Lochia: everything you need to know about bleeding after birth

How long should you normally bleed for after the birth of your baby? And how do you know if something is wrong and you are at risk of infection? We reveal the signs to watch out for in postnatal bleeding.

What causes lochia?

Lochia is the medical term given to the one month ‘period’ new mums go through after having a baby.

It’s mainly caused by the placenta coming away from the wall of your womb but additional blood might also come from any cuts or tears endured while giving birth.

Sometimes period-like cramps – or mini contractions – can come with it, especially if you’re breastfeeding, as this helps the uterus to contract back to its normal size.

The pains are simply that: the uterus shrinking back to normal, and nothing to be concerned about. They occur as women experience a surge in the hormone oxytocin, the ‘feel good’ hormone, which helps mums to bond with their babies and also helps to stimulate milk production.

The bleeding happens to every new mum, whether their baby was born naturally or through a Caesarean section.

Immediately after birth, the bleeding can be heavy – so you’ll need to stock up on maternity pads – or ultra thick panty liners, to help absorb it. Tampons are an absolute no-no at this time as using them can increase the risk of infection while your tender bits are still incredibly, well, tender. (The extra padding actually comes in quite useful as many new mums find sitting down painful after giving birth, so every little extra bit of cushioning helps.)

The bleeding gradually lessons over time – becoming browner as time passes and your uterus returns to normal. The most any bleeding after birth should last is around six weeks.

What are the types of lochia?

Lochia actually consists of blood, uterine wall lining, bacteria, dead tissue, and mucus. Don’t be alarmed if you see blood clots in the beginning, this is quite normal, and the blood may also have a musty smell, similar to that of menstrual bleeding.

Lochia rubra

This is the first stage of bleeding after birth. The Lochia is bright red in colour and begins a day or two after the birth. It’s mainly composed of blood, small bits of membranes, cervical discharge, and any meconium (otherwise known as your baby’s first poo) that might have escaped from the baby during the birth.

Lochia serosa

Lochia serosa is the second stage of bleeding and is a pinky brown in colour. It becomes more watery in consistency and can continue until around ten days post-delivery.

Lochia alba

Lochia alba is the final stage of Lochia and it’s much less heavy with a yellowish white colour. It lasts from around the third week to the sixth-week after birth. It contains fewer red blood cells and is mainly made up of white blood cells, tissue cells, cholesterol, fat and mucus.

The blood flow may get heavier after breastfeeding as the baby suckling helps the uterus to contract. Heavy work and a lot of movement may also increase the amount of blood leaving the uterus.

A family with a newborn baby

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How much bleeding and pain after birth is normal?

After one day: Mums can expect to see fresh red or browny-red blood loss. The flow of blood may be quite heavy, soaking a maternity pad every few hours. Don’t be alarmed if you pass one or two quite large blood clots, they may even be as large as a plum, or you may pass several smaller ones about the same size as grapes. They are all just remnants of your placenta coming out of your body as it’s no longer needed.

If you feel alarmed by anything, it can be a good idea to show your midwife when she comes to visit. Don’t feel embarrassed, they have seen it all before and are there to help you in the first few days of coping with a new baby. Reassurance at a time when you may be feeling quite vulnerable is essential and hugely comforting.

After one week: Your blood should now have turned a pinky brown colour and the stain on your maternity pads should be getting smaller and lighter. Your pad shouldn’t be soaking at any time and you should let your midwife know if you think you might be passing too much blood after one week. You may pass little blood clots, about the size or a raisin or smaller. This is all totally normal.

After three weeks: Any blood loss at this stage should be a pale, yellowish-white in colour – or you may find there is no blood at all. Your uterus should now be pretty much back to its previous size and cramping or contractions should also be coming to an end.

After six weeks: Some women may experience a small amount of brown, pink or yellowish-white discharge up until six weeks after giving birth. It may appear in small amounts daily or just occasionally. This will be the final stage of Lochia discharge and shouldn’t last beyond six weeks.

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When you should you see a doctor

Continuing to pass large blood clots: If you pass large blood clots after the first 24 hours, or you continue to pass blood clots after one week, it is important to contact your midwife or doctor straight away.

The blood flow increases, rather than decreases: Lochia flow will be heavy in the first few days after giving birth, but the amount should gradually decrease over time. If at any point the blood flow suddenly becomes heavier than it was initially or continues as a heavy or moderate loss for longer than a week, contact your midwife or GP straight away.

The Lochia smells strange: Vaginal blood loss normally has a slight metallic smell but it should not be offensive in any way. If your blood loss smells strange or bad, it may be due to an infection either in your womb or, if you sustained any tears while giving birth, in your vagina or perineum (the bit between your vagina and bum).

If you become aware of a change in smell, despite having recently had a bath or shower and changed your sanitary towel, you should let your midwife or doctor know as soon as possible. The discharge may also change colour when this happens.

The NHS advises mums who might be concerned about any blood loss to keep any heavily stained sanitary towels or any clots they have passed so that the midwife or GP can investigate.

Pelvic pain: Pain in your pelvis can be caused by a urinary infection or constipation. In both cases, mums are advised to drink plenty of water and contact their midwife or GP as soon as possible. A gentle laxative or dietary change may be recommended to help with any constipation, which is very common after giving birth.

More seriously, pelvic pain can also be caused by an infection in the womb, which will cause mums to feel shivery and unwell. In this instance, the GP should be contacted straight away. Infections are caused by bacteria entering the womb and are usually treated with antibiotics.

Lochia infection symptoms: signs you may have an infection and how to treat it

Lochia or postpartum infections can occur between one and ten days after giving birth. They are caused by bacterial infections of the female reproductive tract following childbirth.

Mums may experience a fever with a temperature higher than 38 degrees Celsius or 100 degrees Fahrenheit. They may feel chills, experience lower abdominal pain and possibly bad smelling Lochia.

Treatment is usually administered via antibiotics and the condition should normally improve within two to three days.

Haemorrhages during this time can also be caused by an infection in the uterus – or a piece of placenta that has stuck to the uterus, preventing it from healing in that place. The area that doesn’t heal keeps bleeding and – because it is small – mums probably won’t see a ‘gush’ of blood. Instead, they’ll see a steady drip, which can become a serious problem (just think how fast a sink fills up if the tap is left dripping).

If you experience bleeding that soaks a pad in 15 minutes or less, you must call your doctor immediately. If you cannot get in touch with your doctor, it’s worth visiting A&E as soon as possible.

Lochia after a Caesarean: is bleeding different after a c section?

Mums who have Caesarean sections at birth may have less lochia after 24 hours than mums who had vaginal deliveries, though this is not always the case.

Some mums have reported very light bleeding after undergoing a Caesarean section, while others have stated that it lasted longer than with their vaginal births.

If your baby was delivered through a Caesarean section, you should allow for Lochia discharge to take up to six weeks and follow the same guidelines and warning signs outlined for vaginal birth deliveries.