So you've had your little bundle of joy, and you can't wait to get them home and to embark on your journey with this new addition to the family.
But you're bleeding, and it seems like a lot. Scary! No one wants that, no one needs that; but it's also a normal part of postpartum recovery. But what's normal, and what's not? How much blood is too much blood? We've got your back.
In this article, we'll break down all the symptoms of postpartum haemorrhage, the causes, and the signs it might be time to call your doctor.
What is postpartum haemorrhage (PPH)?
Postpartum haemorrhage, also called PPH, is when you experience significant blood loss (beyond what's normal) after the birth of your bub.
Usually, postpartum haemorrhage occurs within the 24 hours after giving birth — often after the delivery of the placenta — but it can also happen anytime within the first 6 weeks. In rare conditions, it can happen up to 12 weeks after the birth [1].
Postpartum haemorrhage affects between 1 in 100 to 5 in 100 women [2]. Although it's pretty rare, postpartum haemorrhage is a serious condition that can be life-threatening.
It's important to be able to spot the signs and seek medical assistance quickly if you suspect this could be happening to you. Left untreated, the blood loss from PPH can lead to a severe drop in blood pressure, which can send the body into shock and be a fatal condition [1].
Now, it's normal to have some bleeding after giving birth, but postpartum haemorrhage is when, after the birth, you lose more than half a litre of blood.
So how do you tell what's normal and what's not?
Quick signs that you may be experiencing PPH are:
- If you're experiencing heavy bleeding or going through more than one pad every hour, or
- If you're passing blood clots that are the size of an egg, or bigger.
What causes postpartum haemorrhage?
After you've had your baby, the uterus usually contracts and pushes out the placenta. The most common cause of postpartum haemorrhage is when the uterus doesn't contract properly after birth, allowing the blood vessels to bleed freely.
The uterine contractions apply pressure where the placenta was attached, so if the uterus doesn't contract properly, there's not enough pressure on these bleeding vessels to slow the bleeding [3].
This is called uterine atony, and leads to postpartum haemorrhage.
PPH is more likely if you don't wholly pass the placenta, and small pieces remain attached. In fact, placenta problems, like placenta praevia, placental abruption, and placenta acreta can also lead to postpartum haemorrhage [4].
However, postpartum haemorrhage is actually more likely in a C-section birth and can be caused by a number of other issues as well [3]. These include:
- Injury and tears to the uterus, cervix, vagina or perineum
- A weak pelvic floor or weakened uterine muscles
- Long labour
- A large baby
- A very stretched uterus (often caused by carrying multiple babies, or if you have a lot of amniotic fluid)
- Bleeding or blood clotting disorders
- If you've experienced PPH before
- Bleeding into hidden tissues in the pelvis
When does postpartum haemorrhage occur?
Although postpartum haemorrhage can happen in the first 12 weeks after the birth of your bub, it's most likely to occur within the first 24 hours. A rare condition to begin with, the likelihood of experiencing a postpartum haemorrhage decreases significantly with time after the birth.
Of course, if you're concerned at any time about heavy bleeding, and suspect that you're dealing with a PPH, it's important to contact your doctor immediately.
PPH is a serious condition that can be fatal, so it's always better safe than sorry.
How do you know if you have postpartum haemorrhage?
So, how can you tell if your postpartum bleeding is normal, or if you're experiencing a postpartum haemorrhage? Often, PPH will come with a number of other symptoms, so if you're experiencing any of them, it's important that you contact your doctor or call 000 immediately.
March of Dimes and Stanford Childrens report that the signs and symptoms of postpartum haemorrhage include [1][2]:
- Uncontrolled bleeding: heavy bleeding that doesn't seem to be slowing or stopping
- A severe drop in blood pressure or shock symptoms. Signs of low blood pressure and shock include chills, blurred vision, clammy skin, dizziness, confusion, feeling faint, sleepy or weak
- Increased heart rate
- Swelling and pain in the vagina or perineum
- Nausea and/or vomiting
- Pale skin
Are some women more likely than others to have postpartum haemorrhage?
Although postpartum haemorrhage can happen to anyone, there are a number of conditions that can indicate a higher risk of postpartum haemorrhage [1]. These include conditions that affect the uterus and placenta, conditions and complications that occur during labour and birth, and other medical conditions [2].
The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), reports that "some women will have risk factors for heavy bleeding, but most will not" [5].
Here are some of the risk factors that can make PPH more likely:
Conditions that affect the uterus
Uterine atony
Uterine atony is where the muscles in your uterus don't contract properly after the birth, usually after you pass the placenta, which means that the blood vessels bleed freely, causing significant blood loss.
Uterine inversion
This is where the uterus turns inside out after the birth. Don't worry, it's rare!
