Normal bleeding and discharge (lochia)

Is it normal to bleed after delivery?

Yes. All women lose some blood during and after delivery. But because the amount of blood in your body grows by about 50 percent during pregnancy, your body is well prepared for this expected blood loss.

Here's what happens: When the placenta separates from the uterus, there are open blood vessels in the area where it was attached, and they begin to bleed into the uterus. After the placenta is delivered the uterus continues to contract, which closes off those blood vessels, dramatically decreasing the bleeding. If you had an episiotomy or tear during birth, you may bleed from that site as well until it's stitched up.

Your caregiver may massage your uterus and give you synthetic oxytocin (Pitocin) to help it contract. Breastfeeding, which prompts your body to release natural oxytocin, also aids in the process. (That's why you may feel cramps, or afterpains, when you nurse.)

Occasionally, the uterus does not contract well after delivery, resulting in excessive blood loss.

What is lochia?

Lochia refers to vaginal discharge during the postpartum period. (The term comes from a Greek word that means "relating to childbirth.") It consists of blood and sloughed-off tissue from the lining of the uterus.

For the first few days after birth lochia contains a fair amount of blood, so it will be bright red and look like a heavy menstrual period. It may come out intermittently in small gushes or flow more evenly. If you've been lying down for a while and blood has collected in your vagina, you may see some small clots when you get up.

If everything proceeds normally, you'll have a bit less discharge each day, and by two to four days after you've given birth, the lochia will be more watery and pinkish in color. By about ten days after the birth, you should have only a small amount of white or yellow-white discharge, mostly composed of white blood cells and cells from the lining of the uterus.

The amount will taper off before it stops, a process that generally takes another two to four weeks, though a small number of women continue to have scant lochia or intermittent spotting for a few more weeks.

But if you've started on the progestin-only birth control pill (the "minipill") or gotten the birth control shot (Depo-Provera), you're likely to have spotting for a month or more, and that's perfectly normal.

How should I manage lochia?

In the beginning, use the heavy-duty sanitary pads that the hospital gives you and, if you haven't stocked up already, buy more pads when you get home. As your lochia tapers off, you can switch to minipads. Don't use tampons for at least six weeks, because they increase the risk of infection in your healing vagina and uterus.

Pee often, even if you don't feel the urge to go. In the first few days after you give birth, your bladder may be less sensitive than usual, so you may not feel the need to urinate even when your bladder is quite full. In addition to causing urinary problems, a full bladder makes it harder for your uterus to contract, leading to more afterpains and bleeding.

And get as much rest as you can. If you're doing too much, you may bleed longer or start bleeding again after your lochia has already lightened or gone away.

How can I tell if I'm bleeding too much?

If bright red spotting reappears after your lochia has already lightened, it may just be a sign that you need to slow down. But if you continue to spot after taking it easy for a few days, check in with your midwife or doctor.

Don't wait to call if your bleeding is getting progressively heavier, though, or if:

• Your lochia is still bright red four days after your baby's birth.
• Your lochia has a foul odor or you come down with fever or chills.
• You have abnormally heavy bleeding (saturating a sanitary pad in an hour or blood clots bigger than a golf ball). This is a sign of a late postpartum hemorrhage and requires immediate attention.