What Every New Mother Should Know About Postpartum Haemorrhage
What is Postpartum Haemorrhage?
Postpartum haemorrhage (PPH) is defined as the loss of more than 500 mL of blood after delivery and is the most common maternal morbidity in developed countries, occurring in up to 18% of births worldwide and 15 out of every 100 Births in Australia. Despite well-documented risk factors and preventive strategies, not all cases are expected or avoidable. In Australia, PPH remains a significant concern, affecting many new mothers annually.
This comprehensive overview aims to inform and empower new mothers with the knowledge needed to manage and prevent postpartum haemorrhage effectively. Stay informed, stay safe, and prioritise your health during this crucial time.
Causes and Management
The primary cause of PPH is uterine atony, where the uterus fails to contract properly after childbirth. This condition can be managed through uterine massage combined with medications like oxytocin, prostaglandins, and ergot alkaloids. In some cases, retained placenta can cause PPH, requiring careful examination and manual removal of the retained tissue. Rarely, an invasive placenta may necessitate surgical intervention.
Other causes of PPH include traumatic injuries such as lacerations, uterine rupture, and uterine inversion. Coagulopathies, or blood clotting disorders, also contribute to PPH and require specific treatments involving clotting factor replacement.
Risk Factors
PPH is more likely to occur in women who:
Used medications to induce labor
Are of Asian descent
Are over 40 years old
Have had a cesarean section
Had an episiotomy
Have a low red blood cell count (anemia)
Have had multiple or large babies
Are obese
Symptoms and Signs
Signs of PPH include:
Early signs to watch for include bright red spotting after lochia has lightened, heavy bleeding, and blood clots larger than a golf ball
Increased heart rate
Feeling faint upon standing
Increased breath rate
Feeling cold
Dropping blood pressure
Unconsciousness in severe cases
If these symptoms persist, immediate medical attention is necessary. This is why nurses monitor your blood loss and want to know about and monitor blood clots after you have had your baby.
Joanna’s Story
Joanna, is a Mumma to two beautiful children, Charles and Chiara. In June 2024, Joanna passed a huge bloodclot at home while preparing lunch for her eldest son. She was admitted to hospital twice. With her permission, we are sharing her story here.
”No one prepares you for the shock of PPH. One minute you’re holding your newborn, basking in the joy of new motherhood…the next, you’re fighting for your life…it was so scary and even scarier for Nick (Joanna’s husband), he thought I was going to die in his arms…and then again during surgery to remove the blood clots.”
You can read more about Joanna’s story on her instagram here which she has bravely shared to raise awareness for PPH.
“I feel that the bleeding, the pain, the fear... it’s a trauma that stays with you long after the physical wounds heal. The shock and anxiety linger, a reminder of the fragility of life. But in the trauma of it all, there is hope. There is support. There is healing.
To all the mothers who have gone through PPH, I see you. I hear you. I am you. Let’s break the silence, share our stories, and support each other through the trauma and beyond.”
Complications
Complications from PPH can include:
Orthostatic hypotension (dizziness upon standing)
Anemia and fatigue, making it challenging to care for the newborn
Increased risk of postpartum depression
The necessity for blood transfusions, with associated risks
Severe cases leading to hemorrhagic shock, which can delay or prevent lactation (postpartum pituitary necrosis)
Occult myocardial ischemia, dilutional coagulopathy, and even death
Prevention and Treatment
Preventive measures include:
Reducing known risk factors
Administering oxytocin after childbirth to stimulate uterine contractions
Using misoprostol as an alternative in resource-poor settings
Treatment options for PPH include:
Intravenous fluids and blood transfusions
Medications like ergotamine to promote uterine contractions
Manual efforts to compress the uterus if other treatments fail
Compression of the aorta by pressing on the abdomen in extreme cases
Use of non-pneumatic anti-shock garments, as recommended by the World Health Organization, until surgical measures can be undertaken
Global Perspective
Globally, PPH is responsible for approximately 86,000 deaths annually, making it the leading cause of maternal mortality. In developed countries like Australia and the United Kingdom, PPH-related deaths are rare, with approximately 0.4 deaths per 100,000 deliveries. This is because of timely postpartum monitoring and access to emergency care postpartum.
Recognizing PPH
It's crucial for new mothers to recognise the signs of PPH. If you experience any of the following symptoms, seek medical attention or notify your carers (including the Borne team) immediately:
Persistent bright red bleeding beyond four days postpartum
Lochia with a foul odor, fever, or chills
Heavy bleeding that saturates a sanitary pad within an hour
Blood clots larger than a golf ball
Ensuring Your Safety
Understanding the risks and symptoms of postpartum hemorrhage can help new mothers and their families seek timely medical intervention, potentially saving lives and ensuring a smoother postpartum recovery.
Sources
Australian Institute of Health and Welfare (AIHW).
World Health Organization (WHO). WHO Recommendations for the Prevention and Treatment of Postpartum Hemorrhage
