As a normal part of the healing process, the uterus sheds it’s lining after childbirth. This substance is called Lochia and is made up of blood, tissue, and mucous similar to a menstrual period. Depending on how much you are able to rest after your birth, and other factors, you can expect to bleed for as little as 2-3 weeks or as long as 6 weeks, with the flow lessening over time.
There are 3 “normal” phases of lochia and it’s important that you recognize each stage in order to be able to tell if something is amiss. In very general terms, you can expect that bleeding will be heaviest for the 1-3 days immediately following childbirth. You may notice heavier flow when you move from a prone or sitting position to standing however, this is nothing concerning. It is simply the release of blood that has pooled in your vagina. It’s less important to count the days of each lochia stage (as it can vary from woman to woman), and much more important that the amount of lochia consistently diminishes and the colour changes from red to pink to creamy or white.
These are the normal stages of lochia
1. Lochia rubra — first 2 to 3 days after delivery
• the lochia is mostly blood
• the blood looks bright red
• the blood flow can be heavy to moderate
• you may see small blood clots
2. Lochia serosa — starts at about day 4 and lasts until day 10
• the colour changes to pink or pinkish-brown
• the flow is much less
• flow is ongoing
Blood clots or bright red blood during this time may be signs of a problem.
3. Lochia alba — from about day 10 until day 21
• the color is light yellow to a cream color
• the flow has almost stopped and does not smell
The presence of clots, a bad smell, or bright red blood may be signs of a problem.
Generally there is a progression from lochia rubra through lochia serosa to lochia alba. If you are overextending yourself, you may experience some red spotting that should stop and rest. You should call your health care provider immediately at any time after birth if your bleeding does not decrease or if you are filling more than one menstrual pad in one hour.
Passing clots of blood is not uncommon during the first two weeks postpartum and clot size can range from the size of a pea to a golf ball – and can be quite shocking if you’re not prepared.
Blood clots form when you are sitting or laying down – remember that blood we talked about pooling in the vagina? As it pools, the blood may clot. Some women experience discomfort walking or using the toilet and many report that after passing a clot the discomfort goes away. Typically the rule of thumb is golf-ball sized clots are fine but baseball-sized clots require follow up with your midwife or doctor.
However, if you have prolonged red bleeding and clots after the first week postpartum and are experiencing pain in your abdomen or have any sign of fever or chills you should contact your care provider.