Lochia

The birth of a child comes with great joy but also a complete change in bodily conditions. Women lose blood during and after delivery.

This happens whether the birth is a vaginal birth or a cesarean birth. Many women tend to be surprised at the amount of blood loss and by the duration of the bleeding. It is important to be aware of this and also know the difference between menstruation and postpartum bleeding or lochia.

What is Lochia?

Lochia is the vaginal discharge that occurs after delivery during the postpartum period. This is basically the uterine wall shedding its lining after birth. The uterus is healing and is returning to its original pre-pregnancy size.

Lochia consists of blood, uterine wall lining, bacteria, dead tissue, and mucus. As blood is the main component of lochia immediately after delivery, the lochia will be bright red in color and may also have blood clots in it. It has a musty odor similar to that of menstrual discharge. It basically resembles a heavy period.

Blood volume increases by about 50% during pregnancy and this extra blood is dispensed from the body as lochia. The blood may flow out in heavy gushes in the beginning and later moves into an intermittent flow.

Many women believe that lochia is absent or lesser in women who have delivered their babies through a C-section. This is not true and lochia occurs regardless of the nature of birth.

Lochia Types

Lochia lasts for 4-6 weeks after childbirth and the bleeding can go on for this period. However, the discharge decreases day by day and becomes lighter in color.

Lochia rubra

Lochia rubra is bright red in color. It is discharged until about 3-5 days after giving birth. It is mainly composed of blood, small bits of membranes, cervical discharge, and meconium.

Lochia serosa

Lochia serosa is pinkish or brown in color. It becomes more watery in nature and can continue till about ten days post delivery. It contains less number of erythrocytes and has more of leucocytes and mucous.

Lochia alba

Lochia alba is a small amount of discharge which is yellowish white in nature. It lasts from around the third week to the sixth-week post delivery. It contains mucus, leucocytes, epithelial cells and decidual cells.

The discharge is heavier after breastfeeding as the suckling by the infant forces the lochia out. Also, heavy work and a lot of movement may also force the lochia out.

Management of Lochia

• In the case of heavy lochia, especially in the beginning, maternity pads will need to be used. These maternity napkins will be those that can support a heavier flow of blood and should be free of plastic covers and contain absorbent gels to absorb the discharge better. As the lochia tapers down, smaller pads can be used.
• It is advisable not to use tampons for the first 6 weeks as there is a chance for the spread of a bacterial infection while the uterus is still healing.
• The woman should urinate often. The urge to urinate may not occur as the sensitivity to bladder sensations are less after giving birth.
• Good hygiene should be practiced. If there is a wound between the vagina and the perineum, the area should be washed to prevent infection from spreading. The maternity pads must be changed regularly as well.
• Rest is advised for the woman especially during the beginning of lochia. It is advisable not to perform any vigorous activity or lift heavy objects. This is especially advised if there are indications of red lochia still being present.

When does the doctor need to be called?

It is important to keep a check on the amount and color of discharge as time passes. The doctor must be contacted under the following conditions:

1. If the lochia smells extremely unpleasant, it could be an indication of an infection. This can occur if tampons are used instead of sanitary napkins or if proper hygiene is not maintained.
2. If the bleeding is accompanied by fever, frequent chills, increased heartbeat, irregular heartbeat or feeling dizzy.
3. If the bleeding is very heavy and the color of the lochia stays a bright red even after the first week.
4. If the woman needs to change pads almost on an hourly basis because the bleeding is that heavy.
5. If there is the presence of large blood clots in the lochia.
6. If the woman experiences intense pain on the lower sides of the abdomen.

It is important for the doctor to check out these symptoms as they could be indicative of Post Partum Hemorrhage.

Lochia Complications

There can be instances when you observe some complications. The smell of lochia is just like your menstrual blood, so if you notice any different or pungent smell then you immediately need to inform your doctor about the same.

Also, have a close look at the color of your lochia. If you find that the color is turning to be greenish then report it immediately to your doctor. This can because of the presence of some micro-organisms in it.

Post Partum Hemorrhage

Post-Partum Hemorrhage or PPH occurs as a result of very heavy bleeding. If PPH happens within 24 hours, it is called primary PPH. If it happens between 24 hours and 12 weeks after delivery, it is called secondary PPH. This excessive postnatal bleeding is caused when a piece of membrane or a bit of placenta remains or when the uterus does not contract properly. Medical intervention is needed immediately in this case.

The uterus will then be inspected by the doctor to inspect whether there is any membrane or placental residues. If they are found, they will need to be removed. Sometimes if the woman has lost a lot of blood, a blood transfusion may be needed if the hemoglobin levels go below 12 gm per cent. Antibiotics are taken in case of an infection that needs to be treated.

Apart from this, the woman will need to take plenty of rest avoid vigorous physical activity and practice good hygiene.

Lochia is the postnatal discharge that occurs after a woman has given birth. It consists of blood and parts of the uterine wall. Lochia lasts for about 4-6 weeks after delivery. In case of heavy bleeding, as time goes by, it is important to get medical intervention as there could be a chance of postpartum hemorrhage.

References:

https://www.babycentre.co.uk/a553465/bleeding-after-the-birth-lochia

https://www.babycenter.com/0_postpartum-normal-bleeding-and-discharge-lochia_11722.bc

https://my.clevelandclinic.org/health/articles/physical-changes-after-delivery

http://gynaeonline.com/lochia.htm

http://www.natracare.com/mother-baby/lochia-bleeding-after-birth/

http://www.webmd.com/baby/tc/postpartum-bleeding-topic-overview

http://www.bounty.com/pregnancy-and-birth/birth/post-birth/bleeding-after-birth-lochia

https://www.nct.org.uk/parenting/explaining-blood-loss-after-birth