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If you are pregnant with your first baby, you have probably never heard of the term lochia.
So what is lochia? (pronounced lōkēə)
It is the medical term for postpartum bleeding.
Now before you get nervous or freaked out, please know that vaginal bleeding after childbirth is perfectly normal!
In this post, I’m going to explain everything you need to know about postpartum bleeding:
- What’s normal?
- What’s not?
- Why do women bleed after childbirth?
- How do you handle bleeding?
- How do you heal faster and bleed less?
- When to seek medical care?
- When you need to rest more?
Lochia: What’s Normal?
Vaginal bleeding after birth is perfectly normal.
This is your body’s way of getting rid of the extra blood, tissue, mucus, bacteria and fluid as the uterus heals.
What Happens After Birth
Almost immediately after your baby’s birth, the placenta pulls away from the lining of the uterus.
If you had a vaginal birth, your body will deliver the placenta in the same way your baby was born. After a few contractions, you may be directed to push the placenta through and out of the birth canal.
Many women don’t even notice when this happens as they are busy getting to know their new babies!
If you had a cesarean section, your doctor will remove the placenta surgically.
Once the placenta is out of your body, your uterus will continue to contract. The contractions are necessary to help seal off the blood vessels where the placenta was attached inside the uterus.
This is a very important part of childbirth because problems with delivery of the placenta are one of the leading causes of postpartum hemorrhage!
These initial contractions are also a vital part of the process of returning your uterus to its normal size.
While this is happening, the uterus will also be sloughing off the blood, tissue, and mucus of the endometrium, or lining of the uterus.
This sloughing is what we call lochia.
Uterine Contractions After Birth
Wait. What? More contractions after birth?
The good news is that they are less intense and are much easier to manage.
Here’s the scoop…
After-pains, or cramps, are caused by uterine contractions. These contractions are absolutely necessary to stop the bleeding from the area where the placenta was attached.
When the placenta separates from the uterus, there are open blood vessels in the area where it was attached, and they begin to bleed into the uterus.
After the delivery of the placenta, the uterus continues to contract, closing off these blood vessels, dramatically reducing the bleeding.
These pains are more common in women who have had more than one pregnancy. The discomfort can initially be quite intense, but will gradually subside.
But these contractions or “after-pains” are a good sign!
It means that your uterus is clamping down (as it should) and this will help your body to heal more quickly.
The contractions also help your uterus to return to its pre-pregnancy size much quicker.
If your uterus is not contracting properly, your caregiver may massage your uterus. This can be uncomfortable, yet very effective!
Synthetic oxytocin (called pitocin) may also be administered to help the uterus contract, avoiding postpartum hemorrhage.
Breastfeeding and After-pains
Breastfeeding is another great way to encourage your uterus to contract!
While breastfeeding, your body releases oxytocin, a natural hormone that helps your uterus contract.
This is why it is very common to feel cramping or after-pains when nursing during the first few days.
These cramps are most intense at the beginning of a breastfeeding session. They will gradually improve and no longer be noticed after the first few days.
Occasionally, the uterus doesn’t contract well after delivery, resulting in excessive blood loss called a postpartum hemorrhage.
This can be a very serious postpartum complication that you really want to avoid!
Lochia: What to Expect the First Few Days
During the first few days after birth, you can expect much heavier bleeding.
This stage of postpartum bleeding is called lochia rubra.
For the first few days after birth, your bleeding will be bright red and you will also be passing clots.
Some clots may even be the size of a quarter or slightly larger. These clots are simply clumps of red blood cells that your body no longer needs.
It is also quite normal to feel a gush of blood when you stand. This is because the blood will pool inside your uterus when you are sitting or lying down.
Sometimes that feeling of gushing blood can be scary if you are not expecting it, so rest assured… it’s completely normal!
However, make sure that you keep in communication with your caregiver if you are passing larger clots or if the heavy bleeding continues more than three days.
You also want to make sure that you understand what’s NOT normal. (Keep reading further down this post to learn more about that!)
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.
Since heavier bleeding is normal during the first few days, heavy-duty pads are necessary.
If you are birthing in a hospital, they will provide you with large hospital-grade pads to handle the heavier flow of the early few days.
If, however, you are planning a home or birth center birth, you may need to provide your own high-absorbency pads.
Lochia: What to Expect Days 4-10
After the first few days, the lochia will lighten in color. The medical term for this stage of lochia is lochia serosa.
You will notice that the flow begins to look more watery, pinkish or light brown in color.
At about day 7, the lochia resembles a light period and may begin to look more creamy or yellowish in color. (if you are resting)
By about ten days after the birth, you should have only a small amount of white or yellow-white discharge. At this point, the lochia is mostly white blood cells and cells from the lining of the uterus.
This is a good sign that your uterus is healing well! Keep up the good job of resting and taking it easy!
If, however, you notice the heavier bleeding returning or not subsiding, your body is speaking to you… Listen! It’s time to slow down and rest!
