Lochia Rubra: Causes, Stages, Management

Lochia is the vaginal bleeding that occurs after childbirth. It consists of blood, mucus, and tissues from the placenta and uterus lining. This discharge is a part of the postpartum process.

Lochia occurs due to the detachment of the placenta from the uterine wall. It can be after delivery or shortly after labor.

There is bleeding that is usually heavy in the first few days and it gradually lightens after a week and it transitions into a different type of discharge known as lochia serosa.

Lochia rubra resolves on its own without any medical intervention. An evaluation by a doctor may be needed in case of any signs of infection such as heavy clots, odor, or fever.

A fetus takes 9 months to develop in the womb, surrounded by the placenta and amniotic fluid surrounding it. High estrogen and progesterone levels help the uterine wall to thicken and cushion the fetus.

After the child’s birth the placenta passes out and the body expels the lochia too. Lochia is the layers of blood, endometrial lining, and mucus in the womb.

The body needs to clear the lochia, no matter the type of birth. Even a person after a cesarean delivery needs to expel lochia rubra. As the placenta detaches from the endometrial wall, tears and bleeding occur at the placental site. Lochia flow may increase for a person who is too active. This can slow down healing, bringing in a need for rest and recovery.

Lochia rubra is the starting or the initial stage of postpartum discharge. There are other two stages, which include the following:

• Lochia Serosa

  This is a transition stage in which the flow lightens and becomes watery. Its color changes from red to pinkish-brown. This stage may last up to 5-9 days. ⁽¹⁾

  Now in lochia there are more white blood cells than red blood cells, which is a reason the color is light.

• Lochia Alba

  This is the final stage of postpartum discharge in which the discharge color gets yellowish-white. It no longer appears bloody. This stage lasts for 2 weeks.

  This discharge contains mainly mucus and is hardly noticeable at this point.

The consistency of lochia is similar to menstrual blood. However, it may appear thicker and stringy. The increased thickness may be due to the sloughed tissue from the placenta, mucus, and bacteria.

Lochia rubra may sometime contain more clots than present in menstrual periods. The reason for these clots may be the pooling of blood. In this case, it gets important to inform the doctor about it.

There may be cramping and discomfort in the uterus as it shrinks to its usual size. A person may notice cramping while breastfeeding, which may be due to the rush of oxytocin, a hormone that is involved in contraction and lactation.

Lochia rubra is heavy for 3-4 days. ⁽²⁾ The flow gradually gets lighter and watery over a few weeks.

People might use pads during the entire lochia period. It is important to change pads frequently to avoid bacterial growth. One should try and rest as much as possible to help the body heal faster. Also, one should drink plenty of water to avoid dehydration.

It is important to get medical attention in the case of:

• Fever
• Vomiting
• Nausea
• Chills
• Presence of swelling and pain around the vagina or perineum

These symptoms may signal an infection or postpartum hemorrhage.

Also, one should seek help in the following condition:

• • Passing of very large clots
  • Lochia reduces in amount and flow
  • Lochia is red even after one week. ⁽¹⁾
  • For any concerns regarding lochia or changes in body post-delivery
  • Very heavy bleeding from the vagina
  • Signs of post-partum hemorrhage

Lochia rubra is the first stage of postpartum discharge and a normal change post-delivery. It consists of mucus and sloughed tissue from the placenta. Typically, it lasts up to 12 weeks following delivery. Its color fades too, gradually. If a person experiences excessive bleeding, fever, or chills or if the lochia doesn’t get lighter a doctor should be consulted.