Lochia rubra refers to vaginal bleeding and discharge after childbirth. Specifically, it consists of blood, mucus, and tissue from the placenta and the uterus lining. This type of discharge is a typical part of the postpartum process.

Typically, the detachment of the placenta from the uterine wall causes lochia rubra. This detachment can happen during labor or shortly after delivery.

The bleeding is usually heavy for the first few days. It gradually lightens over the next few weeks as it transitions into a different type of discharge known as lochia serosa. Then, it becomes lochia rubra.

Lochia rubra resolves on its own without the need for medical intervention. However, further evaluation by a doctor may be necessary for any signs of infection or atypical bleeding, such as heavy flow, clots, odor, or fever.

This article provides an overview of lochia rubra and what to expect in the postpartum period.

Share on Pinterest
Layland Masuda/Getty Images

During lochia rubra, a person’s flow appears bright red or pink in the first few days after delivery.

The consistency of the flow is usually similar to a menstrual period. However, lochia rubra may appear thicker and stringy. The increased thickness may be due to the discharge containing sloughed tissue from the placenta, mucus, and bacteria.

Lochia rubra may also contain more clots than menstrual periods. These clots may occur due to pooling blood. Although this is typical, people need to call their doctor if clots are large.

During this stage, a person may experience the most cramping or discomfort as the uterus shrinks to its original size. If breastfeeding or chestfeeding, a person may notice cramping as the baby feeds. In this instance, a rush of oxytocin — a hormone involved in contraction and lactation — may be causing cramps.

How long does lochia rubra last?

Lochia rubra is heavy for around the first 3 to 4 days. The flow then becomes lighter and more watery over a few weeks.

A fetus develops in the womb for around 9 months, with the placenta and amniotic fluid surrounding it. High levels of the hormones estrogen and progesterone help the walls of the uterus, or endometrium, to become thick and cushion the fetus during pregnancy.

After childbirth and the passing of the placenta, the body must also expel the lochia. The lochia refers to the layer of blood, endometrial lining, and mucus in the womb.

The body must clear the lochia, no matter the type of birth. For instance, a person undergoing cesarean delivery will have lochia rubra that needs expelling.

As the placenta detaches from the endometrial wall, it causes tears and bleeding at the placental site. If the person is too active, lochia flow increases as the placental site bleeds. This can slow healing, highlighting the need for rest and recovery in the first few weeks after childbirth.

Lochia rubra is the initial stage of postpartum discharge. There are two other stages of lochia.

Lochia serosa

This is the transition stage, where the flow lightens and becomes more watery. It also changes color from red to pinkish-brown. Lochia serosa can last about 5 to 9 days.

There are now more white blood cells than red blood cells in the lochia, which may be responsible for the color change.

Lochia alba

This is the final stage of postpartum discharge. It is a yellowish-whitish color and may no longer appear bloody. Lochia serosa can last about 2 weeks.

The discharge now contains mainly mucus, and the flow should hardly be noticeable by this point.

People may wish to wear sanitary pads during the entire lochia stage. Changing pads as often as possible is vital, as bacteria can grow on damp or soiled pads and cause infections.

After childbirth, a person should also rest and not overexert themselves, as rest helps the body heal faster. They also need to drink plenty of fluids — to prevent dehydration — and eat a balanced diet.

People need to seek medical attention if they experience excessive bleeding or other symptoms, such as:

  • fever
  • nausea
  • vomiting
  • chills
  • swelling and pain around the vagina or perineum — the area between the vagina and rectum

These symptoms may signal that a person has an infection or postpartum hemorrhage.

Below are some common questions and answers about lochia rubra:

What is scant to moderate rubra?

Scant to moderate rubra indicates that the flow is lighter than normal, but not so light that doctors would consider it lochia serosa.

Scant hemorrhage is 10 milliliters (mL) of blood and lochia or less, while moderate involves 25–50 mL.

What is the difference between lochia and postpartum hemorrhage?

Lochia is not the same as postpartum hemorrhage.

Postpartum hemorrhage refers to a blood loss of around 500 mL or more after the third phase of labor. Lochia is a typical process that doctors expect, while hemorrhage is a medical emergency.

What is a typical amount of lochia rubra a person should have?

The amount varies between people, but the amount should not fill more than one menstrual pad in 1 hour.

A moderate lochia flow is 25–50 mL in the first 2 hours after birth. From day 2 onward, this amount should gradually decrease.

People should seek medical attention if:

  • they pass very large clots or persistent clots
  • lochia does not seem to reduce in amount or flow
  • lochia is persistently red after 1 week
  • they have any concerns about the lochia or other changes to their body post-delivery
  • they experience heavy bleeding from the vagina — soaking a menstrual pad in less than 1 hour — that is not stopping or slowing
  • they experience any signs of postpartum hemorrhage, such as nausea, drops in blood pressure, or paleness

Lochia rubra is the first stage of postpartum discharge. The discharge is a mixture of blood, mucus, and sloughed tissue from the placenta. The typical postpartum bleeding process can last up to 12 weeks following delivery.

The color fades from bright red or pink in the first few days to brownish-red, then eventually yellow or white as the discharge gets lighter.

If a person experiences excessive bleeding, fever, or chills, they need medical attention immediately. Otherwise, people need to call their doctor if the clots are larger than a golf ball or the lochia does not become lighter after 3 days.