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Is it normal to bleed after delivery?

Postpartum haemorrhage refers to the loss of more than 500 mL of blood after delivery.          All women lose some blood immediately after giving birth, and women who have a C- sectiongenerally lose more than those who deliver vaginally. Your body is well prepared to deal with a certain amount of blood loss because your total blood volume increases by almost 50 percent during pregnancy.

Normal bleeding just after childbirth usually happens when the placenta begins to separate from the uterus. As the placenta detaches, it leaves open blood vessels that bleed into the uterus. After the placenta is delivered, the uterus usually contracts, closing off these blood vessels and stopping the bleeding. (You may also bleed from an episiotomyor tear you get during delivery.)Your doctor may help your uterus contract by pressing firmly on your abdomen. You may also get a synthetic form of the hormone oxytocin (Pitocin) Breastfeeding also helps because it prompts your body to release oxytocin naturally.

Unfortunately, some women bleed so much after giving birth, that further treatment is necessary. This excessive blood loss is called a postpartum haemorrhage (PPH), and it happens in up to 5 per cent of births.

Haemorrhaging within 24 hours after giving birth is considered an early PPH (also called an immediate or primary PPH). When it happens in the days or weeks after delivery, it’s a late (or delayed or secondary)PPH.

What might cause a postpartum haemorrhage?

The most common cause of PPH is uterine atony, which means the uterus isn’t contracting effectively after delivery. This is more likely to happen if you gave birth to a very large baby or if your labor was either rapid or prolonged.

Other risk factors for uterine atony include:

  • Obesity
  • Previous PPH
  • Having multiples
  • Previous pregnancies

However, many women who have a PPH don’t have any risk factors.

Having fibroids or any kind of infection can lead to a PPH, and occasionally it may result from such pregnancy complications as placenta previa, cervical lacerations, and deep tears in your vagina or perineum or even a large episiotomy can be other sources of bleeding. Finally, a systemic blood clotting disorder may cause a haemorrhage. This maybe an inherited condition or one that develops during pregnancy from complications such as severe pre- eclampsia or a placenta abruption. A haemorrhage can also cause clotting problems, leading to even heavier bleeding.

What's the treatment for PPH?

There are a number of steps that your health provider will take right away if you begin to bleed excessively.

  • Your provider will massage your uterus by inserting one hand inside your vagina, placing her other hand on your belly, and gently compressing your uterus between her two hands. She’ll also remove clotted blood from inside your uterus to help it contract.
  • You’ll also be given intravenous oxytocin, and your provider may insert a catheter to empty your bladder. (A full bladder makes it more difficult for your uterus to contract.)
  • You may get other medications in addition to oxytocin, and in most cases, the medication works very quickly to contract the uterus and stop the bleeding.

If you continue to bleed, you’ll be transferred to the operating room and given pain medication. Your provider will do a pelvic exam to check for lacerations that could be the source of the bleeding as well as any fragments of the placenta that are still attached to your uterus. You may need stitches to repair any tears or a procedure called dilation and curettage (D&C) to remove the remaining placenta.

You may have a tiny “balloon” placed in your uterus. This creates pressure against the uterine walls to compress blood vessels and encourage blood clotting. In rare cases (like if bleeding doesn’t stop or your vital signs aren’t stable), you may get a blood transfusion. Even more rarely, a hysterectomy is necessary to stop a haemorrhage. (The risk of needing a hysterectomy is much higher if you have abnormal placentationor if you’ve had a previous C-section.)

After the bleeding is controlled, you’ll continue to receive IV fluids and medication to help your uterus stay contracted, and you’ll be watched very closely to make sure the bleeding doesn’t resume and to monitor your overall health.

As part of routine postpartum care, your blood pressure and pulse will be taken frequently to help your provider gauge how your body is coping with the blood loss. An abnormally low blood pressure along with high pulse rates is a sign of significant blood loss and alerts your provider to intensify management.

You’ll also have blood tests to check for anaemiaand, if necessary, to see whether your blood is clotting normally.

What’s the recovery like?

You may feel weak and lightheaded at first, so don’t try to get out of bed on your own while you’re still in the hospital.

In general, your recovery will depend on how much blood you lost and what your “reserves” were – that is, how much your blood volume increased during pregnancy and whether you were anaemic before having a PPH. It’s also possible to develop anaemia from the blood loss.

At any rate, you’ll want to take it easy when you come home from the hospital. Get plenty of rest, drink enough fluids to stay hydrated, and eat nutritious food. It’s likely that your health provider will prescribe an iron supplement in addition to prenatal vitamins with folic acid. Sometimes, milk production can be delayed or inadequate, and hence have to wait a few hours to nurse your baby.In such cases, continuous attempts at breastfeeding is encouraged.

Postpartum warning signs: Signs to watch out for after giving birth:

Call your healthcare provider right away if:

  • You’re feeling extreme sadness or despair or having delusions or thoughts of harming yourself or your baby.
  • Your bleeding isn’t tapering off, continues to be bright red after the first four days, resumes after slowing down, contains clots bigger than a coin, or has a foul odour.
  • You have severe or persistent pain anywhere in your abdomen or pelvis, or   after pains that get worse instead of better.
  • You have worsening pain or soreness that persists beyond the first few weeks, or redness, swelling, or discharge at the site of your C- section incision. You have severe or worsening pain in your vagina or perineum, foul-smelling vaginal discharge, or swelling or discharge from the site of an episiotomy or a tear.
  • You have pain or tenderness in one area of the breast that’s not relieved by warm soaks and nursing, or swelling or redness in one area, possibly accompanied by flu-like symptoms or fever.
  • You have pain or burning when urinating; you have the urge to pee frequently but not a lot comes out; your urine is dark and scanty or bloody; or you have any combination of these symptoms. (Stinging after the urine comes out and hits an abrasion or laceration is normal.)
  • You have severe or persistent pain or tenderness and warmth in one area of your leg, or one leg is more swollen than the other.
  • You have double vision, blurring or dimming of vision, or flashing spots or lights.
  • You have severe or persistent vomiting.
  • The site of your IV line insertion becomes painful, tender, or inflamed
  • Call your local number for emergency services if:
  • You have shortness of breath or chest pain, or are coughing up blood.
  • You’re bleeding profusely.
  • You’re showing signs of shock, including light-headedness, weakness, rapid heartbeat or palpitations, rapid or shallow breathing, clammy skin, restlessness and confusion.
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