Heavy Bleeding After Birth (Postpartum Haemorrhage)

Maternity Service Women & Children’s Group

This leaflet has been designed to give you important information about your condition / procedure, and to answer some common queries that you may have.

Introduction How could a PPH affect me? It is normal to bleed after having a baby, but If you lose a lot of blood, it can worsen the this leaflet is to inform you about heavy normal tiredness that all women feel after bleeding which some people may having a baby. experience. Bleeding that is heavier than If heavy bleeding does occur, it is important normal can sometimes be called a that it is treated quickly. A major ‘haemorrhage’. haemorrhage can be life-threatening so it is important to prevent it if possible. What bleeding can I expect after my baby is born? Who is at risk? It is normal to bleed after having a baby. The Risk factors for primary PPH – bleeding mainly comes from the area in your womb (uterus) where the placenta was Before the birth: attached, but it can also come from any tears  Having had a PPH in a previous caused (or cuts performed) during the birth. pregnancy Bleeding is usually heaviest just after birth  Having a BMI of more than 35 and gradually becomes less over the next few hours. The bleeding will continue to  Having had 4 or more babies before reduce over the next few days. The colour  Carrying twins or triplets will change from fresh red to brown over a few weeks. This bleeding is called lochia  South Asian ethnicity and should stop by the time your baby is 6  Having a low-lying placenta (placenta weeks old. praevia) What is a postpartum  The placenta coming away early haemorrhage? (placental abruption) Postpartum haemorrhage (PPH) is heavy  Pre-eclampsia and/or high blood bleeding after birth: pressure  Primary PPH is when you lose more than  Anaemia 500ml of blood within the first 24hrs after In labour: birth. It is common, affecting 5 in 100 women. Severe haemorrhage (more  Delivery by Caesarean Section than 2 litres or 4 pints) is much less  Induction of Labour common, affecting only 6 in 1000 women after birth.  Retained placenta  Secondary PPH occurs when you have  Episiotomy (a cut to help delivery) abnormal or heavy vaginal bleeding  Forceps or ventouse delivery between 24 hours and 12 weeks after the birth. It affects fewer than 2 in 100  Labouring for more than 12 hours women.  Having a big baby (more than 4kgs/9lbs)

 Having your first baby if you are more What happens if I have a primary than 40 years old PPH? There is often very little that you can do Other members of staff will come into the about these factors but in some cases steps room to help. Your midwife will tell you what can be taken to reduce the risk of having a is happening and why. PPH and therefore the likelihood of needing a blood transfusion: In the majority of cases, heavy bleeding will settle with the following simple measures. 1. If you are anaemic during pregnancy, taking iron supplements may reduce the The midwife or doctor may: likelihood of needing a blood transfusion  Massage your uterus through your if you have a PPH. abdomen to stimulate a contraction 2. If you have had a Caesarean Section  Give you a second injection to help your previously, it is important to check that uterus to contract. This injection may the placenta has not attached itself to the make you nauseous. area of the previous scar. If it has, the placenta may not come away easily after  Put a catheter (tube) into your bladder to birth. This condition (placenta accreta) is empty it as this may help your uterus to uncommon, but can cause major contract haemorrhage.  Put a drip into your arm, and take some Treating major haemorrhage may include a blood for testing. blood transfusion, if this worries you, talk to  If may be necessary to perform bi- your midwife. It is important that your wishes manual compression. This is where the are known well in advance and written clearly Dr or midwife puts one hand inside the in your notes. vagina and another hand on your abdomen and squeezes the uterus in- What can be done during birth to between, in an attempt to slow the reduce the chance of a primary bleeding. PPH?  Check to make sure all the placenta has If you have a vaginal birth, injecting the drug come out – if there are any missing Syntocinon (oxytocinon) into your thigh just pieces still inside your uterus, you may as the baby is born can help reduce blood have to have them removed, this is loss. This injection helps the placenta to usually done in an operating theatre with come away from the wall of your uterus an anaesthetic normally. Once your placenta has delivered,  Examine you to see whether any stitches you will be examined for any tears. If these are required if the bleeding continues are bleeding heavily, they will be stitched after your uterus has contracted. promptly to reduce blood loss. Your blood pressure, pulse and temperature If you have a caesarean section, Syntocinon will be checked regularly. You may will be injected into the drip in your vein and breastfeed if you wish. your placenta will be removed through the wound.

