All women lose some blood during  childbirth when the  placenta separates from the uterus and afterwards. Women who go through cesarean deliveries lose more blood  than those who deliver vaginally.  However during pregnancy the blood in the body increases by 50% and as a result the body is well prepared for this blood loss.
 

 
Bleeding after delivery is normal and comes from open blood vessels in the uterus at the site where the placenta was attached. If you had a tear during delivery, you may also bleed from the site if it is not already stitched.

During separation of the placenta from the uterus, these blood vessels bleed into the uterus. The blood vessels close off as the uterus continues to contract. Your healthcare provider will give you a massage or give you the synthetic form of the hormone oxytocin (pitocin) to help the uterus contract.  Breastfeeding also causes your uterus to release oxytocin and that can also aid in the process .

However after delivery some women may bleed excessively. This is called postpartum hemorrhage PPH and may require special treatment. It happens in up to 6% of births. It usually happens  while the placenta is separating or soon after. If postpartum hemorrhage occurs within 24 hours of birth, it is called early , immediate or primary PPH. If it occurs days or weeks after delivery, it is called late,  delayed or secondary PPH.

What are the other causes of postpartum bleeding ?

 
Other possible causes of PPH include he following :

• raptured or inverted uterus
• deep tear in the vaginal or perineum
• systemic blood clotting disorder

What is the treatment for postpartum bleeding ?

 
Your healthcare provider will take a number of steps to treat postpartum bleeding right away. Uterine atony  which is the loss of tone is the most common cause of PPH.  Therefore your health care provider will give you  a massage to help your  uterus contract while you get oxytocin through IV.  If you don’t already have an IV, the nurse will  start one immediately.  A catheter will be installed to make sure your bladder is empty . This is because a full bladder makes it difficult for the uterus to contract.

Your healthcare practitioner will attempt to deliver the placenta if it is not out yet. This will be done manually. He may have to  reach up inside your uterus and remove the placenta manually. You will be given pain medication before the procedure. You will also be moved to the operating room if you are in the birthing room.

If bleeding continues after the placenta is removed, you will receive other medications in addition to the oxytocin while your caregiver massages your uterus. Most of the time, the medication works quickly and the uterus contracts.

If necessary , your health care provider will insert a hand into your vagina and place the other hand on your belly and compress your uterus between the two hands. This together with the medication usually stops the bleeding.

If you still continue to bleed , you will be taken  to the operating room and given pain medications to keep you comfortable. Your doctor will check to make sure there  are no laceration that appears to be the source of the bleeding. He will check your uterus through your vagina for any fragments of the placenta that may remain. In some cases , you may need a dilation and curettage (D&C)  to remove them.

You will be given blood transfusion if the bleeding is extensive and vital stats are not stable. Rarely, you may need an abdominal surgery and hysterectomy to stop the bleeding. Your blood pressure and pulse will be taken frequently to find out how you are coping with blood loss. You  will also have a blood test to check for anemia and if your blood is clotting properly.

Recovering from postpartum hemorrhage

 
You will  still continue to receive IV fluids and medication after the bleeding is controlled. This is to help your uterus contract. You will be  monitored closely for further bleeding and any complications. It is recommended that you do not get out of bed due to being weak and light-headed .

Recovery will depend on how much blood you lost and how much your blood increased during pregnancy. Your doctor may prescribe prenatal vitamins with folic acid as well as iron supplements.