What lochia is and why it happens
Lochia is the discharge from the uterus after birth. It consists of blood, wound fluid and pieces of tissue being expelled while the uterus contracts and the site where the placenta was heals.
Many people first think of bleeding. Practically speaking, lochia is more of a process: it changes, usually decreases and shifts in colour. The aim is not to monitor every small variation but to recognise patterns and warning signs.
A clear explanation of why lochia occurs and how it can change is also available from the NHS. NHS: Body after birth
How long lochia lasts: a realistic timeframe
How long lochia lasts is individual. It is often heaviest in the first days and then gradually decreases. For some people there is hardly any left after two to three weeks; for others it lasts longer.
More important than the exact week is the trend. If it is overall decreasing and the colour shifts towards brown and then lighter shades, that usually fits normal healing. If it becomes noticeably heavier again after an improvement, that is a sign to take a closer look.
What can influence the course
- How much you exert yourself and whether you spend a lot of time standing or carrying
- Breastfeeding, because the uterus often contracts more strongly then
- Whether fragments of tissue remain in the uterus, which is uncommon but can be relevant
- Infections, which are more likely to become apparent through smell, fever and increasing pain than by colour alone
Understanding colours: from bright red to light
Colour is often the first thing people notice. It is only part of the picture. The combination of colour, amount, smell and how you feel overall is what matters.
Bright red
Bright red lochia is common in the first days. It can flare up again later, for example if you do considerably more activity or become active again after a longer rest. If bright red bleeding becomes stronger again, lasts longer, or is accompanied by clots, dizziness or weakness, an assessment is advisable.
Brown, reddish-brown, yellowish, light
Many see more brown or reddish-brown tones after a few days. Later the discharge can become more yellowish or lighter. This often fits healing, as long as smell and how you feel are unremarkable.
What colour alone does not reliably indicate
A light or dark shade does not automatically mean everything is fine. Warning signs are more often visible in the overall course and accompanying symptoms than in a single colour.
Lochia smell: what can be normal and what is not
Lochia usually has its own smell. Many describe it as metallic, slightly sweet or like menstrual blood. That can be unpleasant but is not automatically a problem.
It becomes unusual when the lochia smells distinctly foul, putrid or sharp, especially if fever, chills, increasing lower abdominal pain or a markedly worse general condition occur at the same time. In such cases, an infection should be ruled out.
Warning signs after birth that should be medically assessed are also described by the RCOG. RCOG: Heavy bleeding after birth
Clots and tissue pieces: when it's normal
Small clots can occur in the first days, especially after lying down for a while. A brief episode of heavier bleeding after getting up is not uncommon, because blood can pool and then flow out.
What is generally unremarkable
- Small clots in the first days if the amount then decreases again
- A short period of heavier discharge after rest
- Clots without fever, without a foul smell and without increasing pain
What does not usually fit normal lochia
- Large or repeatedly numerous clots, especially if the overall bleeding increases
- Weakness, dizziness, a racing heart or feeling unstable
- Clots together with fever or severe, new lower abdominal pain
Amount and rate: when bleeding may be too much
In the postnatal period it is normal to need several pads a day, especially at the beginning. What feels like too much depends greatly on the product and personal body awareness, so a pragmatic assessment is helpful.
Signs you should have assessed promptly
- You need to change very frequently because the pad becomes completely soaked quickly
- The bleeding becomes noticeably stronger again after clear improvement and stays bright red
- You feel circulatory instability or unusual weakness
- Large clots appear or many clots recur
If you are unsure, a useful question is: Is it overall getting better or worse? The trend often matters more than a single day.
Hygiene and safety in daily life
In the postnatal period the uterus is still healing. Good hygiene means mainly clean and gentle, not sterile or excessive.
What is usually recommended
- Pads rather than tampons or menstrual cups until healing is complete
- Change regularly, even if the amount is small
- Wash hands before and after changing
- Lukewarm water is often sufficient; harsh intimate washes are usually not necessary
Bathing, swimming, sex
Many wait with full baths, swimming and penetrative sex until lochia has clearly subsided and there are no warning signs. It's not about a fixed day but about keeping infection risk low and giving the body time to recover.
Fever and lower abdominal pain in the postnatal period
Fever is not a typical symptom of lochia. If fever occurs, medical assessment should always be sought, especially if a foul smell, increasing lower abdominal pain or a markedly worse general condition accompany it.
Lower abdominal pain can be caused by afterpains, especially during breastfeeding. Again, the course is decisive. If pain becomes stronger rather than weaker, or if it is constant and increasing instead of coming in waves, it should be evaluated.
A guide to postpartum warning signs and when to seek help is also available from ACOG. ACOG: Warning signs postpartum
Conclusion
Lochia is a normal part of healing after birth. Colour and amount often change over weeks, and a mild odour can be part of it. What matters are the course and accompanying symptoms: if bleeding becomes strongly bright red again, if large clots occur, or if fever, a foul smell and increasing pain appear, you should have it assessed.