What happens if I continue to bleed How will I feel afterwards? very heavily? You may need a longer hospital stay. If tests If you have lost a lot of blood, you are likely show you are anaemic or you are feeling to feel dizzy, light headed, faint and/or faint, dizzy or light headed, you may be nauseous. You will be given oxygen and offered a blood transfusion. maybe a second drip for extra intravenous When you go home, you may still be tired fluids. and anaemic, requiring treatment with iron. Drugs will be used in an attempt to help stop You should recover over the following few the bleeding and you may be given a blood weeks. transfusion and fluids to help your blood clot. You and your birthing partner may have If the bleeding continues, you may be taken found the experience distressing, and it is to the operating theatre so the doctors can often helpful to talk through the events. You check for the cause of the haemorrhage. will have the opportunity to discuss what has You will need an anaesthetic for this. Your happened before you leave the hospital. partner will usually stay in the delivery room You may be offered, or can request, a further with your baby and will be kept informed meeting with a senior member of the team about how you are and what is happening. who looked after you. There are several procedures the doctors I have experienced a primary PPH may use to control the bleeding: in a previous pregnancy – what  A ‘balloon’ may be inserted into your about future births? uterus to put pressure on the bleeding vessels. This is usually removed the If you have had a previous birth that was following day. complicated by a primary PPH, there is an increased risk of PPH in future pregnancies –  An abdominal operation (laparotomy) 1 in 10 women will have a PPH again in a may be performed to stop the bleeding. future pregnancy.  Very occasionally, a hysterectomy When you are admitted in labour, a blood (removal of the womb) is necessary. sample may be taken to check your latest This would only be considered if other blood count and a cannula may be inserted measures have not controlled the heavy into a vein in your arm so that fluids and bleeding. medication can be given if necessary. You Once your bleeding is under control, you will will be advised to have the drug Syntocinon either be transferred back to the labour ward to help the placenta come away and lessen or you may be transferred to an intensive the chance of a PPH. care or high dependency unit. You will be monitored closely until you are well enough to go to the postnatal ward/area.

What happens if I have a secondary References PPH? Royal College of Obstetricians and A secondary PPH is often associated with Gynaecologists, Information for you: Heavy infection and usually occurs after you have bleeding after birth (postpartum left hospital. You should contact your haemorrhage). midwife or GP if your bleeding is getting heavier or if your lochia has an offensive Concerns and Queries smell. You are likely to be given a course of If you have any concerns / queries about any antibiotics. of the services offered by the Trust, in the If the bleeding is heavy or continues, you first instance, please speak to the person may be referred to hospital for blood tests providing your care. and you may have an ultrasound scan. For Diana, Princess of Wales Hospital Depending on the results, you may be admitted to hospital. You may need Alternatively you can contact the Patient antibiotics through a drip and/or less Advice and Liaison Service (PALS) on commonly an operation to clear your uterus (01472) 875403 or at the PALS office which of any infection, blood clots or small pieces is situated near the main entrance. of placenta that were not expelled after your For Scunthorpe General Hospital baby was born. Alternatively you can contact the Patient Your baby can usually stay with you, if you Advice and Liaison Service (PALS) on wish, and you can continue to breastfeed (01724) 290132 or at the PALS office which even if you are taking antibiotics. situated on C Floor. Key points Alternatively you can email: [email protected]  It is normal to bleed after you have a baby. Initially the bleeding can be quite Northern Lincolnshire and Goole heavy but it reduces with time. You may Hospitals NHS Foundation Trust continue to bleed after birth for several Diana Princess of Wales Hospital weeks. Scartho Road  Sometimes bleeding is much heavier Grimsby than expected and this is called 01472 874111 postpartum haemorrhage (PPH). It is Scunthorpe General Hospital important to remember that the majority Cliff Gardens of women will NOT experience a Scunthorpe haemorrhage after giving birth. 01724 282282  If bleeding is very heavy, it is important Goole & District Hospital to act quickly. Doctors and midwives are Woodland Avenue trained in controlling heavy bleeding. Goole  In the majority of cases, heavy bleeding 01405 720720 will settle with simple measures. www.nlg.nhs.uk

Date of issue: October, 2013 Review Period: October, 2016 Author: Operational Matron - Women & Children's Group - SGH IFP-773