You might notice increased lochia when you get up in the morning, when you are physically active, or while breastfeeding.
Many moms also notice increased lochia during the evening hours, especially if you’ve been up and about more than you should be!
Moms who have cesarean sections may have less lochia after 24 hours than moms who had vaginal deliveries.
Lochia: What to Expect Weeks 2-6
If you have been getting enough rest, you will be feeling much better!
After about 10-14 days, you should begin to notice much less bleeding, too.
By now, you will (hopefully) be bleeding only lightly or spotting. The bleeding will appear much like a very light period.
Eventually, the discharge will no longer appear like blood, but more resemble mucus or a light brown color.
This stage of postpartum lochia is called lochia alba.
At about 2-3 weeks postpartum, many women start to feel like their old selves again.
However, STRONGLY resist the temptation to return to your pre-pregnancy activities!
The reason for this is that when new moms begin to feel better, they unknowingly push themselves too much.
They may no longer be focusing on self-care or getting enough rest and that could be a very serious mistake!
Listen to Your Body: Watch Your Lochia!
Did you know that our postpartum bodies speak to us?
What do I mean by that?
Well, if you are overdoing it or simply not getting enough rest, you will notice that your lochia will increase!
Yup. Not a good sign.
It’s your body’s way of telling you to slow down… listen to your body!
By slowing down and resting more, you may very well prevent a very serious postpartum complication!
How Long Does Postpartum Bleeding Last?
Lochia usually lasts 4-6 weeks. But, it may even last up to 8 weeks.
Moms who have given birth to twins or multiples, often have longer postpartum bleeding.
However, the length of postpartum bleeding is largely dependent on how much you take seriously your need to rest and recover!
It’s very important to plan ahead for a full postpartum recovery, so that your body can heal well.
How do you plan appropriately for your postpartum recovery?
You plan on plenty of time to rest! But, you cannot do that without help!
How do you get enough rest and help? Find out more in this post!
Although postpartum bleeding begins with very heavy bleeding, it should soon taper off and become like a light period, before it stops altogether between 4-6 weeks.
Again, the more you rest and take it easy, the sooner the site where your placenta was attached will heal and stop bleeding!
Healing the Wound in the Womb!
Did you know that after childbirth, the uterus now has a large wound where the placenta was once attached?
That wound is approximately 8-1/2 inches in diameter. That’s the size of a small dinner plate!
Most people don’t realize that.
If you had a wound that large on the outside of your abdomen, it would be easier for everyone to understand your need to heal. You would also take the advice to rest more seriously, right?
Well, even though you cannot see this wound, it’s still there and needs time to heal!
This is why it is so very important to rest and recover after childbirth!
Why You Need a Postpartum Plan!
But it’s hard to rest when you don’t have enough help.
You still need to care for yourself, baby and family.
This is why you need to plan ahead and have a postpartum plan.
A postpartum plan sets you up for the help you need for a great postpartum recovery!
I have also written a FREE Email Course that includes my FREE printable postpartum plan and lots of other free planning resources, too!
Is There Still Lochia after Cesarean Births?
Yes. The healing of the placental site is the same for all births.
However, moms who have had cesarean births may have less bleeding after the first 24 hours.
Again, this depends on a few factors, including how much the new mom is able to rest and recover!
How to Deal with Lochia?
Dealing with your lochia is similar to how you deal with a menstrual period.
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.
I highly recommend staying away from chlorine-bleached sanitary pads. They can irritate delicate sensitive tissue in the perineum.
Also, do not use tampons for at least six weeks after birth.
Using tampons may introduce bacteria into your vagina, making it more likely for you to get an infection as your vagina and uterus continue to heal.
Other Helpful Tips to Manage Normal Postpartum Bleeding
Empty your bladder often.
In the first few days after you give birth, your bladder may be less sensitive than usual, so you may not feel the need to urinate even when your bladder is full.
You may be excited about this, especially since you had to pee so much during late pregnancy, but resist the temptation to wait too long.
In addition to causing urinary problems, a full bladder may prevent your uterus from contracting efficiently, leading to more severe afterpains and bleeding.
Rest as much as you can. If you are overdoing it, you may bleed longer or start bleeding again after your lochia has already lightened or gone away.
Let’s Get Real!
Okay, time for a dose of reality…
If this is your first baby, there are some things that you just need to know about the 4th trimester…
It can get really messy!
Blood, pee, leaky breast milk, spit up, drool…. you get the idea, right?
All these body fluids can really mess up your bed or furniture!
Ladies… trust me… you WILL have leaks… your bottom will leak, your boobs will leak, your baby will spit up and have diaper blow outs. It’s inevitable.
This is especially true while you are sleeping. Those sanitary pads don’t always keep everything inside. Neither do your baby’s diapers!
Not only that, but your breasts will leak during sleep, too.
