need to. As your lochia tapers off, you can switch to regular pads.

Don't use tampons for at least six weeks, because doing so may increase the risk of infection in your healing vagina and uterus.

In the first few days after delivery, you may need to pee often, even if you don't feel the urge to go. Immediately postpartum your body is going through a lot of changes and healing; your bladder may be less sensitive than usual, so you may not feel the need to urinate even when your bladder is quite full. In addition to causing urinary problems, a full bladder makes it harder for your uterus to contract, increasing your risk of excessive postpartum bleeding.

Does lochia smell?

Yes, lochia can have a distinct odor, similar to menstrual blood. But if your lochia has a foul smell or you come down with fever or chills, call your doctor. That can be a sign of a postpartum infection.

Should I ever worry about lochia?

Yes, if your bleeding gets very heavy or is accompanied by other symptoms. Call your doctor or midwife if:

• Your lochia is still bright red a week after your baby's birth.
• You have abnormally heavy bleeding (saturating a sanitary pad for two hours straight or having blood clots bigger than a golf ball). This is a sign of a late postpartum hemorrhage and requires immediate attention.
• Your bleeding has been improving or stable but suddenly increases again.

These symptoms are also signs that you need immediate medical attention:

• Pale or clammy skin
• Confusion, dizziness, or feeling faint or weak
• Rapid heart rate
• Pain and swelling near your vagina
• Foul-smelling discharge from your vagina

If bright red spotting reappears after your lochia has already lightened up, it could be something called eschar bleeding. This is caused when the scab left behind from your placenta dissolves. This happens around the 10-day mark postpartum, and should only last for a few hours.

Note: If you're bleeding very heavily or feeling faint, call 911.

Learn more

• Watch for these warning signs during your postpartum recovery
• Learn how a postpartum doula can help
• Get tips on how to get the help you need as you adjust to life with a newborn
• Find out when you'll get your period again after having a baby.