“Lochia isn’t that different from a period — a period is the endometrium layer of the uterus shedding after a month in which an ova isn’t fertilized, and lochia is the uterine lining that has built up over nine months of pregnancy,” explains Annemarie Sawatzky, a former doula and current medical assistant at a women’s health clinic in Canada.
As this description indicates, the main difference is the amount of uterine lining that’s being shed. Basically, “there’s a lot more that needs to come out,” Sawatzky says. “Clots are very common, and they can be shockingly large” — as large as a tennis ball.
“Lochia is often very heavy and red at first, and then as it progresses it gets quite dark,” she explains. “It can come in waves of heaviness for a few weeks, and slow to a trickle that is brown or pink for quite a while. After two weeks it shouldn’t be that heavy, and it should be done by two months postpartum.” You can also expect contractions. “The letdown reflex (which is almost always part of the postpartum process even if nursing isn’t happening) will trigger contractions, and those will result in a rush of fluid. It feels gross,” Sawatzky says.
Although a heavy flow is normal, you should see a doctor if you notice “clots bigger than a tennis ball, soaking a full-sized pad per hour, or a sudden return of fresh blood after it has subsided,” Sawatzky says.
No matter how you had your baby, you’ll experience lochia: if you had a C-section, the uterus still needs to shed its lining. But if you had a vaginal birth, lochia will also contain residual bleeding from vaginal tearing. Even if you didn’t experience major tearing during childbirth, “the birth canal almost always experiences microtears, as the tissues are stretched during dilation and by the baby’s head,” Sawatzky explains.
The first few weeks postpartum can be a difficult time, and it’s important to take care of yourself physically and emotionally. “The combination of lochia, tenderness, and possible stitches can make the whole area very uncomfortable, and it can have a strong psychological impact, so being gentle with your physical and emotional self is really important,” Sawatzky says.
On the physical side, you’ll want to wear thick, disposable postpartum pads, not tampons or a menstrual cup. “Give the vagina a break,” says Sawatzky, adding, “The very thick, massive pads are far, far better postpartum than the thin ones. In this case, feeling like it’s a diaper is great. Lots of people talk about ‘padsicles’ — those thick pads soaked in witch hazel and frozen — and they’re great.”
She adds that she doesn’t recommend cloth pads during the first few weeks when the flow is heaviest, but they’re fine after "the flow has slowed and stabilized.” If you feel itching, check with a professional instead of attempting to self-treat. “From my own 3x experience of stitches, I was convinced I had a yeast infection three days postpartum, but it was just my stitches coming out,” Sawatzky says. “Don’t stick Monistat up there, it is BAD.”
Sawatzky also suggests making sure you have informed support on hand. “[When I was a doula] I got a lot of ‘is this normal’ questions about lochia, and most of the time the answer is yes," she says. Because of this, she always encourages people "to have a doula or a trusted, knowledgeable friend to ask. [Lochia can be] sometimes frightening, and support makes such a difference.”