Postpartum haemorrhage : what you need to know

While delivering my daughter, I suffered a primary postpartum haemorrhage (PPH). I knew it was likely, because due to my EDS I’m prone to bleeding and have weak connective tissues. However, during my recovery in the postpartum period, I was surprised by how little others knew about PPH, but I understood every mother’s fear about suffering excessive bleeding.
Here’s what you need to know about postpartum haemorrhage.

What is it?

A postpartum haemorrhage is defined as losing more than 500ml of blood from the female genital tract after a natural delivery, or more than 1L after having a caesarean section.  There are two types of postpartum haemorrhage –
1) Primary – this occurs within the first 24h after giving birth, and affects 5 in 100 women. A severe primary haemorrhage is much more rare. This affects 6 in 1000 women, and involves losing more than 2L of blood.
2) Secondary – this occurs between 24h and 12 weeks after delivery, and affects 2 in 100 women.

What causes it?

A PPH happens most commonly because the womb doesn’t contract strongly enough after birth. It also happens because part of the placenta was left in the womb (retained placenta), or because of an infection in the lining of the womb (endometritis).

Who is more at risk?

How is it prevented?

During labour you will be offered an injection of Oxytocin as your baby is being born to stimulate contractions to help deliver the placenta.

How will having a PPH affect me?

It is important to treat a PPH quickly, as it can be life threatening. Once treated effectively, it is important to remember that having a postpartum haemorrhage can worsen the tiredness all women feel after delivering a baby.  If you had a previous PPH you have a 1 in 10 chance of experiencing it again,

How is it managed?

PPH is managed in different ways depending on the severity of the bleed. Treatment can involve massaging the uterus to stimulate contractions, inserting a catheter to empty the bladder to help the uterus contract, injections to make the uterus contract (which may cause nausea) and checking to make sure there is no retained placenta. If bleeding continues heavily, blood transfusions or surgery may be required. 
The NHS has a fabulous leaflet with more detailed information on more detailed management of PPH here.
While the concept of a PPH is scary, the reality is that doctors and midwives are trained in controlling heavy bleeding, and bleeding after childbirth is quite normal. Have you experienced a PPH or know someone who has? Let us know your story below.

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Foetal Distress… Where my labour went wrong

I was in slow labour for a solid 2 weeks. I’d had 2 sweeps and I remember so vividly on New Year’s Day going into hospital for a midwife to say, “something is definitely happening, you’re 2cm now rather than 1.” Woohoo! One whole cm in a week, I thought to myself… I practically sulked in the car on the way home.

The next day, things picked up, so we went back up to the hospital. This time I was told; “okay, you’re 3cm. I don’t want to send you home as I can see your contractions are really picking up, but I really need either your waters to go or for you to be 4cm, can you try walking for me and we can get things going”, Despite being booked to be induced the next day on my due date…I became a woman on a mission.

After some lunges, walks and a bumpy car ride the midwife checked me again. “Yep, you’re 4cm…and….there go your waters, you’re in labour”… HALLELUJAH.

I remember looking at the midwife and saying “HA, you can’t send me home now!” The poor midwife, she had suffered enough with my waters going all over her hand, let alone me sassing her.

My labour progressed surprisingly quickly from then. I had pethidine and gas and air in labour, I slept pretty much most of it once I had pethidine, I would wake up, have a contraction, make some sort of moo-ing noise while using gas and air then go back to sleep. When I was around 9cm I remember my midwife just staring at the contraction monitor. Throughout the labour she had been coming in, checking the monitor and going again…but this time she wasn’t, she was staying in the room with me for longer and she looked concerned. There was an elephant in the room for sure (and that wasn’t in reference to the size of heavily pregnant me)!

“Is everything okay?” I heard my mother in-law at the time ask my midwife, Emily. Emily smiled sweetly and said, “I’m just going to get another midwife to check something, Amy can you just roll onto your right side for me, Baby isn’t liking how you’re laying.” Another midwife came in and looked at the monitor with Emily and it was very hushed and secretive, but I remember so clearly her saying, “yep, you’re right it’s classic…,” completing the sentence by gesturing her hands around her throat to mimic strangulation. Alarm bells were ringing in my head.

“Amy, we’re just going to fast bleep the doctor. Baby is having something called lates.

Lates – Emily explained that during a contraction, a baby’s heart rate can drop, but it’s expected to pick up pretty quickly afterwards…except my little boy’s wasn’t. It was staying at about 50-60 bpm for a little longer than it should have (nearly half of what it should be). The doctor arrived promptly and again the hushed tones were talking and one of the sisters mentioned an emergency C-section but the doctor shook her head and said, “she’s 10cm, let’s look at another option, this isn’t cord around the neck, this is foetal distress.

Foetal Distress- An uncommon complication of labour which is when the baby isn’t receiving enough oxygen.

“Amy, your baby is in distress. Now, we need to get him out as soon as possible, ideally. His heart rate isn’t picking up – you’re 10cm now so I would like to do an assisted delivery if that’s okay?” I nodded. “Just do whatever needs to be done,” I shouted, mid-contraction. My bladder was full and had to be emptied via catheter during my contractions, too – lush, eh?

“Okay Amy, what will happen is I will attach this to baby’s head and as you push, I will pull.”

I was ready to go. The pushing was a military operation.

“Okay, you did really well then. I want you to grasp your breath ready for the next contraction…I can see it’s building…1,2,3 Push!” The Doctor said. “Chin to chest, that’s it Amy, PUSH,” the sister said holding my hand.

