What is Childbirth, heavy bleeding?

Childbirth, heavy bleeding

What is heavy bleeding after childbirth?

It's normal to have some bleeding when you give birth. But if you lose a pint or more of blood, it means your bleeding is heavy.

Doctors call heavy bleeding after childbirth postpartum hemorrhage. If you lose about a quart or more of blood after childbirth, then you have severe postpartum hemorrhage.

Source:
Maughan KL, Heim S, Galazka SS.
Preventing postpartum hemorrhage: managing the third stage of labor.
American Family Physician. 2006; 73: 1025-1028. Available at http://www.aafp.org (accessed on 27 January 2009).

It can be difficult for doctors to tell exactly how much blood you lose after you have a baby. But your doctor or midwife will monitor you carefully after your baby is born to check that you're not losing too much blood. They will look at how much you are bleeding, and check your

blood pressure
Blood pressure is the amount of force exerted by the blood on the walls of the vessels that carry it. You can think of it like the water pressure in your home: the more pressure you have, the faster and more forcefully the water flows out of the shower. Blood pressure is measured in millimeters of mercury (written as mm Hg). When your blood pressure is taken, the measurement is given as two numbers, for example 120/80 mm Hg. The first, higher, number is called the systolic pressure, and the second, lower, number is the diastolic pressure. The systolic number is the highest pressure that occurs while the heart is pushing blood into the arteries. The diastolic number is the lowest pressure that happens when the heart is relaxing and is not pushing the blood.

blood pressure,

pulse rate
Your pulse rate is the number of times that your heart beats in one minute. A normal rate is between 60 and 100 beats per minute, but the heart can speed up under certain circumstances, such as when you exert yourself or when you have an infection.

pulse and general health. These things will help them decide if you're losing too much blood and need treatment.

Heavy bleeding (

hemorrhage
Hemorrhage is a word doctors use for bleeding. Any time blood escapes from a blood vessel, it's called a hemorrhage.

hemorrhage) can happen during the first 24 hours after you give birth or up to six weeks later.

If you get heavy bleeding within 24 hours of giving birth, it's called primary postpartum hemorrhage.
If you get heavy bleeding after the first 24 hours and up to six weeks later, it's called secondary postpartum hemorrhage. If you are at home and think you're bleeding heavily and you feel dizzy and weak, call your doctor right away. You may need treatment.

Bleeding heavily after having a baby is a problem because:

It can lead to

anemia
Anemia is when you have too few red blood cells. Anemia can make you get tired and breathless easily. It can also make you look pale. Anemia can be caused by a number of different things, including problems with your diet, blood loss and some diseases.

anemia (when you have a low number of

red blood cells
Red blood cells are the part of your blood that makes it red. Their main job is to carry oxygen from your heart and lungs out to the tissues of your body. Once these cells unload oxygen, they pick up carbon dioxide. They take carbon dioxide back to your lungs so you can breathe it out of your body.

red blood cells in your body)
You may need a

blood transfusion
If you've lost too much blood from your body, you may need a blood transfusion to replace it. People with diseases of their blood, like sickle cell anemia, sometimes need blood transfusions to replace blood that doesn't work right.

blood transfusion
You can die because of it. But this is rare.

Most women who bleed heavily after they've had a baby do so because their uterus (womb) doesn't shrink (contract) properly. Doctors call this uterine atony. As your uterus contracts and separates from your

placenta
The placenta is an organ that grows in the womb during pregnancy. It joins the woman to the growing baby. The placenta provides the baby with oxygen, water and nutrients from the mother's blood. It also produces the hormones that are involved in pregnancy.

placenta (afterbirth), the blood vessels in your uterus close up. If some of the placenta doesn’t come away completely, the uterus can’t contract properly and the blood vessels will continue bleeding. The treatments we talk about here are given to help the uterus shrink after childbirth. (See What treatments work to prevent heavy bleeding after childbirth?)

