Once the patient delivers the placenta after the birth, her womb (uterus) should contract strongly to shut off the blood vessels where it was attached. The most common reason for heavy bleeding soon after the birth is the womb not contracting down properly. Uterine atony is the medical term used for this.
Naturally the womb does contracts in the third stage of labour making the placenta peel away and then pushing it out. A routine method should take place in third stage, which involves an injection to help the womb to contract down and then your nurse helps to deliver the placenta.
One can reduce the risk of heavy bleeding soon after the birth after having an injection.
Losing 500 ml or more of blood in the first 24 hours after having a baby is referred to as a primary postpartum haemorrhage (PPH). It is very common for women to have a minor PPH, losing between 500 ml and 1000 ml of blood after birth, and most of the patients are able to cope physically well with a blood loss of this amount.
A major primary postpartum haemorrhage (PPH) would be blood loss of over 1000 ml. Major PPH after a vaginal birth is rarer and more serious. If nurse founds a very heavy bleed after the birth, the patient is likely to find herself suddenly surrounded by doctors and nurses, all there to give you emergency treatment.
Though it's not always the case, primary primary postpartum haemorrhage (PPH) is more likely to happen because of uterine atony if the patient:
- was bleeding prior giving birth (ante partum hemorrhage)
- had an over-stretched womb because of a big baby, twins or polyhydramnios
- went through primary PPH before (this applies to 15% to 25% of cases)
- is having a low-lying placenta
- is obese
- is anemic
- is aged over 40
- is having a very short or very long active labour
- is having an induced labour or speeded-up labour
- became pregnant using assisted conception
If the patient has gone through heavy bleed after the birth, she may feel the blood trickling out of her vagina, or it may build up inside womb or vagina. One should not even be aware of PPH until other signs and symptoms appear, like:
- reduced blood pressure
- increase in your pulse rate
- faint and dizzy feeling
The nurse will regularly check the top of the patient's womb after she has given birth to ensure it stays firm and contracted. If it is soft, the nurse will encourage a contraction by massaging the patient's tummy. She'll also monitor the patient's vaginal blood loss to make sure it isn't too heavy.
The nurse will treat the patient with drugs via a drip, injection, or a suppository to help womb to contract down. If the patient has a tear, the midwife or doctor will carefully stitch it.
The doctor may also give the patient some iron tablets to help her blood levels return to normal. If the patient loses a lot of blood, she may need a blood transfusion, but this is rare.
There are several other reasons why heavy bleeding may occur after the birth, which are less common than uterine atony. These include:
- Retained placenta or membranes left behind in the patient's womb after the birth, which stop the blood vessels sealing off properly.
- Injury to the patient during the birth, as a result of a planned or emergency caesarean birth. Greater blood loss is expected on average during a caesarean birth when compared with vaginal birth, particularly in an emergency caesarean.
- Injury to the patient during an assisted birth. This is usually associated with forceps rather than ventouse, episiotomy or tears to the patient's vagina or perineum, or more rarely, an injury to her cervix.
- Complications that affect the ability of the patient's blood to clot including pre-eclampsia, gestational hypertension or having a fever in labour.
Losing 500 ml or more of blood between 24 hours and 12 weeks after having baby is called secondary PPH. It's most common in the second week. However secondary PPH only happens in less than 1% of births.
If the patient is at home and passes a clot larger than a 50p piece or have a sudden gush of blood, then contact nurse or maternity unit as soon as possible. If the patient can keep hold of the clot she has passed then this will help the nurse assess the situation when she examines the patient.
One is more likely to have secondary PPH if the patient had a primary PPH or a retained placenta.
The bleeding may be due to small pieces of the placenta or membrane being retained in the womb, or an infection. If this is the case, the patient may need to have some antibiotics to clear the infection or doctor may need to perform a minor operation to remove tissue fragments from your womb.
One should take care of the nursing home before having a delivery there as that nursing home has the facility of blood back up or not. If not, then don't opt for that nursing home as further it can be a severe complication if not taken care off.