Postpartum haemorrhage: What you need to know

Postpartum bleeding or haemorrhage (PPH) is excessive bleeding after your baby is born and happens in the third stage of labour. Risk factors can include long labour and anaemia as well as BMI and maternal age over 40.

After you’ve had your baby, bleeding is normal, but this amount should lessen each day. If it doesn’t, let a medical professional know.

There are two types of PPH – primary and secondary. The first type is the most common and is obvious within 24 hours of giving birth due to the amount of blood loss. The most common cause is from a lack of contractions in the womb which help to seal the blood vessels on the uterine wall and stop bleeding. If these contractions don’t occur, the bleeding may continue. PPH can also be as a result of a traumatic delivery or infection.

The second type of PPH happens between 24 hours and 12 weeks of giving birth. There is typically less blood loss and it is due to the placenta remains still being inside.

Treatment: What treatment you undergo will depend on how severe your case of PPH is. Rarely, a blood transfusion may be needed. In cases of secondary PPH, surgery may be required to remove the remainder of the placenta if it doesn’t pass naturally.

Before labour, risk factors are:

• Previous postpartum haemorrhages
• A body mass index (BMI) above 35
• A twin or triplet pregnancy
• Low-lying placenta (placenta previa)
• Placenta coming away early (placental abruption)
• Pre-eclampsia or high blood pressure
• Anaemia
• Growths in or around the womb
• Taking blood-thinning medication
• Blood clotting problems.

During labour, risk factors are:

• Caesarean section birth
• Induced labour
• Retained placenta
• Episiotomy
• Forceps or vacuum-assisted vaginal delivery (ventouse) birth
• Your labour lasted longer than 12 hours
• Having a baby that weighs in at more than 4kg (9lbs)
• Having your first baby when you’re over 40 years old
• Having a raised temperature during labour
• Needing a general anaesthetic.

Iron-deficient new mums are also advised to take a supplement. Symptoms include extreme fatigue, pale face or palpitations which are a sign that you are severely anaemic.

Other less common symptoms include: 

• Headache
• Sore tongue
• Itchy skin
• Changes in how food tastes
• Craving unusual food like ice (a condition known as Pica)

Tell your doctor or health visitor if you have symptoms of anaemia and they can arrange a blood test and prescribe suitable iron tablets.