Another topic that most women tend to avoid talking about:  Lochia.  Hell, most women probably don’t even know the word! Lochia is the bleeding that takes place after giving birth. It doesn’t matter whether you have a medicated vaginal birth, a natural homebirth, or a c-section, you will experience this lovely stage of motherhood. My husband just walked by and asked, “What research are you working on?”  When I answered, “Lochia, you know, the postpartum bleeding period,” he just laughed and replied, “You need to do research? Haven’t you experienced it enough times to know it all?” HA.  NOT.FUNNY.  

I like to categorize postpartum bleeding with the other parts of birth that you forget about over time. You know what I am talking about: the painful contractions, the ring of fire, the afterbirth pains, all of it.  Somehow the happy hormones flood it all away and you decide to get pregnant again (and again and again, in my case).  Maybe I’m alone on all that? I could be, but I don’t think so. Lochia is no joke.  It is blood – and typically a lot of it… and it seems to last FOREVER (in the moment).  But knowing what to expect will help you prepare and handle it better.

Lochia

There are three phases to the postpartum bleeding stage.  The length of each phase is completely dependent on each mother, as no one is the same, and no birth is the same. Studies show that the average duration of the entire lochia period is 27 days, but that bleeding for over 40 days is still completely normal and common.  Most women fall somewhere between 1 to 6 weeks of bleeding. So take note of the timeframes, but do not write them in stone for yourself and your upcoming birth. As a woman births, the placenta separates from the uterus causing the blood cells attached to it to rupture and shed. Once labor ends, the placenta is expelled, leaving the location where the placenta was once attached raw and needing to heal. Not only does this location produce slight blood to be discharged, but the uterus itself must shed it’s lining after carrying a pregnancy. This shedding creates a vaginal discharge, known as lochia, or postpartum bleeding.  It is a combination of blood, tissue, and bacteria.  The point of placental implantation will heal and pull away from the uterine wall forming a “scab.” 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

 

Three Phases of Lochia

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 off. You may notice heavier flow when you move from lying down or sitting to standing however, this is nothing concerning. It is simply the release of blood that has pooled in your vagina.  It’s important that the amount of lochia consistently diminishes and the color changes from red to pink to creamy or white. Depending on how much physical activity you perform, your healing and bleeding will be prolonged. This is still normal, but remember that resting will speed the recovery process.

Phase 1:  Lochia Rubra

• Typically lasts 3-4 days after birth
• It is bright red in color as the liquid contains significant amount of blood
• Bright red in color
• Blood clots are normal

Phase 2:  Lochia Serosa

• Typically starts around day 4 and lasts a week
• This is the lochia which is thin in density
• Color turns from red to pink to pinkish-brown
• This discharge contains mucus, exudate, leukocytes, and erythrocytes.
• Flow is much less than Lochia Rubra, with very few to no clots, but the flow is ongoing

Note: Large blood clots or bright red blood during this time may be signs of a problem.  If this phase continues for weeks, it can be a sign of postpartum hemorrhaging. Phase 3: Lochia Alba

• Typically lasts 2-4 weeks
• The discharge changes from the pinkish-brown to a yellowish-white or whitish liquid
• The liquid contains little amount of red blood cells and mostly contains leukocytes, cholesterol, fat, epithelial cells and mucus.
• There should be no odor and no real flow

Note: The presence of clots, a bad smell, or bright red blood may be signs of a problem. If this condition continues over several weeks, then it may indicate genital lesion. 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 signals you should stop and rest.   You should call your midwife or doctor 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.

Caring for Yourself While Bleeding

• Stock up on overnight pads or cloth pads for this period.  Tampons cannot be used and are a source for infection.
• Once flow lessons, you can use lighter pads, but still no tampons.
• Urinate often, keep your bladder clear. After you give birth, during the first few days, your bladder becomes less sensitive. So, sometimes you won’t feel the need to pee even if you are moving with a full bladder. This makes it hard for the uterus to contract and can result in serious postpartum bleeding.
• Take herbal baths with Epsom salt to speed the recovery process.
• Try to get as much rest as you can. Too much work will cause you to bleed even after your lochia condition has passed over.

(source of photo unknown)

Blood Clots

Passing clots of blood is common during the first two weeks postpartum. Clots can range in size from a pea to a golf ball – and can be quite shocking if you’re not prepared. Blood clots form when you are sitting or lying down. As blood pools, it may clot. Some women experience discomfort walking or using the toilet and many report that after passing a clot the discomfort goes away.

When to call the doctor

The following symptoms indicate infections in the uterus, including a retained placenta (a small portion still attached to the uterine wall). Contact your doctor as soon as possible if these signs show up.

• Lochia will come with unpleasant smell.
• Mother will suffer from fever or chills.
• Bleeding remains a bright red color.
• The stomach will feel tender on one or both sides.
• Unusually heavy bleeding (soaking a large maxi pad in under an hour)
• Typically, the rule of thumb is golf-ball sized blood clots are fine but baseball-sized clots require follow up with your midwife or doctor.
• Dizziness or fainting occurs

Reducing Lochia

There are several ways you can aid the body in recovering after giving birth.

• Breastfeed – Breastfeeding releases oxytocin, which helps the uterus contract and reduces bleeding.
  
  
• Avoid early hormonal contraception – Generally it’s best to avoid sex before 6 weeks postpartum. It’s best to wait for your postpartum checkup before starting hormonal birth control, which can cause further bleeding or spotting.
  
  
• Urinate frequently – A full bladder can distend the uterus or make it softer, leading to more bleeding.
  
  
• Herbal Salt Baths – Helping you heal from the inside out.
  
  
• Herbal remedies – Blue Cohosh, Cotton Root Bark and Raspberry Leaf, Witch Hazel and Lady’s Mantle are just a few of the herbs that can reduce blood flow. Fresh herbs or tinctures work best and you should always talk to your midwife or doctor before dosing.
  
  
• Increase Iron Intake – Low iron can lead to hemorrhaging after birth. Iron is an important part of blood formulation and low iron is common, especially in women.
  
  
• Avoid ibuprofen & aspirin – Blood thinning medications can lead to heavier or more prolonged bleeding.

  References:

http://www.ncbi.nlm.nih.gov/pubmed/10772198 http://www.ncbi.nlm.nih.gov/pubmed/3755355 http://www.ncbi.nlm.nih.gov/pubmed/10519614