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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Baby Loss Awareness Week ‘17

This is for the families of babies born too small, born too sick or born sleeping. For, the 1 in 4 women- who have carried a baby that she never got to meet, that she never got to watch grow. For all of the broken hearts, tears, pain, loneliness, loss of hope, isolation that losing a baby causes.

I know SO many (painfully far too many), incredible families and amazing women who have had to face this pain. Women who have had one or multiple miscarriages. Women who have had babies born too small to survive. Women whose babies have been born sleeping. Women whose babies were born appearing healthy, but never made it home. Often these women feel like they have to grieve silently, they feel numb, they need far more support. So many of these women manage to keep holding on, when it must feel like they are falling apart.

I had a substantially large bleed at the start of my pregnancy with Florence (around 7 weeks), which was put down to the loss of a second baby. This is something that it took me a year and a half to even discuss with anybody- I constantly convinced myself that surely I don’t deserve to be upset over this? That as I’ve got Florence I should just put up and shut up? It’s so incredibly hard to know how quite how to deal with these feelings, but depriving myself of a right to feel was just about the worst way to go about processing such an ordeal. I now know that I shouldn’t be shutting any of these feelings away, I’m entitled to every single emotion I have felt and every emotion there is left to feel. I’m no longer convincing myself every time I hear bloody “everything happens for a reason” out of the fear of sounding unappreciative or ungrateful. I count my blessings for having Florence in my life every single day, because no medical professional could make sense of quite how she managed to stay. This was one of the reasons it took me so long to announce my pregnancy. I was convinced that I would lose her. I feel that I am often referred to as ‘melodramatic’ when I refer to my daughter as a ‘miracle’- but when I think of everything we’ve been through and that she’s still here, I really feel that I am the luckiest Mummy alive.

If your pain demands to be felt- Feel it. You’re not alone. You’re never alone! Please enable yourself to feel. Please never feel that you’re not allowed to be pained or upset because ‘you already have children’ or any other reasons you may find to invalidate your own feelings at an already very painful and very difficult time. Talking to my counsellor and being open with my amazing Mum- Was the best thing I could have done for myself and I wish I did it a lot sooner.

Lots of love to all of the mummies we know; your family, children, babies and angel babies are in our heart and prayers this week and always.

Bleeding in pregnancy

I was 27 weeks pregnant when I was admitted to hospital with abdominal cramps and PV bleeds, my little boy’s chance of making it to his due date was cut short as the doctor told me the SCBU at our hospital was full and I was being prepped to be transferred to another hospital where I would face delivering my little boy early when he was weighing just 2lb 2oz.

 
Bleeding in pregnancy can sometimes be referred to as PV bleeds 

Around 20-25% of women will experience PV bleeds in their first trimester, whereas bleeding in the second and third trimester is less common.

Bleeding in early pregnancy can be a sign of either miscarriage or an ectopic pregnancy. Whereas bleeding in later stages of pregnancy can have different meanings.

The most common bleed is known as an “implantation bleed” which is when the fertilised egg implants itself into the lining of a uterus. An implantation bleed is discharge or spotting and is usually pinkish or dark brown, implantation bleeding tends to only happen will the egg is attaching itself into the uterus, it may last anything from a few hours or 1-2 days.
I was 27 weeks pregnant when I was admitted to hospital with abdominal cramps and PV bleeds, my little boy’s chance of making it to his due date was cut short as the doctor told me the SCBU at our hospital was full and I was being prepped to be transferred to another hospital where I would face delivering my little boy early when he was weighing just 2lb 2oz.
It was a magical moment when the bleeding stopped.I had an urgent ultrasound which showed that there was no known cause for the bleed. I began to puzzle even my doctors… Here was this 27 week pregnant lady who was having PV bleeds but with no cause, my little boy’s growth took a dip and I was kept in hospital for nearly a month of monitoring. I was told every time I bled, I was to add 24 hours to the chances of me going home.

“well Miss Simkins, we don’t know why you’re bleeding, but we’ll monitor your little baby’s growth and keep an eye on you and look at your delivery options” 

Pregnancies with PV bleeds tend to result in small babies. So I was having scans every 2 weeks and gradually Oliver’s growth began to pick up, and as he grew more, my chance of having a natural birth was increasing too. At my last growth scan the sonographer chuckled and told me he weighed 8lb 5oz with still 3-4 weeks to go!

One thing my midwife told me was that I was no longer able to have a water birth and I would no longer be able to deliver on the low-risk unit. I would now have to deliver on the high risk labour ward as I was booked to be induced due to the PV bleeds.
There are many causes for PV bleeds during pregnancy but they can all mean different things and should be reported to a medical professional immediately. To determine what is causing the bleeding, your doctor may request an internal examination, ultrasound and blood tests.
I was incredibly fortunate and ended up having a perfectly healthy baby boy born on his due date weighing 8lb 11oz.