I recall this topic being discussed recently with no definitive
answer.  This abstract of a recent study will be of interest to
anyone wanting to know what is "normal".  Sounds like, until this
study, the abnormal (ie non-breastfeeding) may have once again
determined conventional beliefs/teaching.

Ros Escott BAppSc IBCLC
Tasmania, Australia
----------------------------

Cynthia M. Visness, MA, MPH; Kathy I. Kennedy, DrPH, and Rebecca
Ramos, MD.  Obstet Gynecol. 1997;89:159-163

The Duration and Character of Postpartum Bleeding Among
Breast-Feeding Women

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 breastfeeding 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.