Hemorrhage

It's normal to lose some blood after giving birth. When the placenta separates from the uterine wall, the resulting wound bleeds until the blood vessels close off with help from your contracting uterus. And since your body's blood volume increases by about 50 percent during pregnancy, some blood loss won't affect your health.

But sometimes, women bleed too much after giving birth, which is called a postpartum hemorrhage. This happens in up to 5 percent of all births, and is most likely to happen while the placenta is separating or soon afterward.

Alert

Sometimes, a mother will hemorrhage days or even weeks after birth. This rare but serious condition is called a late or delayed postpartum hemorrhage and is usually caused by retained membranes or tissue in the uterus. If you experience unexpected heavy bleeding days or weeks postpartum, lie down, stay warm, nurse your baby if possible, and call 911.

A few things can make it more likely that you'll bleed too much after giving birth. One cause of postpartum hemorrhage (PPH) is called uterine atony, which means that your uterus has difficulty contracting effectively after birth because it's been overstretched or is tired out. If your labor was induced or augmented with pitocin, you're more likely to experience postpartum hemorrhage. Also, if your uterus was stretched due to an overabundance of amniotic fluid or because you were pregnant with multiples, or if your uterus tired out due to a very long or very short labor, you may be at a higher risk of postpartum hemorrhage.

Another cause of PPH is when your placenta doesn't separate from the uterus quickly enough, or only separates partially, leaving behind exposed blood vessels. This is most often caused by someone pulling on the cord or massaging the uterus too roughly. Uterine fibroids, large blood clots, or fragments of placenta left behind can also make it difficult for your uterus to contract effectively.

Essential

A condition called placenta accreta, when the placenta is implanted too deeply in the uterus and can't separate, can also cause postpartum hemorrhage. The risk of placenta accreta grows with each c-section you have. Placenta accreta is diagnosed shortly after birth and is rare but serious.

Episiotomies or tears in your cervix, vagina, or perineum can also cause some postpartum bleeding. Generally, the amount of bleeding from a tear or episiotomy isn't something to be worried about, but if the episiotomy is large or you have deep or extensive tears, you could lose a considerable amount of blood.

Women with blood-clotting disorders — which can be due to a pregnancy-related condition like pre-eclampsia or a placental abruption — are more likely to bleed heavily. And very rarely, a ruptured or inverted uterus can cause hemorrhage.

Prevention

Like other postpartum complications, your care provider and birth experience can have a significant impact on how much you'll bleed after giving birth. Frequent trips to the bathroom and breastfeeding early and often can help your uterus contract effectively and limit bleeding.

Treatment

If you're bleeding too much after giving birth, your care provider will first determine where the bleeding is coming from. You'll be given an IV to keep your blood pressure up. If the bleeding is coming from an episiotomy or tear, your doctor or midwife will stitch it, and that should stop the bleeding. If the bleeding is coming from your uterus and your placenta has not yet come out, your doctor or midwife may have to manually remove it, or he or she may have to remove blood clots or retained placenta fragments. You may receive a shot or an IV of oxytocin, and your caregiver will massage your uterus to help it contract. Your caregiver may need to massage your uterus directly, with one hand on your belly and one hand inside your vagina.

Question

I've heard that some women require a dilation and curettage (D&C) after giving birth. Could this happen to me?

If your doctor or midwife is unable to get placenta fragments out any other way, a D&C, abdominal surgery, or even a hysterectomy could be required. It's extremely rare, though, and it's very unlikely that it will happen to you.

During the time that your care provider is assessing and treating the bleeding, your blood pressure and pulse will be monitored to give signs as to how you're coping with blood loss.

Recovery after Hemorrhage

If you hemorrhage, you'll continue to receive IV fluids and medication to help your uterus stay contracted after the bleeding is under control, and you'll be watched closely for further bleeding. How long it takes to recover and how you'll feel afterward will depend on how much blood you lost, how much your blood volume increased during your pregnancy, and whether or not you were anemic. You may feel dizzy, weak, or lightheaded, and you'll need help getting out of bed. Be sure to get lots of rest, drink plenty of fluids, and eat nutritious food. You may want to take an iron supplement. Floradix is a good choice: it's a food-based iron supplement that's well absorbed by your body and won't cause constipation. Rarely, blood transfusions may be necessary after a hemorrhage.

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