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Haemorrhage—postpartum

What is a postpartum haemorrhage?

While it is expected that some blood will be lost as part of the normal birthing process, a postpartum haemorrhage (PPH) is excessive bleeding following birth. A primary PPH is when there is loss of more than 500 ml after a vaginal birth or 1000 ml following a caesarean section, in the first 24 hours.

Why did it happen to me?

Once your baby is delivered, your uterus will usually contract again to help expel the placenta and to reduce the bleeding through the big blood vessels which were supplying it. The most common cause of a primary PPH is the uterus failing to contract, as expected, after birth. This is more common when the labour has been very long or when the uterus has been stretched more than usual e.g. if you had twins, extra amniotic fluid around the baby or a large baby. Other common causes of PPH are when the placenta doesn’t come away as it should or if the walls of the vagina tear as the baby is being delivered.

How often does this happen?

Between 5 and 10% of women giving birth will experience a postpartum haemorrhage. It is more common after assisted vaginal birth including caesarean section.

Can a PPH be prevented?

Routine maternity care includes a discussion about how delivery of the placenta will be managed.

Although birthing is a normal process, evidence shows that significant postpartum bleeding may occur where medical help is not available. For this reason midwives and doctors discuss the use of a drug to help with delivery of the placenta which has been shown to decrease the risk of the bleeding. For women with additional risk factors for bleeding several medications are often used together to limit the amount of blood lost from the mother at the time of birth.

What happened when there was heavy bleeding after my baby was born?

Your midwife and doctors would have done several things to try to find the cause of bleeding:

  • examined you to see if there was any evidence of a tear in your vagina or cervix and to feel how well your uterus had contracted
  • assessed you for signs of shock by measuring your pulse and blood pressure.

Whether the cause is found immediately or not, there are treatments that are started straight away and these include:

  • a needle (IV) may have been inserted in your vein
  • your uterus may have been massaged
  • a catheter may have been inserted into your bladder
  • blood tests may have been taken
  • medication may have been given
  • you may have been offered a blood transfusion.

What happens if the bleeding doesn’t stop with these treatments?

If you continued to bleed an abnormal amount, after treatment as outlined above, the doctor looking after you may have recommended that you had an examination under an anaesthetic to look for the cause of the bleeding and, if possible, try to control it. This is usually done using a regional (spinal or epidural) or general anaesthetic and the anaesthetic team would decide which is safest for you.

What can happen in the operating theatre?

Most of the time there are big blood clots in the uterus and once they are removed and some medication is given the bleeding settles down. If there are tears in the vagina or cervix these would be repaired under this anaesthetic. If bleeding continued and none of theses treatments helped, other measures to control bleeding may be used and they include:

  • insertion of a balloon into the uterus to put pressure on the place where the placenta was attached
  • making a cut in your tummy (laparotomy) to perform other procedures which can help to control the bleeding.
  • Where possible everything is done to conserve your ability to have more children in the future however, if none of these measures worked it would have been necessary to perform a hysterectomy—this is very rare and would mean it is not possible for you to have any more children. If a hysterectomy was required, your ovaries would not usually have been removed so, although you will not have any more periods, you will not commence menopause.

Feelings that may be experienced after a PPH

It is common for a mother in this situation to be shocked and therefore your memory of what has happened is often limited. The support people with you are usually more significantly affected as they observed the whole process and may need to have some time to discuss what occurred and to be reassured you are going to be okay.

What happens after a postpartum haemorrhage?

Once the abnormal bleeding has been controlled the medical and midwifery staff will monitor you very regularly for any changes in your condition. You may have more blood tests to see if your kidneys and blood clotting are normal. Your blood pressure, pulse, urine output (through a catheter) and your vaginal bleeding will be closely monitored. If you had an operation a drain may have been inserted near your wound to check for any internal bleeding. If a balloon was inserted into your uterus this is usually removed, through the vagina, the following day. Initially you may be cared for in the labour ward or intensive care unit (ICU).

Gradually, as it becomes evident that the high risk time has passed, you will be able to transfer to the postnatal unit and start to be more involved in looking after your baby. You may be quite anaemic and it may be very tiring trying to manage everything to begin with. The catheter in your bladder and the drip (IV) in the veins in your arm will be removed once it is clear you no longer need them.

Do I have an increased risk of postpartum haemorrhage next time?

Studies estimate a risk of up to 15% for recurrence in the next and any subsequent pregnancy. It is important that the midwifery and medical team looking after you in any future pregnancy know you had a postpartum haemorrhage as there are some treatments they can use to reduce the risk of it happening to you again.

© 2010 Mater Misericordiae Ltd. ACN 096 708 922

Mater acknowledges consumer consultation in the development of this patient information.
Mater Doc Num: PI-CLN-430051
Last modified 09/8/2017.
Consumers were consulted in the development of this patient information.
Last consumer engagement date: 07/4/2014
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