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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8 things I wish I knew would happen postpartum

Before Olivia was born, I didn’t give very much thought to what would happen postpartum. The extent of my worrying into that period was limited to my mental health, as I was already suffering from antenatal depression. But, actually, there are a lot of things that I wish I had known about what I would experience in the days and weeks postpartum. Warning, some of them are gross, but childbirth is gross so I’m not apologising!

1. The first poo
Sorry to start off on possibly the most cringeworthy one, but holy mother of Christ… the first poo is a bitch. I tried to go for days. Days of needing it but not being able to get it out… it’s such a glorious and magical time… not.
A friend of mine who has just qualified as a midwife and was training at the time recommended that I try Lactulose (a liquid laxative). Hey, presto! It worked! But it takes a few days to kick in – so if you’re expecting, get some in the house ready for when you need it!
2. The first wee
I promise these aren’t all toilet related…
You may or may not know that you will be expected to produce a certain amount of wee in a bowl and present it to your midwives. However, if you’ve just been stitched up down there, and even if you haven’t, it bloody stings! So for your first wee, I recommend sitting on the toilet backwards and leaning forwards over the tank so as to angle the wee away from your very sore lady parts.
3.  You’ll be expected to leave the hospital ASAP
It’s no secret that the nhs are in crisis and need beds to be available, but sometimes it can seem like the midwives are simply trying to discharge you as quickly as possible. It didn’t make a huge difference to me either way as I wanted to go home the following day, but if you are struggling with any aspect of your postpartum physical or mental wellbeing, breastfeeding or your newborn’s health, then STAY IN THAT BED! Don’t move until you get help from someone. They cannot kick you out before you’re ready (unless you’re obviously taking the piss), so make sure you’re comfortable to leave those hospital walls because once you do, assistance is that little bit further away.
4. Don’t wash your hair
Thankfully after giving birth, my midwife could tell how much pain I was in and I was still pretty weak and shaky from throwing up throughout my labour. So she, being a wonderful kind soul, gave me personal wash down so that I didn’t have to go and brave a bath just yet. That being said, I did take a shower the next morning… and I washed my hair… with shampoo. Am I an idiot? I’d like to think I’m not, but it was pretty stupid to think that as I washed the shampoo out, I would form a magical protective bubble around my vagina that would prevent any shampoo going near my stitches… Think again!!!!!
5. Maxi dresses are your best friend
I wish I’d had more, because that first week, at least, postpartum, is so painful downstairs that you need to have absolutely no pressure on the area. A maxi dress will also conceal the hairy legs you’re 100% not going to shave and is just the most comfy thing that you can possibly wear after just giving birth.
6. Stock up on maternity pads/mats
For the car journey home from hospital I had to borrow maternity mats from the ward to put on the seat of the car. I say borrow… I didn’t give them back, don’t worry! I hadn’t even considered that. Even more shockingly – I hadn’t even considered that I might need them for when my waters broke on the way into hospital! They didn’t (they broke over a midwife’s hand instead), but it is still a possibility and you really don’t want to be cleaning that out of your car when you’ve got a newborn.
7. You will need separate bags
I don’t think I was quite realistic about the hospital stay. I assumed my birth plan would be totally accurate and so only packed one outfit for me, far too many for Olivia and absolutely nothing whatsoever for Jamie. Obviously, he then had to leave me with Olivia’s godmother in the hospital while he went home for provisions. Put whatever you want in your bags, but do pack separate ones for each of you!
8. Finally, it will go too quickly
All of the pain you feel and the sleep exhaustion will make the days and nights seem never-ending. But I promise you this, I wish I had known that it flies by in what feels like a blink. I don’t even remember my baby as a baby – she is a completely different child in both appearance and personality. I’d give anything to go back to having my tiny Olivia again and at the same time I love the way she is now (except the tantrums). For all of the stress, emotion and being so physically and mentally drained, it is worth it, and you’ll realise that all of those people who really pissed you off by saying that in your last weeks of pregnancy we’re absolutely right.

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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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