Postpartum haemorrhage

Postpartum haemorrhage (PHH) is heavier than normal bleeding from the vagina in the 6 weeks after giving birth.

PPH can happen:

• within 24 hours of giving birth - primary postpartum haemorrhage
• 24 hours to 6 weeks after giving birth - secondary postpartum haemorrhage

Treatment for PPH is usually medicine to help your womb contract. For example, oxytocin. If the bleeding continues, you may need a blood transfusion or a procedure.

If you are at risk of PPH, your midwife may offer you an injection of oxytocin during labour to prevent heavy bleeding.

Normal bleeding after birth

You will have some bleeding from your vagina after a vaginal birth or a caesarean birth.

The bleeding can last for up to 6 weeks. It is usually the heaviest straight after the birth and gradually reduces.

The blood is bright red at first and becomes more brown over the weeks.

Heavy bleeding after birth

Heavy bleeding means you lose 500ml (1 pint) or more of blood within 24 hours of giving birth.

Your midwife is trained to know if you are bleeding heavily.

Primary postpartum haemorrhage

Primary postpartum haemorrhage (PPH) is heavy bleeding within 24 hours of giving birth. It is also called early PPH.

Risk of having a primary PPH

Your risk of primary PPH may be higher due to:

• your medical history, including a high body mass index (BMI)
• previous pregnancies and births (obstetric history)
• how your pregnancy goes - for example pre-eclampsia or multiple pregnancy
• what happens during labour and birth - for example, episiotomy or an assisted vaginal birth

Most people with risk factors do not have a PPH. But if you have some risk factors, you usually need to give birth in a maternity unit. This is in case you need a blood transfusion.

Preventing primary PPH

To prevent primary PPH your midwife, GP or obstetrician will recommend that you:

• take iron supplements if you have anaemia
• have an oxytocin injection just after the birth

They may also recommend extra scans to check the placenta - especially if you had a previous caesarean.

Tell them about any blood-thinning medicines you take, such as aspirin or heparin. They will tell you when to stop taking these medicines before the birth.

After a vaginal birth, your midwife or obstetrician will examine you. This is to check for any cuts or tears. They will give you stitches if you need them.

Treating primary PPH

Your midwife or obstetrician will examine you. They will check if you need stitches or if any placenta is still in your womb.

To reduce the bleeding, your midwife or obstetrician will:

• recommend that you breastfeed your baby if possible
• rub your lower tummy firmly to help your womb to contract
• give you an injection into your thigh, even if you already had one

To help with the treatment, they may need to:

• put a drip into a vein in your arm or hand - this is a small plastic tube to give you extra fluid or blood
• put a tube called a catheter in your bladder
• check your temperature, blood pressure and pulse often
• take blood for testing

When you are getting treatment, more staff may come into the room quickly. Your partner may be asked to leave for a few moments.

If the bleeding does not reduce

If you continue to bleed, your midwife and obstetrician may:

• give you medicine through a drip or in your bottom
• give you a blood transfusion
• put in another drip for extra fluids or other medicines

They may need to take you to an operating theatre and do a procedure to:

• find the cause of the bleeding
• help reduce the bleeding
• insert a balloon into the womb - they usually remove this after 24 hours

The team will tell you and your partner what is happening and why. Staff will care for your baby if you need to go to the operating theatre.

Secondary postpartum haemorrhage

Secondary postpartum haemorrhage (PPH) is heavy bleeding between 24 hours and 6 weeks after giving birth. It is also called delayed PPH.

Secondary PPH can happen because of:

• an infection – usually in the lining of your womb (endometritis)
• some placenta remaining in your womb after the birth (retained placenta)

Treating secondary PPH

Treatment for secondary PPH is usually antibiotics.

You may need to go back to the maternity unit if:

• your bleeding is very heavy
• you keep bleeding after taking the antibiotics

Treatment in hospital

In the hospital, you may have:

• antibiotics through a drip
• a scan to check if any placenta is still in your womb

If your obstetrician thinks there may be placenta in your womb, you may need an operation to remove it.

Your baby can stay with you and you can continue to breastfeed.

After a postpartum haemorrhage

Losing a lot of blood after you give birth can make you feel very tired and weak.

Your doctor:

• may advise that you take iron tablets for a few weeks
• will give you medicine to prevent blood clots in your legs or lungs
• will plan a follow-up appointment in the hospital to see how you are doing

It's normal to have upsetting and confusing thoughts after a difficult experience.

Pregnancy after having a postpartum haemorrhage

You are at increased risk of another PPH during another pregnancy, if you had one before.

If you get pregnant again, you usually need to:

• see an obstetrician at the hospital for most of your appointments
• take an iron supplement in pregnancy to reduce the chance of anaemia
• have a drip put in during labour for fluids or medicine
• have medicine to contract your womb immediately after the birth