Hemorrhaging After Birth

Some women experience excessive vaginal bleeding after birth. Excessive bleeding after birth is medically termed postpartum hemorrhage (PPH). This is a fairly rare condition that is known to affect 1%-5% of women who have given birth. It can occur within hours of childbirth or sometimes even days later. Whilst blood loss is normal in childbirth whether in vaginal delivery or surgical caesarean section, PPH is characterized as greater than normal blood loss.

Is It Normal to Hemorrhage After Birth?

Hemorrhaging after birth is not normal. Usually women can lose about half a liter of blood in a vaginal delivery and one liter in a caesarean section. PPH is diagnosed when blood loss exceeds these normal levels. Medical professionals can further classify the PPH depending on the total blood loss which can range from minor PPH to major PPH which can be life-threatening.

In countries where the healthcare standard is high and prenatal education is common, PPH is preventable and thus rare. Some third world countries experience a 60% incidence of PPH where women can die due to the hypovolemic shock (not enough blood to circulate to the various organs in the body) or experience severe anemia (not enough red blood cells carrying oxygen around the body).

How Do You Know If You Have Postpartum Hemorrhage?

Even once you are home with the new baby, you have to be aware of the possibility of hemorrhaging after birth. This is called secondary PPH. Although it is quite rare, it normally occurs in the second week after labor. The following signs indicate PPH and you should contact your healthcare professional as soon as possible:

  • Although vaginal bleeding is normal after childbirth, be on the lookout for excessive blood flow that won’t slow down or stop.
  • Pale and ashy-looking skin
  • Pain and swelling around the genital area
  • Feeling nauseous
  • Low blood pressure which is characterized by feelings of confusion, rapid pulse rate, blurry vision, dizziness and weakness

Why Does Hemorrhaging After Birth Occur?

1. Racial Predisposition

Studies have shown that Asian and Hispanic women are more likely to develop this condition. More research is being conducted in this field.

2. Uterine Atony

Normally after childbirth, the muscles of the uterus contract which minimizes the blood loss from the area where the placenta was attached to the womb. It is possible that this doesn’t occur because the uterus is unusually stretched due to a large baby or twins. Having too much amniotic fluid can also prevent the uterus from tightening.

3. Inverted Uterus

It is possible that the uterus turns inside out after labor.

4. Previous Uterine Surgery

Scar tissue in the uterus from a previous C-section or other uterine surgery may rupture due to the powerful contractions.

5. Placental Abruption

The placenta separates from the womb either partially or fully.

6. Location of Placental Implantation

Sometimes the placenta attaches and grows very deeply into the womb.

7. Medications

Medications used for general anesthesia (e.g. emergency C-section) may sometimes precipitate the PPH. Other medicines that stop contractions in cases of preterm labor can also initiate PPH.

8. Lacerations During Birth

Sometimes medical practitioners have to use tools to allow the baby to move easily through the birth canal, like forceps. These may cause damage to the internal tissues of the uterus or cervix, causing hemorrhaging after birth.

How to Recover from Postpartum Hemorrhage

Your doctor will begin the following treatment once PPH is diagnosed:

  • Uterine massage to encourage the uterus to contract
  • Intravenous drip of oxytocin to help the muscles of the uterus contract
  • Possible blood transfusion to replace lost blood volume
  • Dilation and curettage to remove any placental tissue from the womb after childbirth
  • Uterine arteries may have to be compressed to curb the blood loss. The doctor may place sutures to stem blood flow.

These are steps you can take once at home after PPH:

  • Take the iron supplements your doctor prescribes.
  • Drink plenty of fluids.
  • Eat iron-rich foods like beef/lamb, spinach, chickpeas, nuts and seeds.
  • Eating foods rich in vitamin C help your body absorb the dietary iron. Strawberries, citrus fruits and tomatoes will help.
  • Express your feelings and ask for support. It is important to recognize that recovery is a long process with many women reporting feeling "low" even months after the PPH.
  • Take time to rest and heal your body.

Are You at Risk of Postpartum Hemorrhage?

Usually your medical professional will assess your risk factors before the childbirth. If the risk is high, you will be advised to deliver the baby in the obstetric unit of your hospital.

The risk factors associated with developing PPH are:

  • Older than 35 years
  • Placenta previa: Placenta that is low-lying and covers the cervix
  • Multiple previous births
  • Obesity
  • Lower than normal levels of hemoglobin at the onset of labor
  • History of PPH or retained placenta

During labor, the following factors may increase your risk of PPH:

  • Use of medicines to induce labor like Pitocin
  • A very long or rapid labor
  • Caesarean section birth

 Prevention of Postpartum Hemorrhage

Hemorrhaging after birth is prevented and managed by your medical professional in the following ways:

  • Screening for and treating anemia before childbirth
  • Limiting labor induction, the use of tools to assist delivery to prevent tearing
  • Actively managing the third stage of labor when the placenta is expelled
  • After placental delivery, the genital area will be examined for any tears. Placental tissue is examined for completeness and the uterus is checked to see if it is contracting.

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