Childbirth, heavy bleeding - What is it?

It's normal to have some bleeding when you give birth. But if you lose half a litre (about a pint) or more of blood, it means your bleeding is heavy.

Doctors call heavy bleeding after childbirth postpartum haemorrhage. If you lose about one litre (about two pints) or more of blood after childbirth, then you have severe postpartum haemorrhage.[1]

It can be difficult for doctors to tell exactly how much blood you lose after you have a baby. But your doctor or midwife will monitor you carefully after your baby is born to check that you're not losing too much blood. They will look at how much you are bleeding, and check your blood pressure, pulse and general health. These things will help them decide if you're losing too much blood and need treatment.

Heavy bleeding (haemorrhage) can happen during the first 24 hours after you give birth or up to six weeks later.

If you get heavy bleeding within 24 hours of giving birth, it's called primary postpartum haemorrhage.
If you get heavy bleeding after the first 24 hours and up to six weeks later, it's called secondary postpartum haemorrhage. If you are at home and think you're bleeding heavily and you feel dizzy and weak, call your doctor straight away. You may need treatment.

Bleeding heavily after having a baby is a problem because:

It can lead to anaemia (when you have a low number of red blood cells in your body)
You may need a blood transfusion
You can die. But this is rare.

Most women who bleed heavily after they've had a baby do so because their womb (uterus) doesn't shrink (contract) properly. Doctors call this uterine atony. As your womb contracts and separates from your placenta, the blood vessels in your womb close up. If some of the placenta doesn’t come away completely, the womb can’t contract properly and the blood vessels will continue bleeding. The treatments we talk about here are given to help the womb shrink after childbirth. (See What treatments work to prevent heavy bleeding after childbirth?)

Other problems that also can cause heavy bleeding after childbirth are:[2]

Bits of the placenta (afterbirth) getting stuck in your womb after delivery, instead of coming out
Cuts or tears around your vagina or cervix (the opening of the womb) during delivery
A hole or tear in your womb
Your blood not clotting normally.

Certain things make it more likely that you'll get heavy bleeding after childbirth. These are called risk factors. Having a risk factor doesn't mean you'll bleed heavily for certain. And women without the risk factors can still have problems. But if you have a risk factor, you have a greater chance of having heavy bleeding than a woman who doesn't have any risk factors.

Some risk factors for heavy bleeding after childbirth are:[3] [1]

Being in labour for a long time can make you more likely to have heavy bleeding.

Having a general anaesthetic (a medicine to make you sleep through the delivery)
Having heavy bleeding after a previous birth
Having anaemia when you go into labour
Being very overweight (obese)
Bleeding during your pregnancy (after 24 weeks)
Having a low-lying placenta
Being over 35
Having twins
Having a condition in which you have extra fluid in your womb during pregnancy (called polyhydramnios)
Being in labour for a long time (more than 12 hours)
Being in the third stage of labour for a long time (more than 30 minutes). The third stage of labour is the time between when your baby is born and when you deliver the placenta (afterbirth)
Having a drug called oxytocin to start your labour and make your contractions stronger
Having had many pregnancies (more than 4)
Having a womb that didn't shrink properly after a previous pregnancy
Having pre-eclampsia. Pre-eclampsia is a condition where you have high blood pressure, swelling and protein in your urine during pregnancy. To learn more, see our information on Pre-eclampsia
Being in labour for the first time
Having a cut to make your vagina wider during childbirth (these cuts are called episiotomies). To learn more, see our information on Childbirth, tear or cut
Having your baby delivered with the help of instruments (such as a vacuum pump or forceps).

References

Maughan KL, Heim S, Galazka SS. Preventing postpartum hemorrhage: managing the third stage of labor. American Family Physician. 2006; 73: 1025-1028. Available at http://www.aafp.org (accessed on 20 February 2008).
Chelmow D, O'Brien B. Postpartum haemorrhage: prevention. April 2006. BMJ Clinical Evidence. Available at http://www.clinicalevidence.com (accessed on 20 February 2008).
National Institute for Health and Clinical Excellence. Intrapartum care: care of healthy women and their babies during childbirth. September 2007. NICE clinical guideline 55. Available at http://www.nice.org.uk/cg055 (accessed on 18 February 2008).

Glossary

blood pressure: Blood pressure is the amount of force that's exerted by your blood on to your blood vessels. You can think of it like the water pressure in your home: the more pressure you have, the faster and more forcefully the water flows out of the shower. Blood pressure is measured in millimetres of mercury (written as mm Hg). When your blood pressure is taken, the measurement is given as two numbers, for example 120/80 mm Hg. The first, higher, number is called the systolic pressure, and the second, lower, number is the diastolic pressure. The systolic number is the highest pressure that occurs while your heart is pushing blood into your arteries. The diastolic number is the lowest pressure that happens when your heart is relaxing and is not pushing your blood.
pulse rate: Your pulse rate is the number of times that your heart beats in one minute. A normal rate is usually between 60 and 100 beats per minute, but the heart can speed up under certain circumstances, such as when you exercise or when you have an infection.
haemorrhage: Haemorrhage is a word doctors use for bleeding. Any time blood escapes from a vessel, it's called a haemorrhage.
anaemia: Anaemia is when you have too few red blood cells. Anaemia can make you get tired and breathless easily. It can also make you look pale. Anaemia can be caused by a number of different things, including problems with your diet, blood loss and some diseases.
red blood cells: Red blood cells are the part of your blood that makes it red. Their main job is to carry oxygen from your heart and lungs to the tissues of your body. Once these cells unload oxygen, they pick up carbon dioxide. They take carbon dioxide back to your lungs so it can be breathed out of your body.
blood transfusion: If you've lost too much blood from your body, you may need a blood transfusion to replace it. People with diseases of their blood, like sickle cell anaemia, sometimes need blood transfusions to replace blood that doesn't work properly.
placenta: The placenta is an organ that grows in the womb during pregnancy. It joins the woman to the growing baby. The placenta provides the baby with oxygen, water and nutrients from the mother's blood. It also produces the hormones that are involved in pregnancy.
cervix: The cervix is a piece of tissue that sits between a woman's womb and her vagina. It has a small opening in it that gets much bigger when a woman is having a baby.
general anaesthetic: You may have a type of medicine called a general anaesthetic when you have surgery. It is given to make you unconscious so you don't feel pain when you have surgery.
high blood pressure: Your blood pressure is considered to be high when it is above the accepted normal range. The usual limit for normal blood pressure is 140/90. If either the first (systolic) number is above 140 or the lower (diastolic) number is above 90, a person is considered to have high blood pressure. Doctors sometimes call high blood pressure 'hypertension'.
proteins: A lot of your body's tissues are made out of proteins. Proteins can be made in your cells. Proteins are also part of the food you eat, particularly meat and dairy products. Your body breaks down the protein you eat into amino acids. Your cells then use these amino acids to build new proteins, which make up muscles, joints, hair and other parts of your body.

This information does not replace medical advice. If you are concerned you might have a medical problem please ask your Boots pharmacy team in your local Boots store, or see your doctor.