What it is
If you are bleeding too much after birth, soaking a pad an hour or feeling faint, call 911 or press the call button now. That is the whole first line of this entry.
A postpartum hemorrhage, or PPH, is losing more blood after birth than the body can spare, roughly a liter or more, or any amount that makes you dizzy, pale, or fast-hearted. It happens in about 3 in 100 births. Most happen in the first 24 hours, often in the first hour, while you are still with the team. A smaller number happen later, up to 12 weeks out, usually from a piece of placenta left behind or an infection.
The most common cause is a uterus that does not clamp down after birth. Others are tears, a retained placenta, and rarely a clotting problem.
What's typical
In the room, it moves fast. Someone presses hard on your belly to make the uterus contract. You get medication through the IV or a shot. If the placenta has not come, the provider may reach in to remove it, which hurts and is quick. Some mothers need a balloon placed in the uterus for a day, and some need a transfusion. Surgery is rare. Afterward, most mothers are anemic and wiped out for weeks. Dizziness on standing, a racing heart, and a slow milk supply in the first days are common after a big bleed. Full energy often takes a month or more to return.
What's known
ACOG and the WHO describe PPH as the leading cause of maternal death worldwide and one of the most preventable. In California, the Maternal Quality Care Collaborative's hemorrhage toolkit is used in most hospitals, and the state's death rate from hemorrhage fell by more than half after it was adopted. Risk is higher with a long or very fast labor, twins, a big baby, induction, a prior hemorrhage, or a placenta that sits low. Many mothers have no risk factors at all. Many postpartum food traditions center on blood-building: bone broth, liver, dates, dark greens, and iron-rich stews in the first weeks.
What helps
- Ask the team afterward exactly what happened and how much blood you lost. You are allowed to know.
- Stand up slowly for a few weeks. Sit on the edge of the bed first.
- Eat iron-rich foods and ask your provider about checking your blood count.
- Say yes to every offer of help. Anemia makes everything twice as hard.
- Ask a lactation consultant to watch your supply in the first week. A big bleed can delay milk coming in.
- If the memory keeps replaying, tell someone. A hemorrhage is one of the strongest links to birth trauma.
When to call someone
- Nowsoaking a pad in an hour for two hours, a clot bigger than an egg, feeling faint, a racing heart, or blurred vision. Call 911.
- Todaybleeding that gets heavier again after it had slowed, bleeding with a bad smell, or a fever.
- Todaydizziness every time you stand, or shortness of breath climbing stairs.
- At your next visitask for a blood count, a plan for iron, and a debrief of the birth.
Who helps
Tools: Postpartum Prep Checklist · My Birth Team
Related
- Postpartum bleeding (lochia): what's normal, what's notPostpartum: Your Body
- Anemia and exhaustion after birthPostpartum: Your Body
- Blood-building foods after birthNourishment and Traditions
- Postpartum warning signs: the one-page listPostpartum: Your Body
- Cord clamping and what happens to the placentaGetting Ready for Birth
- Birth trauma and postpartum PTSDPostpartum: Mind
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Sources
- American College of Obstetricians and Gynecologists — Postpartum hemorrhage practice bulletin
- Centers for Disease Control and Prevention — Hear Her campaign: urgent maternal warning signs
- California Maternal Quality Care Collaborative — OB hemorrhage toolkit
- World Health Organization — Recommendations for the prevention and treatment of postpartum haemorrhage
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