Case Scenario #8

As the nurse working on a postpartum unit, you are caring for Mary, 28-year-old, G2P2, who had a
healthy baby boy via normal spontaneous delivery. As you prepare her for discharge, she asks “How do I
know if my lochia is normal?”

GUIDE QUESTIONS:

1. How can you best explain to Mary, a normal lochia flow?

2. What assessment finding should prompt Mary to contact her primary care provider
immediately?

1.The blood you see after childbirth is called lochia. It’s a type of discharge that’s similar to your
menstrual period, and typically lasts for four to six weeks postdelivery. It contains:

 blood
 pieces of the uterine lining
 mucus
 white blood cells

Like a period, this bleeding is caused by the shedding and restoration of your uterine lining.

At first, the lochia will be mostly blood. As the days and weeks pass, you’ll likely see more mucus than
blood.

For the first one to three days after your baby is born, the blood you see will likely be bright or dark red.
It may smell like the blood you typically shed during your menstrual period. There might also be a few
clots in the blood, ranging from the size of a grape to the size of a prune. Between days four and seven,
the blood should turn a pinkish or brownish color. Clots should get smaller or disappear. By the end of
the first week, the discharge will likely be white or yellow in color. In three to six weeks, it should stop.
And you could expect during a vaginal delivery is your bleeding might increase Bleeding should slow and
then taper off within a few weeks after delivery. But a few things can temporarily increase the blood
flow, including:

 getting out of bed in the morning

 breastfeeding (your body produces the hormone oxytocin while you nurse, which stimulates
uterine contractions and accelerates healing)
 exercising
 straining when urinating or defecating.

2. When to call your doctor

If the bleeding gets heavy enough to soak through a hospital pad in less than an hour or doesn’t lessen
after a few days, call your doctor.

Also, tell your doctor if you notice:

- signs of infection, like foul-smelling discharge

- a fever of 100.4°F (38°C) or higher, or chills

blood that remains bright-red and heavy the second week

- a tender feeling in one or both sides of your tummy

- dizziness or feeling faint

- irregular heartbeat that starts racing

- You should also tell your doctor if you have very large clots or a high number of clots. This could mean
that your uterus is having trouble shrinking back to its original size.