Postpartum Bleeding (Lochia): What's Normal and When to Worry
Postpartum Bleeding (Lochia): What's Normal and When to Worry
Understanding Postpartum Discharge and When It's Concerning
You delivered your baby. You're bleeding. Profusely. You're soaking through pads. You're panicked. You're convinced something is wrong. You're terrified you're hemorrhaging. You're wondering if this is normal or if you need emergency care. Your provider says it's normal, but it doesn't feel normal. It feels like too much blood, too much gushing, too much fear. You're wondering when the bleeding stops. You're concerned about the clots you're passing. You're anxious about whether your body is healing correctly. Here's what you need to know: postpartum bleeding (lochia) is normal and expected. The amount can seem alarming, but most heavy postpartum bleeding is physiologically normal. However, knowing the difference between normal lochia and concerning postpartum hemorrhage is critical for recognizing when urgent medical care is needed. This guide helps you understand normal postpartum bleeding, the expected timeline, warning signs of concerning bleeding, and when to seek immediate medical evaluation.
Understanding Lochia: Normal Postpartum Discharge
What Is Lochia?
Lochia is postpartum discharge—a complex fluid consisting of blood, placental tissue fragments, endometrial (uterine lining) tissue, white blood cells, bacteria, and mucus. This fluid exits your body through the vagina after delivery. Lochia is not simply blood, though blood is a significant component. It's your body's way of shedding pregnancy tissues no longer needed and cleaning the uterus after delivery. The term "lochia" comes from Greek meaning "to flow" or "wash away." That's exactly what's happening—your body is expelling everything pregnancy created.
Where Does It Come From?
After delivery, your uterus begins involuting (shrinking back to pre-pregnancy size). This process happens over 6 weeks as uterine muscles contract. The placental site—where the placenta was attached to your uterine wall—is a large wound approximately the size of your placenta. This placental wound bleeds during the first hours and days postpartum as your uterus contracts and blood vessels clot. Your uterus also sheds its endometrium (lining), similar to a very heavy menstrual period but more pronounced. All these tissues and blood combine to form lochia. This is normal postpartum physiology—evidence your body is healing and returning to pre-pregnancy state.
Why Is It So Heavy?
Postpartum bleeding seems dramatically heavier than you'd expect. During pregnancy, your blood volume expands by approximately 50% to accommodate pregnancy demands. After delivery, this extra blood volume is no longer needed. Your body eliminates excess blood through lochia. Additionally, the placental wound is substantial and bleeds significantly in the first days after delivery. Uterine contractions work to compress blood vessels, stopping bleeding, but this takes time. The combination of excess blood volume elimination and substantial wound bleeding creates the heavy lochia in the first postpartum days.
Lochia Timeline: What to Expect
Days 1-5: Heavy Bright Red Lochia (Lochia Rubra)
The first few days of postpartum bleeding are the heaviest. This phase is called lochia rubra (red lochia) because of the bright red color. You may soak through one or even two heavy-flow pads per hour. You may pass clots. Some clots are small (grape to walnut-sized). Occasionally larger clots occur (plum-sized), particularly if you've been lying down and blood pools. This heavy bleeding is normal and expected. Your uterus is contracting to close placental wound blood vessels. This heavy bleeding is actually a sign your uterus is working properly. The heavy lochia should decrease gradually over these days. If you're soaking more than 2 pads per hour despite frequent changes, or if you're passing numerous large clots (larger than golf ball size), this warrants medical evaluation. But standard heavy postpartum bleeding in the first few days is entirely normal.
Days 5-10: Decreasing Brown/Dark Red Lochia (Lochia Serosa)
By day 5-10, lochia changes character and decreases in volume. This phase is called lochia serosa (brownish lochia) because of the darker color. The discharge transitions from bright red to brownish or rust-colored. Volume decreases—you may soak through one pad every 1-2 hours, then gradually less frequently. The brownish color reflects older blood and tissue that's been sitting in the uterus and oxidizing. Some women notice a slightly heavier flow on days 5-8, which is normal. Lochia serosa typically lasts until about 10-14 days postpartum. The trend should be decreasing volume—if lochia is increasing after initially decreasing, this warrants evaluation.
Days 10-14+: Light Whitish/Pinkish Lochia (Lochia Alba)
By days 10-14, lochia becomes very light and changes to whitish or light pink color. This phase is called lochia alba (white lochia) because of the color. Volume is minimal—light spotting or staining of pads rather than soaking. This phase can persist until 3-6 weeks postpartum in some women. Lochia alba represents the tail end of the lochia process—mainly tissue fluid and bacteria rather than significant bleeding. Some light spotting or staining throughout weeks 3-6 is normal. Lochia alba may be heavier or resume heavier bleeding if you increase activity (exercise, long days on feet), which is normal—lochia can fluctuate with activity level.
