Postpartum Haemorrhage (PPH) is heavy bleeding during and after childbirth.

What is normal?

It is normal to bleed from the vagina after your baby is born, this comes from the area of your womb (uterus) where the placenta was attached and may also come from any cuts or tears that happened during birth. Bleeding is often heaviest in the first few hours after birth, and should reduce over the next few hours and days. Sometimes bleeding is heavier than expected, called postpartum haemorrhage.

PPH

Postpartum haemorrhage (PPH) is heavy bleeding during and after childbirth and is defined as more than 500mls (a pint) of blood most commonly within the first 24 hours of the birth of your baby. This is called major if you lose over 1000mls (over 2 pints).

If heavy bleeding occurs, it is important it is recognised and treated very quickly to prevent it from escalating, which can have serious consequences.

Am I at risk of PPH?

Most women and birthing people that have a PPH do not have any known risk factors, and most of those that do have risk factors will not go on to have a PPH. It is important for the team looking after you to consider if there are any risk factors present, so that steps can be taken to reduce the risk of having a PPH and the chance of having a blood transfusion. Some risk factors for PPH include:

·       Multiple previous pregnancies

·       Bleeding during this pregnancy or PPH in a previous pregnancy

·       Previous surgery on the uterus

·       A high or low body mass index

·       Carrying twins or triplets

·       Anaemia or low platelets in pregnancy

·       Blood clotting problems or taking blood thinning medications

·       A placenta that has implanted into the uterus very low or in a very adherent manner

·       A large baby or large amount of amniotic fluid

·       A long labour (over 12hours), needing a hormone drip to help with the labour or developing an infection during labour

·       Caesarean, forceps or ventouse birth

·       Retained placenta (or bits of placenta) in the uterus after birth

Why does PPH happen?

Bleeding during and after childbirth is usually due to one or more of the following problems:

·       Failure of the uterus to contract effectively after birth

·       Tissue trauma to the womb or vagina, such as tears sustained during birth or a cut given to aid birth (an episiotomy)

·       Retained placenta

·       Problems with how the blood can form clots

What will happen if I have a PPH?

If your baby has been born at home or a midwifery-led unit, the midwife looking after you may arrange for you to be transferred to hospital. If you are already in hospital, your midwife will summon help from other members of the medical and midwifery team. Initially the doctor or midwife may perform the following to address heavy bleeding:

·       Massage your womb through the tummy (and sometimes vaginally) to encourage it to contract

·       Give medications to help the womb to contract – these may be given via an injection or via a drip

·       Put a catheter (tube) into to bladder to empty it and therefore help the womb to contract

·       Insert a drip into your hand/arm and take some blood tests

·       Ensure that the placenta has delivered and that all of it has come out

·       Examine you to see if there have been any tears in the vagina that require stitches

If you continue to bleed heavily, additional measures may be required to stop the bleeding such as:

·       Additional medications given to help the womb to contract

·       Being transferred to the operating theatre to further assess and treat the cause of bleeding

·       A balloon may be inserted into to womb to put pressure on bleeding blood vessels – this is usually removed after a few hours

·       An abdominal operation to stop the bleeding

·       Rarely, the womb may need to be removed if bleeding is life threatening

·       A blood transfusion

What happens afterwards?

You may need a longer hospital stay, particularly if you are anaemic and are feeling dizzy or faint. You may be offered a blood transfusion.

You are able to breastfeed after a PPH and can ask for extra support if you would like.

You and your birthing partner/s may have found the experience frightening or confusing. In this situation it can be helpful to talk through the events with your team. This can be done before you go home and again later if you would like.

When you go home, it may be recommended that you take iron tablets for a short period of time. Your GP may repeat your blood tests when your baby is a few weeks old to check your blood count.

In your next pregnancy, there may be an increased risk of having another PPH and you may be advised to have your baby in hospital in a consultant led maternity unit.