For this reason, I would absolutely make sure that you get water-proof bed protection.
There are many water-proof bed protection products out there, but I really love this one because it is especially designed for mom and baby! These organic cotton washable under-pads can be used while breastfeeding, diaper changing, mom and baby sleep and more.
I think they are a great investment since your child can continue to use them as they begin potty training or to avoid accidents in their “big kid” beds! Many moms also like to layer a couple of them with crib sheets to make middle of the night crib sheet changing much faster.
Lochia: What’s NOT Normal
During all three stages of lochia, your bleeding should have an odor similar to that of normal menstrual flow.
If you notice an offensive or unusual smell, this may be a sign of infection. See your doctor.
How Do You Know if You’re Bleeding Too Much?
If you notice bright red or heavier bleeding that reappears after your lochia has already lightened, it probably means you need to slow down.
But, if the bleeding continues even after you have been resting for a few days, check with your doctor.
Although, not very common, the most serious concern with excessive postpartum bleeding is hemorrhaging.
It’s time to call the doctor RIGHT AWAY if you notice these symptoms:
When to Call Your Doctor or 911
- You are soaking one large pad every hour or less
- Your lochia is still heavy four days after your baby’s birth
- You are passing large clots, especially after the first 24 hours.
- Your bleeding has a foul or offensive odor that does not smell like a normal menstrual period.
- You have a fever or chills
- You are experiencing abdominal or back pain
- You are not seeing any lochia during the first 2 weeks
- Your bleeding becomes heavy again after it has already lightened
- Blurred vision
- Clammy skin
- Rapid heartbeat or breathing
- Feeling faint or weak
- Feeling restless
Abnormally heavy bleeding after giving birth is called postpartum hemorrhage.
Although, not a common occurrence, It can affect up to 5% of women who give birth.
Postpartum hemorrhage is most likely to happen within the first 24 hours after delivery. However, it can happen anytime within the first 12 weeks after your baby is born.
When hemorrhaging occurs between 24 hours and 12 weeks, it is called late postpartum hemorrhage.
About 1 percent of postpartum women develop late postpartum hemorrhage.
If you have any of the above symptoms, seek medical care immediately!
Postpartum hemorrhaging is a serious postpartum complication that needs to be treated. It’s very important to get medical help right away!
Some of these symptoms (above) may also be indicators of infection.
What Causes Postpartum Hemorrhage?
The most common cause of early postpartum hemorrhage is what’s called uterine atony.
This simply means that the uterus fails to properly contract after birth, due to poor muscle tone.
Poor muscle tone can be caused by a number of factors, such as a very long (or very short) labor, the use of pitocin during labor, or multiple gestation to name a few.
When the uterus is unable to contract, the site where the placenta was attached, continues to bleed uncontrollably.
Other less common causes of hemorrhaging after childbirth include trauma, retained placenta or placental abnormalities, blood clotting disorders, or a tear in the vagina, cervix or uterus.
Risk Factors for Postpartum Hemorrhage
You are at higher risk of postpartum hemorrhage if any of the following is true:
- You’ve had a previous experience of postpartum hemorrhage
- You are Asian or Hispanic
- You are giving birth to multiples
- Your baby weighs more than 8 pounds 13 ounces
- You have a long labor
- You have a very short labor (less than 3 hours)
- You have given birth several times before
- You have a uterine rupture
- You’ve had a cesarean section
- You’ve experienced tears in the vagina or cervix during delivery
- You have been under general anesthesia
- You had pitocin during labor
- You had preeclampsia
- You are overweight
- You have experienced other issues that have affected the placenta
- Your baby was delivered with forceps or a vacuum-assisted birth
- You have a uterine or vaginal infection
- You have experienced placenta abruption or placenta previa
Common Treatments for Postpartum Hemorrhage
Here are some of the various treatment options for postpartum hemorrhage. The cause of your bleeding will help your doctor decide the best treatment plan.
- Pitocin to help your uterus contract
- Massage your uterus
- Remove pieces of the placenta still in your uterus
- Perform a laparotomy — surgery to open your abdomen to find out the cause of bleeding and stop it
- Give you a blood transfusion — blood is given to you through a tube that goes in a vein to help replace blood you’ve lost
- Perform a hysterectomy — surgical removal of the uterus
- A procedure called a uterine artery embolization, which limits blood flow to your uterus
- Use something called a Bakri balloon that’s inflated inside your uterus and adds pressure to help slow the bleeding
*Disclaimer – The information in the post is for educational purposes only. It is not intended to be medical advice. Please make sure that you talk with your doctor if you have any questions or concerns about postpartum bleeding, your recovery from childbirth or the care of your newborn.
How About You?
Do you have any ideas or suggestions for how to deal with postpartum recovery or specifically, postpartum bleeding? What did you do that was helpful? What did you wish that you had done to prepare for a smoother postpartum recovery? Your ideas and suggestions really help new moms. Please share!