Lochia is the vaginal discharge that occurs after childbirth as the uterus sheds its lining and heals. After the placenta detaches from the uterus following birth, it leaves behind open blood vessels at the site of attachment, causing bleeding into the uterus. Once the placenta is delivered, the uterus continues to contract, helping to close these blood vessels and significantly reduce bleeding. These contractions also aid in shedding the remaining uterine lining that supported the baby during pregnancy and in returning the uterus to its normal size.
It is a natural process that helps clear out blood, mucus, and other tissues from the uterus. Lochia occurs after both C-sections and vaginal births as the uterus contracts and heals from placenta removal. However, women who have had a C-section may experience lighter bleeding compared to those with vaginal deliveries. Sometime contraction does not occur well leading to postpartum haemorrhage which is fatal and needs Doctor’s attention.
Lochia typically lasts for about 4–8 weeks postpartum, but its duration and appearance can vary among individuals. Use super-absorbent period pads within this period because bleeding can be heavy at first and change to normal when it tapers off. Change the pads regularly, washing your hands before and afterwards to prevent infections.
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Types of Lochia
Lochia is classified into three stages based on its colour, composition, and timing:
- Lochia Rubra (Red or Bright Red Discharge):
Timeframe: Occurs during the first 1–4 days postpartum.
Characteristics:
Bright red or dark red in colour due to the presence of fresh blood.
Contains blood, fragments of the uterine lining, mucus, and possibly small clots.
Heaviest flow, similar to a heavy menstrual period. You may notice the bleeding is redder and heavier when you breastfeed. This happens because breastfeeding makes your womb contract in response to the Oxytocin released associated to the milk let-down. If you’ve been lying down for a while and blood has collected in your vagina bleeding may be heavier. You may also feel cramps similar to period pains.
Normal Signs:
May have a mild odour.
Warning Signs:
Large clots (bigger than a golf ball) or an extremely foul odour could indicate complications like retained placental tissue or infection. Please escalate to your midwife or GP
- Lochia Serosa (Pinkish-Brown Discharge):
Timeframe: Occurs from about day 4 to day 9 postpartum.
Characteristics:
Pinkish or brownish in colour as the blood flow decreases.
Contains old blood, serum, leukocytes (white blood cells), and mucus.
Lighter flow compared to lochia rubra.
Normal Signs:
Gradual reduction in volume.
Warning Signs:
Sudden return of bright red blood may indicate overexertion or a postpartum complication.
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- Lochia Alba (Whitish-Yellow Discharge):
Timeframe: Occurs from day 10 up to 4–6 weeks postpartum.
Characteristics:
Yellowish-white or creamy in colour.
Contains fewer red blood cells and primarily mucus, leukocytes, and epithelial cells.
Light flow or spotting.
Normal Signs:
Minimal odour or none at all.
Warning Signs:
Foul-smelling discharge with or without fever and chills could suggest Postpartum infection, call your midwife or Doctor.
Nursing Considerations
Monitor Lochia:
Assess the colour, amount, and odour of lochia regularly to ensure it follows the normal progression.
Check for clots and unusual changes in the flow pattern.
Educate the Mother:
Inform the mother about what to expect with lochia and the signs of complications.
Advise her to avoid heavy physical activity or straining, as this can increase bleeding.
Encourage regular urine output even if she does not feel it. Because at this time bladder maybe less sensitive than normal due to the changes the body is going through. Full bladder prevents uterine contraction leading to postpartum haemorrhage
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Report Abnormalities:
Alert the healthcare provider if there are signs of haemorrhage, infection, or retained placental tissue.
Bright red spotting after lochia has lightened may be eschar bleeding, caused by the placenta’s scab dissolving around 10 days postpartum. It typically lasts only a few hours. If heavy report to your Doctor.
Patientlifematters: By understanding and monitoring lochia, healthcare providers can help ensure a safe and healthy postpartum recovery.
