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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.¹

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

Heavy bleeding (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 (when you have a low number of red blood cells in your body)
• You may need a 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 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:²

• Bits of the placenta (afterbirth) getting stuck in your uterus after delivery, instead of coming out
• Cuts or tears around your vagina or 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:^{1 3}

• Having heavy bleeding after a previous birth
• Having 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 4)
• Having a uterus that didn't shrink properly after a previous pregnancy
• Having preeclampsia. Preeclampsia is a condition where you have high blood pressure, swelling and 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).

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 2008. All rights reserved.