Heavy bleeding in the first 24 hours after giving birth is called primary postpartum haemorrhage (PPH). It's also known as early PPH.
Around 5 in 100 women will lose around 500ml (1 pint) of blood after giving birth. This is sometimes called, a minor PPH. If you are having a PPH you might feel dizzy or sick.
More severe PPHs or major PPHs are much less common. They happen to around 6 in 1,000 women.
When you may be at more risk of a primary PPH
Your risk of a heavy bleed in the first 24 hours after giving birth may be higher due to:
- your medical history
- previous pregnancies and births (obstetric history)
- how your pregnancy goes
- what happens during labour and birth
Medical history risk factors
You may be at a higher risk of a heavy bleed in the first 24 hours after giving birth if:
- you have had a PPH before
- your BMI is above 35
- you have conditions that affect how your blood clots (like bleeding disorders)
- you're taking blood thinners
- you have anaemia (a condition usually caused by low iron)
- you've had 4 or more babies before
- you are over 40 having your first baby
- you've had a previous caesarean birth
Pregnancy risk factors
You may be at a higher risk of a heavy bleed in the first 24 hours after giving birth if:
- there are problems with the placenta, for example placenta previa or placental abruption
- you have high blood pressure or pre-eclampsia
- you are having a multiple pregnancy
Birth and labour risk factors
You may be at a higher risk of a heavy bleed in the first 24 hours after giving birth if:
- you have a caesarean birth
- some of the placenta remains in your womb after the birth (retained placenta)
- there's a delay in birthing your placenta
- you're induced
- you have an Episiotomy
- you have an assisted vaginal birth (forceps or ventouse)
- you're having a big baby (over 4 kg or 9 lb)
- labour lasts more than 12 hours
- you're given a general anaesthetic (where you are put to sleep)
What you can do to prevent primary PPH
Try not to worry
Most people with risk factors won’t have a PPH. But if you do have risk factors you might be advised to give birth in a maternity unit. This is in case you need a blood transfusion.
Take iron if anaemic
If you are anaemic, follow the advice your midwife, GP or obstetrician give you. An iron supplement can reduce your chances of needing a blood transfusion. Each capsule should contain at least 100mg of iron.
Have scans to check the placenta
If you have previously had a caesarean, there is a small chance that your afterbirth during this pregnancy could attach to the scar. If your obstetrician or midwife think this might be happening, they'll advise you to have extra scans.
Oxytocin injection
You will be offered an injection of oxytocin into your thigh just as your baby is born. This is thought to reduce the risk of PPH by 60%.
Suturing cuts and tears
If you have had a vaginal birth, your midwife or obstetrician will need to examine you after the birth. This is so they can see if you have any tears. Any cuts or tears that are bleeding may need to be stitched.
Tell your midwife if you are on blood thinning medication
If you are taking aspirin or heparin make sure your midwife and obstetrician know this. They will tell you when to stop taking these medications before the birth.
Treating primary PPH
If you have given birth in a maternity unit, your midwife will usually need to call other members of staff to help. If you have given birth at home, you will need to go to the nearest maternity unit.
It can be alarming for you and your partner to see people rushing into the birthing suite. But each member of staff has their own role to play. Your midwife will tell you what is happening.
Your temperature, blood pressure and pulse will be checked often. You may be encouraged to breastfeed your baby. Your partner may be asked to leave the room for a few moments, especially if space is limited.
If you have had a caesarean birth, the midwife and nurses looking after you in the recovery room will call for extra help.
Your midwife or obstetrician might:
- Rub your lower tummy firmly - this is to encourage your womb to contract.
- Give you an injection into your thigh, even if you already had one.
- Put a drip into a vein. A drip is a small plastic tube that is placed into a vein, usually in your arm or hand. This tube can be used to give you extra fluid or blood.
- Take blood for testing.
- Examine you to see if you need any stitches.
- Check to see if any of the placenta (afterbirth) has been left in your womb.
- Put a tube called a catheter in your bladder.
Important
Tell your midwife, obstetrician or GP if you prefer not to receive blood or blood products for religious or cultural reasons. This can be written clearly in your medical notes.
If you continue to bleed your midwife and obstetrician might:
- Give you medications through the drip or into your back passage.
- Give you a blood transfusion.
- Put another drip in.
- Bring you to the operating theatre, to have an anaesthetic to find out what is causing the bleeding. They can also do procedures to help the bleeding to stop.
- Inserting a balloon into the womb. This is usually removed after 24 hours.
You and your partner will be told what is happening and why. Your baby will be cared for if you need to go to the operating theatre.
