Bleeding after delivery is normal. In fact, women usually lose about half a quart of blood during a vaginal birth and one quart of blood after a C-section. But when you lose excessive amounts of blood after childbirth — called a postpartum hemorrhage (PPH) — you can experience dangerous complications like a drop in blood pressure and even shock (when your body’s organs don’t get enough blood).
What is postpartum hemorrhage?
Postpartum hemorrhage is excessive, uncontrolled blood loss that usually occurs within a day after giving birth, but can sometimes take place up to 12 weeks after delivery. The bleeding can be from the site where the placenta was attached to the uterus, or can stem from unrepaired vaginal or cervical tears.
An infection can also trigger a postpartum hemorrhage in the days or weeks following delivery.
How common is postpartum hemorrhage?
Thankfully, postpartum hemorrhage is relatively rare, occurring in up to five percent of deliveries.
You’re more likely to have postpartum hemorrhage, however, if you’ve already had one before.
Normal lochia vs. postpartum hemorrhage: What’s the difference?
Normal lochia (i.e., postpartum bleeding) tends to be darker in color — somewhat like your menstrual period, only heavier. The blood from a postpartum hemorrhage, on the other hand, can be bright red in color and excessively heavy, causing you to soak through more than one a sanitary pad an hour, and is accompanied by symptoms of low blood pressure, like dizziness, breathlessness or a racing heart.
Here’s how to distinguish between normal postpartum bleeding and a postpartum hemorrhage:
Normal postpartum bleeding signs include:
- Dark red blood that can last for up to 10 days after giving birth
- Light bleeding and spotting that can last for up to four to six weeks after delivery
Some of the symptoms of a postpartum hemorrhage include:
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- Soaking through more than one sanitary napkin an hour
- Bright-red bleeding for more than a few days
- Passing very large blood clots (think: the size of a lemon or larger)
- Faintness, breathlessness, dizziness or a racing heart
- Nausea or vomiting
- Swelling and pain around the vagina or perineum (the area in between the vagina and rectum)
Who is most at risk for postpartum hemorrhage?
Some pregnancy complications can increase your risk for postpartum hemorrhage, including:
- Having a uterus that doesn’t contract well after birth. Uterine contractions help stop the bleeding from the area where the placenta breaks away from the uterus.
- Having a uterus that becomes overdistended. This can be due to twins or multiples or a large baby.
- Uterine inversion, a rare childbirth complication that occurs when part of the uterine wall collapses and turns inside out.
- Uterine rupture, when an area of the uterine wall tears during labor.
- Placenta previa, a pregnancy complication in which the placenta implants low in the uterus.
- Placenta abruption, when the placenta separates from the uterine wall before delivery.
- Hydramnios, a condition in which too much amniotic fluid builds up during pregnancy.
- Taking drugs or herbs that interfere with blood clotting, such as aspirin, ibuprofen, ginkgo biloba or large doses of vitamin E.
About one in five postpartum hemorrhages occur in women with no risk factors.
How is postpartum hemorrhage diagnosed?
You or your doctor or nurses may notice the symptoms of postpartum hemorrhage. Your doctor may also do a pelvic exam to check your uterus as well as weigh the number of blood-soaked pads and sponges to determine how much blood you may have lost.
What are potential complications of postpartum hemorrhage?
Postpartum hemorrhage is responsible for approximately 10 percent of all pregnancy-related deaths. While most women recover well from postpartum hemorrhage, an untreated postpartum hemorrhage can lead to a severe drop in blood pressure that can cut off blood flow to vital organs and lead to shock and even death. The loss of large amounts of blood can make you feel faint, breathless, dizzy or cause your heart to speed up.
How is postpartum hemorrhage treated?
After the placenta is delivered, your practitioner will examine it to make certain that it’s complete — that no part of it is remaining in your uterus. (If part of the placenta is still in the uterus, it may cause bleeding.)
Your doctor may also massage your uterus to encourage it to contract and suggest that you begin breastfeeding as soon as possible, if you are planning on doing so, which will also help your uterus to contract.
If the bleeding is severe, you may need intravenous fluids (IV) or possibly even a blood transfusion.
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