During pregnancy, the uterus thickens to accommodate the fetus, and the placenta attaches to the uterine wall. After childbirth, the uterine lining sheds during recovery, particularly the decidual tissue at the site where the placenta was attached.
The uterine lining, blood, and necrotic decidual tissue are expelled through the vagina. These materials discharged from the uterus are collectively referred to as lochia.
Normal lochia has a bloody smell but no foul odor. It commonly lasts for 4–6 weeks, with a total volume of approximately 250–500 milliliters. Based on its color, composition, and timing, normal lochia is divided into three stages: bloody lochia, serous lochia, and white lochia.
How Does Lochia Change in Color?
1. What Is Bloody Lochia?
During the first four days after childbirth, lochia contains many red blood cells, necrotic decidual tissue, and a small amount of fetal membrane material.
Its color is bright red, similar to or slightly darker than menstrual blood. The amount is relatively large and may include small blood clots. The volume can be comparable to menstrual flow.
This stage is called bloody lochia and is a normal occurrence during the first few days after childbirth. Postpartum pads should be changed regularly based on the amount of discharge.
2. What Is Serous Lochia?
Serous lochia usually occurs from approximately the third to the tenth day after childbirth.
As the number of red blood cells decreases and the proportions of white blood cells, bacteria, necrotic decidual tissue, uterine fluid, and cervical mucus change, the lochia becomes thinner and takes on a light red or pale pink color.
3. What Is White Lochia?
Around the fourteenth day after childbirth, the discharge contains fewer red blood cells and more white blood cells, necrotic decidual tissue, epithelial cells, and bacteria.
At this stage, lochia may appear milky white, pale yellow, or transparent, similar to vaginal discharge. This stage usually lasts approximately three weeks. The volume gradually decreases, becomes thinner, and eventually disappears.
How to Recognize Abnormal Lochia
If any of the following situations occurs, it may indicate infection, retained tissue, inadequate uterine contraction, or another postpartum complication. Contact a healthcare professional promptly.
1. Abnormally Heavy Bleeding
The amount of lochia should gradually decrease after childbirth.
If a sanitary pad becomes completely soaked within one hour, or if you experience a sudden large amount of bright-red bleeding or pass a blood clot approximately the size of an egg, seek emergency medical care immediately.
2. Discharge Lasting Longer Than Expected
Contact a healthcare professional if lochia has not cleared within six weeks or persists longer than expected.
3. Abnormal Color or Odor
Normal lochia should have no strong odor or only a mild bloody smell. A foul or rotten smell may indicate infection.
If lochia remains bright red in a later stage, it may indicate continued or increased bleeding.
4. Color Reverting to Bright Red
Lochia should gradually become lighter. If it suddenly changes from light red or pink back to bright red—especially if the amount increases—contact a healthcare professional.
5. Concerning Symptoms
Seek medical attention if lochia occurs alongside symptoms such as:
- Fever or chills
- Severe lower-abdominal pain or tenderness
- Dizziness
- Heart palpitations or a rapid heartbeat
- Pale complexion
- Cold, clammy skin
6. Passing a Large Piece of Tissue
If you pass a large piece of tissue, keep it if possible and bring it to a healthcare professional for examination.
What Should You Keep in Mind During Postpartum Care?
1. Maintain Good Hygiene
- Replace postpartum pads or sanitary pads regularly
- Clean the external genital area with warm water 1–2 times a day, wiping from front to back
- Follow your healthcare professional’s guidance regarding bathing during postpartum recovery
- Wear loose, breathable cotton underwear and change it daily
- Wash underwear thoroughly according to its care instructions and allow it to dry completely
2. Observe, Record, and Seek Timely Medical Care
Observe and record the amount, color, odor, and duration of lochia each day.
Seek medical attention immediately if lochia suddenly becomes heavier than your usual menstrual flow, remains bright red for more than two weeks, develops a foul smell, or occurs with fever or abdominal pain.
3. Support Uterine Recovery
Begin gentle movement only when your healthcare team says it is safe and your physical condition allows it.
After a vaginal birth, some individuals may be able to get out of bed within 6–12 hours. After a cesarean section, movement may begin later and should follow medical guidance. Gentle movement may support lochia discharge, circulation, and uterine recovery.
Final Thoughts
The process of clearing lochia does not need to feel frightening. It can be understood as part of the uterus’s natural recovery and repair process after childbirth.
Lochia is an important sign of postpartum recovery and a normal physiological change. However, paying attention to its amount, color, odor, duration, and accompanying symptoms can help you recognize when medical care may be needed.
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