Advertisement

Postpartum bleeding (lochia)

Postpartum bleeding called lochia is a normal part of your recovery after birth. At first, it'll look and feel like a heavy period, but it should soon subside to light spotting.

sanitary pad
Photo credit: iStock.com / Panuwat Dangsungnoen

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.

Advertisement | page continues below

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.

Advertisement | page continues below

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:

Advertisement | page continues below
  • 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.

Advertisement | page continues below

Learn more

Follow your baby's amazing development
Sources

BabyCenter's editorial team is committed to providing the most helpful and trustworthy pregnancy and parenting information in the world. When creating and updating content, we rely on credible sources: respected health organizations, professional groups of doctors and other experts, and published studies in peer-reviewed journals. We believe you should always know the source of the information you're seeing. Learn more about our editorial and medical review policies.

ACOG. 2022. 3 conditions to watch for after childbirth. American College of Obstetricians and Gynecologists. https://www.acog.org/womens-health/experts-and-stories/the-latest/3-conditions-to-watch-for-after-childbirthOpens a new window [Accessed February 2022]

ACOG. 2021. Postpartum birth control. American College of Obstetricians and Gynecologists. https://www.acog.org/womens-health/faqs/postpartum-birth-controlOpens a new window [Accessed February 2022]

ACOG. 2021. You and your baby: prenatal care, labor and delivery, and postpartum care. American College of Obstetricians and Gynecologists.

ACOG. Undated. Your pregnancy and childbirth: month to month. American College of Obstetricians and Gynecologists.

Blackburn, S. 2007. Maternal, fetal, and natal physiology: a clinical perspective. Philadelphia, PA: Saunders Elsevier. https://www.google.com/books/edition/Maternal_Fetal_Neonatal_Physiology/2y6zOSQcn14C?hl=en&gbpv=0Opens a new window

Children’s Hospital of Philadelphia. Undated. Postpartum hemorrhage. https://www.chop.edu/conditions-diseases/postpartum-hemorrhageOpens a new window [Accessed February 2022]

Cleveland Clinic. 2018. Pregnancy: Physical changes after delivery. https://my.clevelandclinic.org/health/articles/9682-pregnancy-physical-changes-after-deliveryOpens a new window [Accessed February 2022]

Deussen, A. et. al. 2020. Relief of pain due to uterine cramping/involution after birth. Cochrane Database of Systematic Reviews. Oct 20;10(10). https://pubmed.ncbi.nlm.nih.gov/33078388/Opens a new window [Accessed February 2022]

Evans, A. 2007. Manual of obstetrics. 7th ed. Philadelphia, PA: Lippincott Williams & Wilkins. https://www.google.com/books/edition/Manual_of_Obstetrics/NWKW3KZv9roC?hl=en&gbpv=1&dq=postpartum+lochia&pg=PA70&printsec=frontcoverOpens a new window

Evensen, A. et al. 2017. Postpartum hemorrhage: Prevention and treatment. American Family Physician. 2017 Apr 1;95(7):442-449. https://www.aafp.org/afp/2017/0401/p442.htmlOpens a new window [Accessed February 2022]

Farley, C. et al. 2018. Prenatal and postnatal care: a woman-centered approach.2nd ed. Hoboken, NJ: Wiley. https://www.google.com/books/edition/Prenatal_and_Postnatal_Care/21o4DwAAQBAJ?hl=en&gbpv=1&dq=postpartum+lochia&pg=PT731&printsec=frontcoverOpens a new window

Marchant S, et al. 1999. A survey of women's experiences of vaginal loss from 24 hours to three months after childbirth (the BLiPP study). Midwifery 14(2):72-81. https://pubmed.ncbi.nlm.nih.gov/10703409/Opens a new window [Accessed February 2022]

Mayo Clinic. 2020. Placenta: How it works, what’s normal. https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/placenta/art-20044425Opens a new window [Accessed February 2022]

National Library of Medicine. 2021. Postpartum care of the new mother. https://www.ncbi.nlm.nih.gov/books/NBK565875/Opens a new window [Accessed February 2022]

Pillitteri, A. 2010. Maternal & child health nursing: Care of the childbearing & childrearing family.6th ed. Wolters Kluwer Health/Lippincott Williams & Wilkins. https://www.google.com/books/edition/Maternal_Child_Health_Nursing/apeLf0mPx1QC?hl=en&gbpv=1&dq=postpartum+lochia&pg=PA422&printsec=frontcoverOpens a new window

Pubmed. 2020. Relief of pain due to uterine cramping/involution after birth. https://pubmed.ncbi.nlm.nih.gov/33078388/Opens a new window [Accessed February 2022]

University of Michigan Health System. 2015. Caring for your bladder during and after delivery. https://www.med.umich.edu/1libr/Gyn/BirthCenterPostpartum/BladderPostpartum.pdfOpens a new window [Accessed February 2022]

Yekel-Melamed, Y. et al. 2006. Postpartum retained placental fragments - who is at risk? American Journal of Obstetrics and Gynecology. 2006 December 1;195(6). https://www.ajog.org/article/S0002-9378(06)01663-2/fulltext#secd8162938e55Opens a new window [Accessed February 2022]

Jessie Van Amburg

Jessie Van Amburg is a freelance health writer and editor who specializes in mental and reproductive health. She lives in Beacon, New York, with her husband and three cats.

Advertisement
Advertisement