Postpartum bleeding or lochia
After giving birth, every mother will experience bleeding. Later, it is called as the postpartum period. This bleeding is a natural mechanism of the body to cleanse the uterus from the blood and placenta formed during pregnancy. One of these forms is lockhea (shed and released during the puerperium). Lochia is defined as postpartum blood or excretion that occurs during the postpartum period. Lochia consists of blood, exfoliated tissue from the uterine lining, and bacteria. For several days after giving birth, lochia consists of a normal amount of blood, so the color is bright red and looks like heavy menstrual blood. Lochia can come out in the form of blood emission. If you lie down for a while and blood has gathered in the vagina. Then, you will see small blood clots when you get up from a lying position.
If everything goes well, the amount of released excretion will decrease every day. Further, within 2 to 4 days after delivery, lochia will become runnier and turn pink. After 10 days of giving birth, mothers will excrete a small amount of yellow-white mixture and mostly consist of white blood cells and cells from the uterine lining. Lochia will gradually decrease before stopping completely. This process generally lasts 2 to 4 weeks, although some women continue to excrete small amounts of lochia or in the form of uneven patches over the next few weeks. If you start taking birth control pills or receive injections of Depo-Provera, it can be found that the spots will continue to come out for more than 1 month. That condition is normal. Many women believe that the lochia flow decreases after a cesarean section. This thought is based on the uterine cavity cleaned after giving birth. Eventually, this is not true. The flow of lochia does not depend on the type of birth, whether normal or cesarean birth. The amount and duration are the same in both cases.
Here are several types of lockhea:
- Lokhea rubra (cruenta). Lokhea has fresh red color and usually comes out until the third day. This is formed from fresh blood, residual tissue – remnants of the placenta, cells of the uterine wall, fetal fat cells, fetal hair (lanugo), and fetal feces (while in the womb or meconium). Containing many germs is potential.
- Lokhea sanguinolenta. Its characteristic is red and slimy. The change between the appearance of the lubra lockhea to the sanguinolenta lockhea usually lasts about 1-2 weeks.
- Lokhea serosa. Its appearance is brownish yellow and pink. This liquid contains fragments of tissue, red blood cells and white blood, and the rest of the cervical mucus. Usually, it starts at 2 weeks to 1 month after giving birth.
- Lokhea alba. Its color is yellowish and clear. This contains a small number of red blood cells and consists mostly of white blood cells, fragments of uterine wall lining, cholesterol, fat, and mucus. The duration is around 2 weeks especially from the 4th week to the 6th week. If the lockhea’s liquid is clear, the sign of the puerperium is normal.
- Purulenta Lokhea. The liquid that comes out is due to infection. Out liquid like foul-smelling pus.
- Lochiostasis. This kind of lochea didn’t come out smoothly.
If lochea’s expenses are longer than those mentioned above, it is possible:
- The loss of the placenta or fetal membrane due to unfavorable uterine contractions.
- Mothers who do not breastfeed their children, spend more on lochea rubra due to rapid uterine contractions.
- Infection of the birth canal can cause contractions of the uterus unfavorable. As a result, it releases longer lochea and lochea smells rancid or fishy.
If the lochea is suppurating and has a bad odor even lower abdominal pain, the possibility of diagnosis is metritis. Metritis is uterine infection after labor which is one of the biggest causes of maternal death. If the mother’s treatment is late or inadequate, it can be a pelvic abscess, peritonitis, even septic shock.
Several conditions cause mothers to experience complications. The smell of lochia is the same as your menstrual blood, so if you feel the difference in smell, immediately consult a doctor. Also, pay attention to your lochia’s color. If the color turns green, consult it immediately to the doctor. This can be caused by the presence of micro-organisms in it.
Lochia can be abnormal if the infection occurs during the puerperium. Infection can be suspected when:
- Lochia remains bright red even after the first week of puerperium
- The lochia color becomes bright red again after becoming paler for several days
- Abnormal heavy bleeding and absorbed in sanitary napkins in 1 hour or less, or blood clots that are larger than golf balls. This is a sign of secondary bleeding after childbirth and requires emergency treatment.
- Has an odor
- Fever accompanied by shivering
- Pain in the lower abdomen that increases during the day.
Treatment during the puerperium
On the first few days, use maternity pads provided by the hospital, if you don’t have them at home, buy more when you get home. After lochia starts to decrease, you can change the size of maternity pads with the usual size. Do not use a tampon for at least 6 weeks, because its use can increase the risk of infection in your vagina and recovering uterus.
Frequent urination is also the normal case for the mother after giving birth. On the first few days after giving birth, the bladder will become less sensitive than usual so it may not feel like peeing even though the bladder is full. Besides, a full bladder makes the uterus more difficult to wrinkle, causing more pain and bleeding. You should try resting as much as you can. If it is too excessive, it can experience longer bleeding or begin to experience bleeding again after lochia is bright or missing. If bright red spots appear after lochia is bright, this can be a sign that you must be careful. If you continue to experience spotting after stopping for several days, consult a doctor or midwife. Don’t delay to contact your doctor if the bleeding is getting heavier, or if you find these cases:
- Lochia is still bright red 4 days after giving birth to a baby.
- Lochia has a bad odor or is accompanied by fever or cold.
- Having abnormal heavy bleeding (filling the pads in 1 hour) or removing blood clots that are larger than the size of a golf ball. This can be a sign of postpartum secondary bleeding (late postpartum hemorrhage).
Immediately go to the hospital if you experience very much bleeding or fall unconscious. Bleeding can threaten safety, so you need to be hospitalized until the bleeding stops. The doctor will examine and begin to infuse to give fluids, drugs to help the uterus contract, and possibly antibiotics. Ultrasound will be performed to see if the placental layer is still present in the uterus. If it is still there, the doctor needs to carry out a surgical procedure called dilation and curettage (D & C) to remove it. In extreme cases, if all attempts to overcome the bleeding fail, you need to undergo a hysterectomy (removal of the uterus).