Uterine rupture
This is when the uterus tears during labour. Although rare, uterine rupture is more likely if you've had a previous C-section, or if you've had other uterine surgeries in the past.
Conditions that affect the placenta
Placental abruption
A placental abruption is when the placenta separates from the uterine wall, either partially or fully, before giving birth.
Placenta accreta, placenta increta, and placenta percreta
If the placenta has grown too deeply into the wall of the uterus, it may not be able to separate properly or completely, which can lead to PPH.
Placenta previa
Placenta previa is when the placenta is positioned very low in the uterus, and blocking the cervix, either partially or fully.
Retained placental tissue
A retained placenta is where you haven't passed the placenta within 30-60 days after birth.
Conditions during labour and birth
Outside of problems that can arise with the uterus or placenta during birth, there are other risk factors that can heighten the likelihood of postpartum haemorrhage. These include:
- Having a C-section or getting general anaesthesia
- Medicines that induce labour
- Medicines that halt contractions during pre-term labour
- Perineal tearing or having an episiotomy
- The use of forceps or a vacuum
- Having either a very fast labour or very extended labour
Other risk factors
- Having a blood condition like von Willebrand disease or disseminated intravascular coagulation (aka DIC)
- Having an infection, like chorioamnionitis, which affects the placenta and amniotic fluid
- Intrahepatic cholestasis of pregnancy (aka ICP), which is a liver condition brought on by pregnancy
- Obesity
- High blood pressure conditions like preeclampsia or gestational hypertension
How is postpartum haemorrhage tested for and treated?
The most important thing to remember is that if you suspect you're experiencing a postpartum haemorrhage, you need to contact your doctor or call 000 immediately.
PPH is a medical emergency and needs to be treated as soon as possible, as the blood loss can lead to shock and maternal death.
Once you're receiving medical care, the doctor will examine you to find the cause of the bleeding. They'll also be monitoring your pulse and blood pressure, looking for signs of shock.
It's likely they'll perform blood tests and measure the amount of blood you've lost. They may also do an ultrasound to check for any problems with the uterus or placenta. The treatments of postpartum haemorrhage will depend on your symptoms and the cause of the bleeding [3].
If you've experienced significant blood loss, IV fluids, medications, oxygen, a blood transfusion and blood products may be required. To apply pressure to the bleeding vessels, they may use a Bakri balloon or a Foley catheter.
Medical professionals may perform a uterine massage to coax the placenta to pass. If the placenta hasn't fully passed, or is too deeply attached to the uterine wall to pass completely, surgery may be required to remove any remaining pieces.
Surgical intervention may also be necessary if there's been any tearing or injury that's causing the bleeding.
In life-threatening cases of severe postpartum haemorrhage, medical experts may need to perform a hysterectomy, where they remove the uterus completely, but this is considered a last resort.
How to prevent postpartum haemorrhage
By now, you'll know that PPH is a very unpredictable condition. It can happen during a short labour, a long labour, a vaginal birth or caesarean delivery, during the birth or up to 12 weeks after the birth.
It's rare, but serious, and can be deadly, so it makes sense that you'd want to know how to prevent it from happening!
Being able to spot the signs and symptoms of PPH will enable you to seek emergency care if you suspect you're experiencing a haemorrhage. Seeking help at the first sign that something's not right can reduce the amount of blood loss, which can stop you from going into shock.
The most important thing you can do is to have trustworthy medical care who can monitor your health throughout your pregnancy and assess your risk of postpartum haemorrhage.
If your medical team believes you're at risk of PPH, they'll advise that you forego any plans of a home birth in favour of a major hospital [3].
RANZCOG reports that "the use of some simple measures — receiving a small dose of medication to help the uterus contract after birth and assisting with delivering the placenta — all reduce the risk of heavy bleeding" [5].
Giving birth at a major hospital will ensure that you have access to any assistance, medication and blood products you may need, in the event of an emergency.
When should I call my doctor?
Usually, a postpartum haemorrhage will happen during the birth itself, often during the third stage of labour or soon after, while you're still in the hospital or near the appropriate medical care.
Still, it can happen in the days, weeks and months after the birth, and if this happens, you need to call your doctor or 000 as soon as possible.
Losing a lot of blood quickly can cause your blood pressure to plummet, which can put you into shock. Shock is when your organs aren't receiving enough blood, which can be fatal if not tended to immediately.
At Kin, we care about your postpartum health, and have a wide range of products available to new mums recovering from birth.
Whether you're feeling the sting of perineal tearing, or having issues breastfeeding, we have something that can help out.
Check out our Postpartum Recovery Bundle, C-Section Recovery Bundle and our complete postpartum range.
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