title: The duration and character of postpartum bleeding among breast-feeding women.
abstract: OBJECTIVE
  To examine the postpartum bleeding experience of a cohort of breast-feeding women and to compare it with the conventional definition of lochia.
  
  
  METHODS
  Four hundred seventy-seven experienced breast-feeding women in Manila, the Philippines, were followed prospectively from delivery and recorded vaginal bleeding in a menstrual diary. The median duration of lochia was calculated using survival analysis. In addition, all bleeding separate from lochia within the first 8 weeks postpartum was noted.
  
  
  RESULTS
  The median duration of lochia was 27 days and did not vary by age, parity, sex or weight of the infant, breast-feeding frequency, or level of supplementation. More than one-fourth of the women experienced a bleeding episode separated from the original lochial flow by at least 4 bleeding-free days and beginning no later than postpartum day 56. Ten breast-feeding women may have had their first menstrual bleed before day 56.
  
  
  CONCLUSIONS
  Lochia lasted substantially longer than the conventional assumption of 2 weeks. It was common for postpartum bleeding to stop and start again or to be characterized by intermittent spotting or bleeding. Return of menses is rare among fully breast-feeding women in the first 8 weeks postpartum.
authors.affiliation: Contraceptive Use and Epidemiology Division, Family Health International, Research Triangle Park, North Carolina, USA.
authors.forename: C M
authors.initials: CM
authors.lastname: Visness
authors.forename: K I
authors.initials: KI
authors.lastname: Kennedy
authors.forename: R
authors.initials: R
authors.lastname: Ramos
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007774:Lactation / Q000502:physiology*; D006473:Postpartum Hemorrhage / Q000503:physiopathology*; D011247:Pregnancy; D011446:Prospective Studies; D013997:Time Factors