Is it normal to bleed a lot after delivery?
women lose some blood as the placenta separates from the uterus and immediately
afterward. And women who have C-sections generally lose more than those who
give birth vaginally. But because the amount of blood in your body increases by
almost 50 percent during your pregnancy, your body is well prepared to deal
with this expected blood loss.
bleeding just after childbirth is primarily from open blood vessels in the
uterus, where the placenta was attached. (If you
had an episiotomy or tear during birth, you may also bleed from that site until
it's stitched up.)
As the placenta begins to separate, these vessels bleed into the
uterus. After the placenta is delivered, the uterus usually continues to
contract, closing off these blood vessels.
Your healthcare practitioner may massage your uterus and give
you a synthetic form of the hormone oxytocin (Pitocin) to help the uterus
contract. Breastfeeding, which prompts your body to release oxytocin naturally,
can also aid in the process.
Unfortunately, some women bleed too much after birth and require
special treatment. This excessive blood loss is called a postpartum hemorrhage
(PPH) and it happens in up to 6 percent of births.
most likely to occur while the placenta is separating or soon after. If it
happens within 24 hours after giving birth, it's considered an early PPH (also
called an immediate or primary PPH). If it happens in the days or weeks after
delivery, it's called a
late (or delayed or secondary) PPH.
might cause a PPH?
cervical lacerations, deep tears in your vagina or perineum, or even a large episiotomy
may be the source of a postpartum hemorrhage. A ruptured or inverted
uterus may cause profuse bleeding, but these are relatively rare occurrences.
systemic blood clotting disorder may cause a hemorrhage. (A clotting disorder
may be an inherited condition or it may develop during pregnancy as a result of
certain complications, such as severe preeclampsia or HELLP syndrome or a placental
abruption.) And a hemorrhage itself can cause clotting problems, leading to
even heavier bleeding.
the treatment for PPH?
There are a number of steps that your medical team will take
right away if you begin to bleed excessively. Since uterine atony (loss of
tone) is the most common cause of PPH, your caregiver will massage your uterus
to help it contract while you get intravenous oxytocin. (If you don't already
have an IV, the nurse will start one immediately.) You will also be
catheterized to make sure your bladder is empty since a full bladder makes it
more difficult for your uterus to contract.
If your placenta hasn't come out yet, your practitioner will
attempt to deliver it, which in some cases requires her to reach up inside your
uterus and remove it manually. You'll receive some pain medication before the
procedure, and if you're in a birthing room you'll be moved to an operating
If you start bleeding – or continue to bleed – from your uterus
after the placenta is out, you'll receive other medications in addition to
oxytocin while your caregiver continues to massage your uterus. In most cases,
the medication works very quickly and the uterus contracts, stopping the
If need be, your practitioner will insert a hand inside your
vagina and place her other hand on your belly, and compress your uterus between
her two hands. This measure in combination with medication is usually enough to
stem the tide.
If you continue to bleed, you'll be transferred to the operating
room and given pain medication to keep you comfortable. The doctor will
carefully check to make sure that there are no lacerations that appear to be
the primary source of your bleeding. She will also "explore" your
uterus (via your vagina) to check for fragments of the placenta that may remain.
In some cases, you'll need a procedure called dilation and curettage (D&C)
to remove them.
If your bleeding is extensive and doesn't stop or your vital
signs aren't stable, you'll get a blood transfusion. This is necessary only in
rare cases. Even more rarely, you'll need abdominal surgery and possibly a
hysterectomy to stop a hemorrhage.
Regardless of the cause of the hemorrhage, your blood pressure
and pulse will be taken frequently to help your caregiver gauge how your body
is coping with the blood loss. (This is done right after birth anyway to help
determine the amount of postpartum blood loss.) An abnormally low blood
pressure or high pulse will provide your caregiver with valuable information.
You'll also have blood tests to check for anemia and, if
necessary, to see whether your blood is clotting normally.
What's the recovery like?
You'll continue to receive IV fluids and medication after the
bleeding is controlled to help your uterus stay contracted, and you'll be
watched very closely for further bleeding and to see how you're doing in
general. You may feel weak and lightheaded. Don't try to get out of bed on your
Your recovery will depend in part on how much blood you lost and
what your "reserves" were to begin with – that is, how much your blood
volume had increased during pregnancy and whether or not you were anemic to
You'll probably develop anemia from the blood loss and will have
to take it easy when you get home from the hospital. You'll need to get plenty
of rest, fluids, and nutritious food. Your doctor will likely prescribe
prenatal vitamins with folic acid, as well as additional iron supplements.