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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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.