Weeks 3-6+: Minimal to No Lochia
By 3-6 weeks postpartum, lochia generally resolves completely or becomes minimal. Most women have minimal or no lochia by 6 weeks. Some women have light spotting for longer. Lochia lasting beyond 6 weeks, if accompanied by foul odor, fever, or other symptoms, warrants evaluation. However, some light spotting through week 6-8 can be normal. The key is the trend—lochia should consistently decrease in volume and normalize in color over time. If bleeding increases or changes character, this warrants medical attention.
Managing Heavy Postpartum Bleeding
Heavy-Flow Pads or Overnight Pads
Use heavy-flow or overnight pads for the first several days. These pads are designed to absorb maximum fluid. Change pads frequently—every 1-2 hours as needed. Frequent changes prevent bacterial overgrowth and allow you to monitor lochia consistency and volume. Keep track of how often you're changing pads—knowing you need new pads every hour versus every 20 minutes helps you and your provider determine if bleeding is normal or excessive.
Hydration and Nutrition
Stay well-hydrated by drinking plenty of water and other fluids. Your body is losing significant fluid through lochia and through normal postpartum sweating. Dehydration worsens fatigue and potentially increases dizziness. Eat iron-rich foods (red meat, poultry, beans, leafy greens) to replace iron lost through lochia. Many postpartum women develop postpartum anemia from blood loss, particularly if they had heavy bleeding. Supporting your body with fluids and nutrition helps replace lost iron and prevents severe anemia.
Rest and Activity Modification
Excessive activity increases lochia flow—moving around, exercise, climbing stairs, long days on feet can increase bleeding. If you're soaking pads more than expected, reduce activity. Rest, lying down, minimal movement can help slow lochia. Balancing rest with some gentle activity (light walking) is ideal. Avoid heavy lifting or strenuous activity for at least 6 weeks postpartum. Modified activity helps manage heavy lochia.
Uterine Massage
Some postpartum providers recommend uterine massage (gentle massage of the lower abdomen where the uterus is) to facilitate uterine contractions and lochia flow. If your provider teaches you uterine massage, perform it gently. If it causes pain or heavy bleeding, stop. Uterine massage isn't necessary for all women, but some find it helpful for managing lochia and uterine cramping.
Warning Signs of Abnormal Postpartum Bleeding
Excessive Volume
Soaking more than 2 pads per hour (even heavy-flow pads) despite frequent changes for more than a few hours is concerning. Continuous excessive bleeding that doesn't decrease despite rest and hydration warrants medical evaluation. Soaking through pads while lying down is particularly concerning—if lying down doesn't slow bleeding, significant hemorrhage may be occurring.
Large Clots
Passing numerous large clots (golf ball-sized or larger) warrants evaluation. One or two large clots occasionally is within normal range. Repeatedly passing very large clots suggests excessive bleeding. Large clots can indicate retained placental fragments or other complications.
Change in Character
If lochia was decreasing and then suddenly becomes heavy again, this warrants evaluation. This pattern can indicate retained placental fragments, infection, or uterine subinvolution. Similarly, if you return to bright red bleeding after already transitioning to brown lochia, this suggests problems. The normal progression is steadily decreasing bright red lochia → brown lochia → light/clear lochia. Deviations from this pattern warrant evaluation.
Foul Odor
Lochia has a normal smell—somewhat like menstrual blood. If lochia develops a strong putrid or foul odor (beyond normal lochia smell), this suggests possible infection. Foul-smelling lochia with fever is particularly concerning for postpartum infection and warrants prompt medical evaluation.
Fever
Fever (temperature above 100.4°F/38°C) in the first weeks postpartum is concerning for infection, especially when accompanied by heavy lochia or foul-smelling discharge. Fever warrants medical evaluation. Fever with severe abdominal pain is a medical emergency.
Systemic Symptoms
Severe abdominal or uterine pain accompanying heavy bleeding is concerning. Dizziness or feeling faint with heavy bleeding suggests possible significant blood loss and shock risk. Rapid heart rate (over 100 beats per minute) with heavy bleeding is concerning. Extreme weakness or fatigue beyond expected postpartum tiredness may indicate significant blood loss. Any combination of these symptoms warrants urgent medical evaluation.
