Postpartum Hemorrhage

Some postpartum bleeding is to be expected after every delivery. After all, giving birth is a challenging (though rewarding) endeavor. However, in some rare cases, this bleeding can become more significant and more severe than is considered safe or normal. This is known as a postpartum hemorrhage.

A postpartum hemorrhage is a serious and possibly life-threatening condition. However, a positive outcome is very often achieved–especially when your OBGYN or Midwife is able to make a quick diagnosis and offer prompt management and treatment. 

Only about 1% to 5% of women will ever experience a postpartum hemorrhage (or PPH), making this a rare complication of childbirth. Still, because the condition can be so serious, your OBGYN or Midwife will be watchful for any symptoms, especially if some specific risk factors are present. 

What is a Postpartum Hemorrhage?

Birthing a child can be physically taxing–as those expecting a baby likely already know! Your OBGYN or Midwife will counsel you to expect a certain amount of bleeding, both during labor, birth and after your child has been born. 

Usually, this postpartum bleeding will stop on its own. After all, the human body is pretty good at birthing a baby! That means you have some natural ways to minimize damage, control bleeding, and promote healing after childbirth. But sometimes those mechanisms don’t work quite right or birth causes more damage than your body can handle. In those cases, you may start to bleed more than what is considered “normal” or uncontrollably.

This uncontrolled bleeding, which doctors call a postpartum hemorrhage, most commonly occurs within 24 hours of childbirth. Less often, a postpartum hemorrhage can present up to 12 weeks after you deliver your baby. 

A postpartum hemorrhage can cause a dangerous drop in your blood pressure. If left untreated, this condition can become life threatening. If you think you’re having a postpartum hemorrhage after discharge from the hospital, it’s essential to dial 911 or contact your healthcare provider immediately.

What Causes a PPH?

There is no single cause of postpartum hemorrhage. However, your OBGYN or Midwife will be able to point you towards behaviors, conditions, and other criteria which may increase your overall risk profile. The higher your risk profile, the more watchful your OBGYN or Midwife will be for signs of a PPH. 

Some of the most common causes and risk factors include the following:

• Having a hypertensive disorder during pregnancy or birth including chronic hypertension (existing before pregnancy), gestational hypertension (first presenting during the pregnancy) or preeclampsia (a more severe form of gestational hypertension).
• Problems with the placenta. This includes placental abruption (when the placenta detaches from the uterus too early in the process), retained placenta (when the placenta does not want to release from the uterine lining and causes more bleeding) and placenta previa (when the placenta covers or is near the cervical opening). 
• Having given birth multiple times.
• A long labor (especially if it lasts longer than usual).
• Stretching of the uterus: this can occur due to an excess of amniotic fluid, having multiple babies (i.e. twins) or a larger than typical baby.
• Some medications used to speed up or slow down the labor and birth process can increase your risk of a PPH even if deemed necessary.
• Disorders of the blood, including blood clotting disorders.
• Tears in any of the blood vessels of the uterus.
• Tears in the tissue of the vagina or cervix.

Chorioamnionitis

One significant risk factor associated with postpartum hemorrhaging is something called chorioamnionitis. This is a condition in which the amniotic fluids and the membranes surrounding the fetus (called the chorion and amnion) become infected with bacteria. 

Chorioamnionitis is itself a fairly serious condition, for both the mother and the baby. In some cases, the infection can lead to an increased heart rate in the baby, necessitating your baby be born immediately.

Among other symptoms, chorioamnionitis can cause a buildup of fluid in the uterus, which can then increase the risk of postpartum hemorrhage.

What Are the Symptoms of Postpartum Hemorrhage?

Symptoms of PPH may vary from individual to individual, as every person’s labor and birth experience is different and unique. However, the most common presentations of a postpartum hemorrhage include the following:

• A drop in blood pressure
• Rapid or increasing heart rate
• Uncontrolled vaginal bleeding
• Vaginal pain or swelling
• A decrease in your red blood cell counts

To diagnose a postpartum hemorrhage, your OBGYN or Midwife will attempt to assess how much blood you have lost (losing about 1000ml after a vaginal birth or C-Section is about normal). Your Midwife or OBGYN may also check for blood clots, take your blood pressure, or do some fast blood work to help gather information quickly and make an effective diagnosis. 

How is Postpartum Hemorrhage Treated?

There are several treatment options available for PPH, and your OBGYN and Midwife will work with you to determine the best course of action for your condition. The optimal treatment will depend on your family history, your overall health, and your symptoms. Additionally, your OBGYN or Midwife will attempt to gauge the severity of the bleeding as it is happening and treat accordingly.

Possible treatments include:

• Medication: One of the most commonly used medications is called oxytocin, which can help control bleeding. But there are several other medication types as well.
• Uterus massage: Your OBGYN or Midwife may employ uterine massage techniques to try to induce contractions (and these contractions can help put pressure on the uterus and minimize bleeding).
• Compression within the uterus: This is often accomplished using a Foley catheter or Bakri balloon–both devices that can apply pressure to the interior of the uterus. This compression can often stop the uncontrolled bleeding.
• Uterus packing: Your OBGYN or Midwife may attempt to place sponges and other sterile material into the uterus in order to place pressure on the bleeding area.

In some cases, more severe postpartum hemorrhaging may require more invasive and serious treatment. Those treatments could include:

• Surgery: If non-surgical methods do not work, your OBGYN or Midwife will need to perform surgery in order to locate the source of the bleeding. Once the source has been identified, your surgeon can begin treatment to stop the bleeding.
• Uterus removal: In the most severe and life-threatening cases, your OBGYN or Midwife may recommend a hysterectomy. This is usually a last resort option, as you will be unable to become pregnant after the procedure (and may face other hormonal changes as well). However, removing the uterus may be a life-saving option depending on the severity of your postpartum hemorrhage.

Can You Minimize Your Risk for PPH?

There are multiple known risk factors for postpartum hemorrhaging. If you have high blood pressure or develop gestational diabetes, for example, your OBGYN or Midwife may want to monitor you more closely for postpartum hemorrhaging. 

If your OBGYN or Midwife believes that you have a high risk of PPH, they may describe preventative actions and prescribe certain medications, such as oxytocin or misoprostol. These medications have been shown to help prevent hemorrhaging for many women. Having an IV placed on admission to the hospital and available to use for administering medications after birth can allow for quick decision-making to help reduce the bleeding if identified early on. 

You can also talk to your OBGYN or Midwife about lifestyle choices or activities that may increase or decrease your risk of developing a PPH. 

Rare and Treatable

It’s important to remember that a postpartum hemorrhage is both relatively rare and quite treatable. Though this is a serious and possibly life-threatening condition, prompt intervention can mean a positive outcome.  

If you’re worried about a postpartum hemorrhage, talk to your OBGYN or Midwife about what your risk factors may be and what treatment may include. Our midwives track their patients’ rates related to postpartum hemorrhage. If you’d like to learn more about those rates or have questions, please contact us at our Wilmette or Glenview locations.