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Woman concerned about postpartum hemorrhaging

What You Need to Know About Postpartum Hemorrhaging

PPH is rare, but it’s best to be informed

It was exactly one week after Kristen Kimmel’s healthy baby Kate was born. The in-laws were over; her husband, Tom Mathews, was making lunch; and earlier in the week, she had even taken the dogs for walks. Everything was fine. As Kimmel sat down to breastfeed, she felt some unusual cramping.

“They tell you that as your uterus continues to shrink, that [cramping] is normal, especially if you breastfeed,” says Kimmel, who lives in Dallas. So she didn’t think much of it. When she went to the bathroom, she noticed some clots in her pad—again, it’s normal to have spotting after giving birth … but there shouldn’t be large clots, and you shouldn’t go through pads quickly. As a safety precaution, Kimmel called her OB-GYN, who told her to watch the bleeding and call back if it worsened.

It did. Kimmel says within 20 minutes, she began feeling heavy and ran to the bathroom. When she looked behind her, she saw a trail of blood. “I passed a clot, but it was a clot the size of a softball,” she reveals. She called her OB-GYN again, and this time, she was told to go straight to the office. As Kristen stood up, she almost passed out. Her husband helped her to the car, and they rushed to the doctor.

How was it possible to be feeling perfectly fine one moment, and bleeding excessively the next?

What Is Postpartum Hemorrhaging?

One of the leading causes of maternal mortality is postpartum hemorrhaging (PPH)—that is, if it’s left untreated. But only 3–5% of women experience PPH, says Dr. Brian Rinehart, director of the maternal high-risk program at Texas Health Presbyterian Hospital Dallas.

What exactly is PPH? It’s defined as excess bleeding after delivering a baby—some professional organizations say 500 cubic centimeters (or 500 milliliters) after a vaginal birth or 1,000 cc after a C-section; however, the World Health Organization suggests it is 1,000 cc or greater of blood loss in the first 24 hours. Rinehart explains that, ultimately, how much blood is too much will vary patient to patient.

Then there’s also late or secondary PPH, the rarer form, which occurs after the first 24 hours. That’s what Kimmel experienced.

There are three main reasons that PPH occurs:

  • uterine atony (when the uterus doesn’t contract after the baby is born)
  • lacerations (or tears) at birth
  • retained placenta or placenta fragments

We know the immediate causes of PPH, and research suggests that certain conditions—including placenta previa, overdistended uterus, hypertensive disorders of pregnancy, obesity and having multiple babies—may increase the chances of PPH.

But in the majority of cases, there are no underlying risk factors, says Rinehart—so technically, there’s no sure way to prevent it.

“There is no magical dietary supplement or routine to make yourself healthier to avoid [PPH],” he says, adding that significant bleeding is harder on someone who is unhealthy. “The best way to prepare is to be in the best shape you can be during pregnancy, so that if this should occur, you can tolerate it.”

Be Prepared

Kimmel was still bleeding when she and her husband arrived at the doctor’s office. “I was like, ‘You guys are going to want to have me come back right away because I don’t want to leave blood in your waiting room,’” she says. Paramedics were called; Kimmel was taken to the hospital. She remembers asking her doctor if she was OK, and the doctor saying only, “You’ve lost a lot of blood.”

At Texas Health, the patient teams are prepared for PPH through regular drills, Rinehart says, and there are medications to treat PPH in every labor and delivery room.

Having the right meds, uterus clamps, blood banks, anesthesia (if necessary) and procedures down to a science can save precious minutes. “It’s not about preventing it because it’s not preventable, but how to deal with it in a timely fashion, so Mom doesn’t get sick,” Rinehart explains.

He adds that the vast majority of patients respond to manual stimulation of the uterus (to make it contract) or medication; surgery is considered a last resort.

“Most women recover from postpartum hemorrhage within the normal recovery time for birth,” he says. “Those that require surgical intervention and transfusion of large amounts of blood may stay in the hospital for a few extra days.”

For moms with secondary PPH, treatment is a little different. Kimmel was quickly hauled in for a dilation and curettage (or D&C) to remove part of her placenta that was still inside the uterus. This condition is rare, but when it does occur, it can become life-threatening, according to the American Pregnancy Association.

The surgery went well, and by the end of the day, Kimmel was on her way home. She was given medications to help increase her iron levels, and she says it took about a week for her face to gain color again.

“Don’t be shy about asking those questions [about PPH],” she shares. “Trust your gut.” You know your body better than anyone else—if you suspect that something’s wrong after you’ve given birth, call a health care provider immediately to save time and ensure your safety.

And if you’re pregnant and concerned about PPH happening to you, find out what precautionary measures your hospital has in place.

What If It Happens Again?

Since recovery time is usually brief, the aftereffects of PPH may be primarily mental or emotional—for example, offers Rinehart, PPH can interrupt bonding or breastfeeding, which is hard on some moms.

Losing a lot of blood is obviously very scary and stressful as well. Some women may therefore be fearful of having another child and experiencing the trauma of PPH yet again. “We had always kind of thought we’d have multiple children, and after that I was very scared for my health,” Kimmel admits.

Though you are more likely to experience PPH if you’ve gone through it previously, the reoccurrence risk is only 15%, says Rinehart. If you’re worried about another delivery after PPH, make sure your provider knows you had it last time, and that they’re equipped to handle it if it happens again.

Despite their worries about having a second child, Kimmel and her husband finally “decided to go for it,” she says. They had moved, and she felt very confident in her new health provider, who listened and took extra precautions.

Baby Jorie arrived, and Kimmel says she breathed a sigh of relief when the first week passed without incident.

“It’s not a topic I’d ever want to scare new mothers about,” Kimmel says, “but at the same time, I think it’s important to know about. I think it’s good to be aware.”

Image courtesy of iStock.