Severe Cramping
Postpartum cramping is normal as the uterus contracts. However, severe cramping that doesn't improve with pain medication, or severe cramping that's localized to one part of the uterus, warrants evaluation. Severe pain can indicate problems like retained placental fragments or infection.
Possible Complications and When to Seek Care
Postpartum Hemorrhage
Primary postpartum hemorrhage (excessive bleeding in first 24 hours after delivery) is typically managed in the hospital. Secondary postpartum hemorrhage (excessive bleeding after first 24 hours, up to 12 weeks postpartum) can develop at home. Causes include retained placental fragments, infection, uterine subinvolution (failure of uterus to involute properly), or blood clotting disorders. Signs include heavy bleeding (>2 pads/hour), large clots, dizziness, weakness, rapid heart rate, or abdominal pain. Seek emergency care immediately if you suspect hemorrhage.
Subacute Uterine Inversion
Rarely, the uterus can invert (turn inside out) days after delivery. This causes severe pain, heavy bleeding, and shock symptoms. This is a medical emergency requiring immediate hospitalization. Suspect uterine inversion with severe abdominal pain, heavy bleeding, and feeling faint. Seek emergency care immediately.
Retained Placental Fragments
If placental tissue remains in the uterus after delivery, lochia becomes heavy and prolonged. Retained fragments can cause infection and complications. Treatment typically involves dilation and curettage (D&C)—a procedure to remove fragments. Suspect retained fragments with prolonged heavy lochia, especially if lochia was improving and then became heavy again.
Uterine Infection (Postpartum Endometritis)
Infection of the uterine lining causes fever, foul-smelling lochia, abdominal pain, and heavy bleeding. Treatment includes antibiotics. Suspect infection with fever (>100.4°F), foul-smelling lochia, and abdominal pain. Seek medical evaluation promptly—untreated infection can become serious.
Frequently Asked Questions About Postpartum Bleeding
Q1: Is it normal to soak through pads in the first days?
Yes. Soaking 1-2 heavy-flow pads per hour in the first 3-5 days is normal. This excessive-seeming bleeding is expected. The bleeding should decrease over days. If you're soaking more than 2 pads per hour despite frequent changes, or if heavy bleeding persists beyond day 5, this warrants evaluation.
Q2: Are clots normal?
Yes. Passing clots in the first few days is normal. Most clots are small (grape to walnut-sized). Occasionally plum-sized clots occur, particularly after lying down. However, repeatedly passing very large clots (golf ball-sized or larger) warrants evaluation—this can indicate excessive bleeding or retained fragments.
Q3: When should I contact my provider about lochia?
Contact your provider for: bleeding that's soaking more than 2 pads/hour and not improving, bleeding that increases after improving, foul-smelling discharge, fever, severe abdominal pain, dizziness or weakness, or any symptoms concerning you. You know your body—if something feels wrong, it's appropriate to ask your provider.
Q4: Can breastfeeding affect lochia?
Breastfeeding can increase cramping and lochia flow temporarily when nursing (oxytocin release increases uterine contractions). This is normal. More robust uterine contractions from breastfeeding can actually help the uterus involute faster and may shorten the lochia period.
Q5: Does lochia smell bad?
Normal lochia has a distinctive smell—somewhat metallic, similar to menstrual blood. It's not pleasant but not foul. If lochia develops a strong putrid or foul odor, this suggests infection and warrants medical evaluation. Normal lochia smell is acceptable; foul odor is concerning.
Q6: What can I do if lochia persists beyond 6 weeks?
Contact your provider. Lochia lasting significantly beyond 6 weeks can indicate retained fragments, infection, or other complications. Your provider can evaluate and determine if treatment is needed.
Q7: Does sex affect lochia?
Sexual activity can increase lochia flow temporarily. Most providers recommend waiting until lochia becomes light (around 2-3 weeks) and you're medically cleared before resuming intercourse. Once cleared, resumed sexual activity may increase lochia flow temporarily, which is normal.
Lochia Is Normal Postpartum Physiology
Postpartum bleeding (lochia) is normal, expected, and necessary. Your body is shedding pregnancy tissues and returning to pre-pregnancy state. The amount of bleeding may seem alarming, but most heavy postpartum lochia is physiologically normal. Understanding the expected timeline helps you distinguish normal lochia from concerning bleeding. Knowing warning signs enables you to seek care when necessary. Most women have perfectly normal lochia and uncomplicated postpartum healing. If you have concerns, don't hesitate to contact your provider. Better to ask and get reassurance than to worry unnecessarily.
Your body is healing. Lochia is evidence of that healing. It will improve, you'll feel better, and in time this will be just another postpartum memory. You're doing great. đź’™