I was tiring quickly, but every minute that passed my baby boy was getting more and more distressed. “Amy, I can see his head,” Oliver’s dad cried out. I remember throwing my head back saying, “I can’t do this”.  The Senior midwife took my hand and placed it on my baby boy’s head (which I still to this day think was super gross). “Amy, that is your baby’s head, you are so nearly there. Now come on and push,” she ordered.

The maternity assistant patted my head down with a cool flannel (it might have been wet paper towel to be completely honest) but at 00:32, the room went silent. “Happy Birthday to you little man,” I heard the doctor say. “Amy, he’s beautiful,” another midwife added. I couldn’t see Oliver at this point, nor could I hear him crying. “Why can’t I hear him cry?” I asked, with an underlying tone of panic to my voice. “No, no, no he’s fine Amy. He’s perfect,”my mother-in law added. I didn’t get to hold Oliver straight away due to me needing a lot of stitches and Oliver needed checking over where he was in distress for so long.

The sister wanted to take the gas and air off of me while I was stitched, but I think the doctor saw how scared I was (either that or she did a real job on me with my episiotomy ) because she let me keep the gas and air while I was stitched. Of course, my problems continued, my placenta wasn’t delivering naturally. They gave me an injection to try and hurry it along, but alas…No placenta, the doctor grew concerned as my blood pressure started to drop rather quickly and placentas need to be out once baby is out. So she decided to remove it manually, which was probably more painful than the actual labour, but she was sweet and still let me keep the gas and air while she did this. Once my placenta was delivered I finally got to hold my baby boy, but only for a short while. The sister insisted I had a bath she had ran for me…Which was one of my less relaxing baths to say the least.

My labour started smoothly but towards the end became a bit traumatic, but I urge new mums to be not to be afraid, every womans labour is different so please don’t be scared and try to embrace what will be the most…unique experience of your life.

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Sarah’s Birth Story – How We Met

Dear Olivia,

It’s 4:30am on a Saturday and I’ve just woken up with pains in my abdomen. I had been having false labour contractions for about three weeks prior to that (you were exactly a week late) so I wasn’t too quick to wake up daddy and tell him that I thought it was for real this time. Instead I went downstairs, used the toilet, bounced on my birthing ball and put on the nightie that I wanted to go to the hospital in.

I was timing the contractions and seemed to be having them about every 7 minutes, and they weren’t too painful at that point.

At about 5:30am I ran a bath. In the run up to having you I was adamant that I desperately wanted a water birth, and thought that the warm water would soothe the pain from the contractions. I got in the bath for all of about 5 minutes before deciding that it was actually irritating me and I didn’t want to be in water at all!

It’s now 6am, contractions are speeding up a bit, once every 5 or 6 minutes and getting a bit more painful. I decided to go and wake Daddy up. Now Daddy is not a morning person, as you will learn, and we had a late night staying up and watching films with Kiera, so I had about 3 hours sleep and Daddy had about 5. Needless to say Daddy was a bit grumpy at first, but he got up quickly, made me a cup of tea and looked after me while I rang the midwife. He also put on the music channel, and for some unknown reason I was listening to Cotton-Eyed Joe and bouncing on my birthing ball at 6 in the morning.

At about 6:30am I started being sick and there was a bit of blood in it too, so Daddy rang the midwife again and they told us to come in as they weren’t that busy anyway. So Daddy went and woke Kiera up and got her dressed. We got into the car and Kiera was crying, you see, we’d booked tickets to watch the new Alice in Wonderland and she was upset that she couldn’t go! You were so inconvenient.

We dropped Kiera off at her mummy’s and by about 8am we made it to the hospital. Between about 8:30 and 9am the midwife came in and asked if I wanted to use the birthing pool, to which I responded with my bath story, and then checked me over and told me I was 3cm dilated, and then my waters broke all over her hand and the bed and everything! Oh great! We thought we would be in for a long while yet.

I got hooked up to the tens machine and Daddy was rubbing my back (though the wrong end, the blithering idiot) and all of a sudden it was too much and too painful and the midwife came in to tell me that as I had a long way to go I should get transferred upstairs to the labour ward for an epidural, and I gave in and agreed to have a bloody huge needle in my spine.

But here comes the twist…

The times become less accurate here because of gas and air (bloody good stuff btw) but roughly an hour later I had another examination upstairs and I was 8cm dilated!!!! Oh, and the anaesthetist was dealing with an emergency c section so no epidural for me! You were coming too quickly and about an hour later again I was being told to push.

Uh oh, there’s another twist…

You got stuck!

I was pushing for about an hour and a half, my legs flatteringly up in stirrups and about 6 people at the end of the bed, Daddy next to me with a straw and a cup of water and the room being like the tropics to everyone else as I shouted at a health worker not to turn the air con on!

I convinced the doctor that I needed help, and so more people came in wielding forceps before they changed their minds and used a kiwi cup instead. They asked Daddy if he wanted to watch but he said no as he knew I didn’t want him to see all the gross stuff. Then with 2 or 3 pushes you were out, and up on my tummy. I said “oh my god” and Daddy laughed. Then he cut the cord and you were moved further up my chest so we could have skin to skin.

It was perfect for a few seconds until I started being sick again and had to have someone put you in the crib as I was shaking so much from the adrenaline and the gas and air comedown!

Once the atmosphere had settled I cried, more out of guilt of having someone move you as I couldn’t hold you straight away after you came out, and I asked Daddy and the midwife if you were okay. You were fine, sleeping peacefully as if nothing had even happened.

I asked if I was just being a blind mother or if you really were that beautiful. And you are. You’re more beautiful than anyone on the planet and I love you so much.

So there you have it, that is how you arrived at 13:06 on your birthday weighing 3.9kg/8lbs 9.5oz.

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