During pregnancy, the uterus thickens to accommodate the fetus, and the placenta attaches to the uterine wall. After the birth of the child, the endometrium inside the uterus sheds, especially the decidual tissue at the site where the placenta attaches during the recovery period. The endometrium, blood, and necrotic decidual tissue are expelled through the vagina together. These excess tissues that fall off from the uterus and are expelled from the body are collectively referred to as lochia.

Normal lochia has a bloody smell but no foul odor. Its duration is 4 to 6 weeks, and the total volume is 250 to 500 milliliters. According to color, composition, and appearance time, normal lochia is divided into three stages: bloody lochia, serous lochia, and white lochia.

I. Changes in the Color of Lochia

1. What is bloody lochia?

During the first 4 days after childbirth, due to the presence of a large number of red blood cells, necrotic decidua tissue, and a small amount of fetal membranes. The color is bright red, similar to or slightly darker than the color of menstruation. The amount is relatively large, and it may also contain small blood clots. The volume of the secretion is comparable to that of menstruation. This stage of lochia is called bloody lochia. This is a normal phenomenon in the first few days after childbirth. You need to replace the postpartum sanitary napkins frequently based on the amount of lochia discharged.

2. What is serous lochia?

Serous lochia usually occurs from the 3rd to the 10th day after childbirth. Due to the reduction in the number of red blood cells, white blood cells, and bacteria, as well as the increased amount of necrotic decidua tissue, uterine cavity exudate, and cervical mucus, the lochia becomes increasingly thin and takes on a light red or pale pink color.

3. What is white lochia?

Around the 14th day after childbirth, there are fewer red blood cells in the discharge. The body will expel a large number of white blood cells, necrotic decidua tissue, epithelial cells, and bacteria. At this time, the color of the lochia will turn milky white, pale yellow or transparent, similar to vaginal discharge. This stage usually last 3 weeks, and the secretion volume will gradually decrease, become thinner, and disappear.

How to identify abnormal lochia

If any of the following situations occur, it may indicate that there is an infection, tissue residue or inadequate contraction in your uterus. At this point, you should immediately contact a doctor or visit a hospital for treatment:

1. Abnormally excessive bleeding

The amount of lochia discharged after childbirth should gradually decrease.

If the entire sanitary pad is soaked within one hour, or if there is a sudden large amount of bright red bleeding or large blood clots (such as the size of an egg), this is a sign of postpartum bleeding and requires immediate emergency treatment.

2. Excessive duration

It has not been completely cleared within 6 weeks.

3. Abnormal color or odor

Normal lochia should have no odor or only a bloody smell. If there is a foul smell or a rotten smell, it may indicate an infection. Additionally, if the color of the lochia remains bright red in the later stage, it indicates a high content of red blood cells, which may mean there is a significant amount of bleeding in the uterus.

4. Color change

The color of lochia should gradually fade. If its color suddenly changes from light red/pink back to bright red and the amount increases.

5. Related symptoms

Fever, chills, severe pain or tenderness in the lower abdomen, dizziness, palpitations, pale complexion, feeling cold and being cold and wet, rapid heartbeat, etc.

6. Tissue resection

If a large tissue piece has been removed, please keep these tissues and bring them to the doctor for examination.

II. What should be noted during postpartum care?

1. Maintain hygiene

Replace sanitary napkins or sanitary pads regularly (initially, it is recommended to use special sanitary napkins).

Clean the external genital area with warm water 1-2 times a day, from front to back.

During the puerperium, avoid taking baths to prevent infection.

Replace cotton, loose and breathable underwear every day. After washing, boil them and dry them in the sun using ultraviolet rays for sterilization.

2. Observation, recording and timely medical treatment

Observe the volume, color, odor and duration of lochia every day and make records.

If the volume of lochia suddenly increases (exceeding the amount of menstrual blood), and the continuous bright red lochia lasts for more than two weeks, accompanied by a foul smell, along with fever and abdominal pain, seek medical attention immediately.

3. Promote uterine recovery

Get out of bed as soon as possible: For vaginal delivery, usually 6 to 12 hours after the delivery, for cesarean section, 24 hours after the delivery, and when physical strength permits, one should get out of bed and move slowly. This helps with the discharge of lochia and the recovery of the uterus.

Final Thoughts

I would like to say that the process of clearing the lochia is not a terrifying thing. It can be regarded as the waste products produced during the "deep cleaning" and repair process of the uterus after childbirth. The appearance of lochia is an important sign of the mother's body's recovery and is also a normal physiological change.