What is a Postpartum Hemorrhage?

Postpartum hemorrhage is defined as excessive bleeding after labor and delivery. It can become a medical emergency if it is not addressed immediately. The signs of postpartum hemorrhage, including heavy bleeding and fatigue, are generally easy to recognize and there are a number of treatments available. This complication appears in less than five percent of births and can often be managed with minimally invasive techniques.

In a vaginal delivery, blood loss of more than half a quart (500 milliliters) is considered postpartum hemorrhage. For Cesarean births, where surgery will contribute to additional blood loss, the threshold is higher, a full quart (one liter) of blood. The most common cause of postpartum hemorrhage is uterine atony, where the uterus fails to contract after the birth, allowing blood to flow freely from the site where the placenta was located. Other causes can include retained placenta or uterine trauma.

Postpartum hemorrhage can set in anywhere within 24 hours of a birth. Bleeding more than a day after the birth is considered a secondary hemorrhage. Some bleeding after birth is normal and expected, but if the patient bleeds heavily and quickly soaks through sanitary pads, it can indicate a postpartum hemorrhage. The patient may also feel weak or dizzy from blood loss, and can appear pale or clammy. These severe symptoms set in with advanced hemorrhages.

One immediate and sometimes highly effective treatment is uterine massage to encourage the uterus to start contracting and clamping down, stopping the flow of blood. Immediate breastfeeding after birth, if possible, also helps the uterus contract, as breastfeeding causes hormones associated with uterine contractions to be released. Medications can also be administered to force the uterus to contract. In the case of retained placental fragments or trauma, surgery may need to be the first line of treatment. In extreme cases, a hysterectomy to remove the uterus may be the best option.

While preparing for labor and delivery, people may find it helpful to talk with an obstetrician about what to expect, so they can be alert to the early warning signs of a medical emergency. Talking about potential complications and their treatments can also help dispel some of the fears associated with childbirth, in addition to keeping the patient more calm in the event of an obstetrical emergency. Knowing what to expect if complications like postpartum hemorrhage develop can reduce stress and anxiety and may result in a more positive treatment outcome.