Postpartum Hemorrhage: Should I Worry About Losing Too Much Blood from Childbirth?

Every woman expects blood loss as part of childbirth, whether by C-section or vaginally. What they don’t expect is to hemorrhage to death, or near death.

Each year about 50,000 U.S. women are injured during childbirth, according to a recent USA Today investigation. About 700 new mothers die. Many of those injuries and deaths could have been prevented if hospitals had put in place safety practices to address postpartum hemorrhage, which is excessive bleeding following childbirth. If postpartum hemorrhage is not properly treated, it can cause the mother’s blood pressure to drop dangerously, which can lead to death, shock and other serious medical conditions.

According to USA Today, California is the only state to buck the alarming statistics, with its maternal death rate falling by half while maternal deaths continue to rise across the nation. There, safety experts and hospitals worked together to implement childbirth safety practices considered by medical societies as the “gold standard of care.” Those practices include “tool kits” to ensure that hospitals have the best protocols and necessary medical supplies and equipment in place to save women’s lives in the event of a hemorrhage, where quick action can mean the difference between life and death.

Below are answers to the eight most common questions asked by new and expectant moms about postpartum hemorrhage.

How Much Blood Loss Is Considered Normal for Childbirth?

The average blood loss for a single baby delivered vaginally is about 500 milliliters, which is about half a quart, according to Children’s Hospital of Philadelphia (CHOP). For cesarean births, the average is about 1000 milliliters or one quart.

What Is the Likelihood That I Will Suffer from Postpartum Hemorrhage?

An estimated 2.9 percent of women who give birth in the U.S. will suffer from postpartum hemorrhage (defined by the World Health Organization as a blood loss of 500 ml or more within 24 hours after birth, while severe PPH is defined as a blood loss of 1000 ml or more within the same timeframe), according to the Association of Women’s Health, Obstetric and Neonatal Nurses. Postpartum hemorrhage affects 125,000 new moms per year.

What Causes Postpartum Hemorrhage?

The most common cause of postpartum hemorrhage is failure of the uterus to adequately contract after a mother gives birth. This condition is called uterine atony. After delivery, the mother’s uterus normally continues to contract and expels the placenta, which is a temporary organ that attaches to the uterine wall during pregnancy that supplies the baby with nutrients and oxygen. Those contractions help compress the blood vessels that attached the placenta to the uterus. If the contractions are not strong enough, the blood vessels will bleed freely, causing postpartum hemorrhage.

Postpartum hemorrhage also occurs when small pieces of the placenta remain attached to the uterine wall after the placenta is expelled.

According to CHOP, some women are at greater risk for postpartum hemorrhaging than others. Conditions that may increase the risk include:

• Placental abruption. The early detachment of the placenta from the uterus.
• Placenta previa. The placenta covers or is near the cervical opening.
• Overdistended uterus. Excessive enlargement of the uterus due to too much amniotic fluid or a large baby, especially with birthweight over 4,000 grams (8.8 pounds).
• Multiple pregnancy. More than one placenta and overdistention of the uterus.
• Gestational hypertension or preeclampsia. High blood pressure of pregnancy.
• Having many previous births
• Prolonged labor
• Infection
• Obesity
• Medications to induce labor
• Medications to stop contractions (for preterm labor)
• Use of forceps or vacuum-assisted delivery
• General anesthesia

Other factors that may cause postpartum hemorrhage according to CHOP are:

• Tear in the cervix or vaginal tissue
• Tear in a uterine blood vessel
• Bleeding into a hidden tissue area or space in the pelvis. This mass of blood is called a hematoma, and it is usually located in the vulva or vagina.
• Blood clotting disorders, such as disseminated intravascular coagulation
• Placenta accreta. The placenta is abnormally attached to the inside of the uterus (a condition that occurs in one in 2,500 births and is more common if the placenta is attached over a prior cesarean scar).
• Placenta increta. The placental tissues invade the muscle of the uterus.
• Placenta percreta. The placental tissues go all the way into the uterine muscle and may break through (rupture).
• Uterine rupture, which is an uncommon event. Conditions that may increase the risk include surgery to remove fibroid (benign) tumors and a prior cesarean scar.

For How Long after Childbirth Am I at Risk for Postpartum Hemorrhage?

Postpartum hemorrhage usually occurs within one day of childbirth. But it can happen up to 12 weeks following birth, according to March of Dimes.

What Are the Symptoms of Postpartum Hemorrhage?

According to CHOP, the most common symptoms of postpartum hemorrhage are:

• Uncontrolled bleeding
• Decreased blood pressure
• Increased heart rate
• Decrease in the red blood cell count (hematocrit)
• welling and pain in tissues in the vaginal and perineal area, if bleeding is due to a hematoma

How Is Postpartum Hemorrhage Treated?

Treatment for postpartum hemorrhage will vary depending upon the situation and severity. According to CHOP, treatment for postpartum hemorrhage can include:

• Medication (to stimulate uterine contractions)
• Manual massage of the uterus (to stimulate contractions)
• Removal of placental pieces that remain in the uterus
• Examination of the uterus and other pelvic tissues
• Bakri balloon or a Foley catheter to compress the bleeding inside the uterus. Packing the uterus with sponges and sterile materials may be used if a Bakri balloon or Foley catheter is not available.
• Tying-off of bleeding blood vessels using uterine compression sutures
• Surgery to open the abdomen to find the cause of the bleeding.
• Surgical removal of the uterus; in most cases, this is a last resort.
• Replacing lost blood and fluids

What Happens If Postpartum Hemorrhage Goes Untreated?

When doctors, nurses, midwives and other medical providers fail to timely recognize and properly treat postpartum hemorrhage, women can suffer devastating harm. Injuries caused by untreated postpartum hemorrhaging include:

• Death
• Shock
• Stroke
• Heart attack
• Kidney failure
• Blood clotting disorders

Women additionally may need to be placed on a ventilator or undergo a hysterectomy.

What Happens If I am Injured By Postpartum Hemorrhage?

The lawyers at Medical Malpractice Lawyers at  Feldman Shepherd Wohlgelernter Tanner Weinstock & Dodig LLP are pursuing medical malpractice claims for women injured by postpartum hemorrhage. The lawsuits filed on behalf of postpartum hemorrhage victims and families seek damages for medical bills, loss of earning potential, pain and suffering, and loss of the pleasures of life.