Other problems that also can cause heavy bleeding after childbirth are:

Source:
Chelmow D, O'Brien B.
Postpartum haemorrhage: prevention.
April 2006. BMJ Clinical Evidence. Available at http://www.clinicalevidence.com (accessed on 27 January 2009).

Bits of the placenta getting stuck in your uterus after delivery, instead of coming out
Cuts or tears around your vagina or

cervix
The cervix is a piece of tissue that sits between a woman's womb and her vagina. It has a small opening in it that gets much bigger when a woman is having a baby.

cervix (the opening of the uterus) during delivery
A hole or tear in your uterus
Your blood not clotting normally.

Certain things make it more likely that you'll have heavy bleeding after childbirth. These are called risk factors. Having a risk factor doesn't mean you'll bleed heavily for sure. And women without the risk factors can still have problems. But if you have a risk factor, you have a greater chance of having heavy bleeding than a woman who doesn't have any risk factors.

Some risk factors for heavy bleeding after childbirth are:

Source:
National Institute for Health and Clinical Excellence.
Intrapartum care: care of healthy women and their babies during childbirth.
September 2007. NICE clinical guideline 55. Available at http://www.nice.org.uk/cg055 (accessed on 27 January 2009).

Having heavy bleeding after a previous birth
Having

anemia
Anemia is when you have too few red blood cells. Anemia can make you get tired and breathless easily. It can also make you look pale. Anemia can be caused by a number of different things, including problems with your diet, blood loss and some diseases.

anemia when you go into labor
Being very overweight (obese)
Bleeding during your pregnancy (after 24 weeks)
Having a low-lying placenta
Being over 35
Having twins
Having a condition in which you have extra fluid in your uterus during pregnancy (called polyhydramnios)
Being in labor for a long time (more than 12 hours)
Being in the third stage of labor for a long time (more than 30 minutes). The third stage of labor is the time between when your baby is born and when you deliver the placenta (afterbirth)
Having a drug called oxytocin (brand name Pitocin) to start your labor and make your contractions stronger
Having had many pregnancies (more than four)
Having a uterus that didn't shrink properly after a previous pregnancy
Having preeclampsia. Preeclampsia is a condition where you have

high blood pressure
Your blood pressure is considered to be high when it is above the accepted normal range. The usual limit for normal blood pressure is 140/90. If either the first (systolic) number is above 140 or the lower (diastolic) number is above 90, a person is considered to have high blood pressure. Doctors sometimes call high blood pressure "hypertension."

high blood pressure, swelling and

proteins
A lot of your body's tissues are made out of proteins. Proteins can be made in your cells. Proteins are also part of the food you eat, particularly meat and dairy products. Your body breaks down the protein you eat into amino acids. Your cells then use these amino acids to build new proteins, which make up muscles, joints, hair and other parts of your body.

protein in your urine during pregnancy. To learn more, see Preeclampsia
Being in labor for the first time
Having a cut to make your vagina wider during childbirth (these cuts are called episiotomies). To learn more, see Childbirth, tear or cut
Having your baby delivered with the help of instruments (such as a vacuum pump or forceps).

Being in labor for a long time can make you more likely to have heavy bleeding.

Sources for the information on this page:

Maughan KL, Heim S, Galazka SS.Preventing postpartum hemorrhage: managing the third stage of labor.American Family Physician. 2006; 73: 1025-1028. Available at http://www.aafp.org (accessed on 27 January 2009).

Chelmow D, O'Brien B.Postpartum haemorrhage: prevention.April 2006. BMJ Clinical Evidence. Available at http://www.clinicalevidence.com (accessed on 27 January 2009).

National Institute for Health and Clinical Excellence.Intrapartum care: care of healthy women and their babies during childbirth.September 2007. NICE clinical guideline 55. Available at http://www.nice.org.uk/cg055 (accessed on 27 January 2009).

This information was last updated on Feb 05, 2009

This information is for educational use only, and is not a substitute for prompt professional medical advice. Readers should always consult a physician or other professional for advice and treatment.
© BMJ Publishing Group Limited 2009. All rights reserved.

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