Childbirth, heavy bleeding - Treatments

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Most women in the UK don't bleed heavily after childbirth, but occasionally it does happen. Doctors have found that some treatments may help to prevent this.

Key points about preventing heavy bleeding after childbirth

  • Your doctor or midwife can take steps to prevent heavy bleeding in the time between when your baby is born and when you deliver the placenta (afterbirth). This is called managing the third stage of labour. Research has found it works. Your doctor or midwife can put a clamp on the umbilical cord, drain the blood out of it, pull gently on the cord, and give you an injection to help your womb (uterus) shrink. Or you might just get an injection on its own.
  • All or most women who have a baby by vaginal delivery will have their third stage of labour actively managed. That's because it's hard to predict who will have problems, and the active management has to be done before the heavy bleeding happens.
  • But some women may decide they want the third stage of labour to be natural with no extra treatments.
  • Doctors think that massaging your womb (uterus) after you give birth helps it to shrink. But there haven't been any good studies about this, so we can't say for certain.
  • Breastfeeding straight after you deliver doesn't seem to help prevent heavy bleeding. But it's good for you and your baby in other ways.

We've looked closely at the research and ranked the treatments into categories, according to how well they work.

Treatments that work

Active management of the third stage of labour

The third stage of labour is the time from when you deliver your baby to when you deliver the placenta (afterbirth).

There is good research to show that women who have their third stage of labour actively managed have a lower risk of heavy bleeding. Active management can sometimes cause minor side effects. But women who've had active management seem more happy with how they've been looked after.[2]

During active management of the third stage of labour, your doctor or midwife may do some or all of the following things:[3] [1]

One summary of five good-quality studies (called randomised controlled trials) found:[2]

  • 5 percent of women who had active management of labour got heavy bleeding
  • 14 percent of women who didn't have this treatment or who only had an injection of a medicine got heavy bleeding.

Women who had their third stage of labour actively managed had other benefits too:

  • They lost less blood on average
  • They were less likely to need a blood transfusion
  • They needed fewer iron tablets after childbirth.

Also, they delivered their placenta in a shorter period of time. Once your placenta has come out, your womb (uterus) shrinks and the blood vessels inside it close up. This stops bleeding from your womb. The longer it takes for your placenta to be delivered, the greater the risk of haemorrhage.

In these studies, doctors used injections of oxytocin (Syntocinon) or a drug called ergometrine, or a medicine that had oxytocin and ergometrine in it together (Syntometrine).

Women who had active management of labour were about twice as likely to get side effects such as nausea, vomiting and headache.

But in one of the studies, women who had active management were more likely to be happy with their third stage of labour, compared with the women who had no treatment.

Treatments that need further study

Massaging your womb (uterus)

Your doctor or midwife can massage your womb after delivery. They do this by massaging your abdomen (tummy). Doctors think that this can help your womb to shrink after you've given birth. Massaging the womb is recommended as a treatment for women bleed heavily after giving birth.[1]

There haven't been any good studies to show whether massaging the womb helps to prevent heavy bleeding after delivery.

Doctors don't think that massaging your womb does any harm.

Breastfeeding straight after childbirth

When you breastfeed or massage your nipples, a part of your brain called the pituitary gland releases a hormone called oxytocin. Oxytocin helps your womb to shrink and also helps you to breastfeed.

One study, which looked at about 4,000 women, found that breastfeeding straight after giving birth didn't help prevent heavy bleeding.[4] But breastfeeding is good for you and your baby in other ways. For example, breast milk contains antibodies, which help your baby fight off infections.

References

  1. 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).
  2. Prendiville WJ, Elbourne D, McDonald S. Active versus expectant management in the third stage of labour (Cochrane review). In: The Cochrane Library, Issue 2, 2005. Wiley, Chichester, UK.
  3. 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).
  4. Bullough CH, Msuku RS, Karonde L. Early suckling and postpartum haemorrhage: controlled trial in deliveries by traditional birth attendants. Lancet. 1989; 2: 522-525.

Glossary

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.
hormones
Hormones are chemicals that are made in certain parts of the body. They travel through the bloodstream and have an effect on other parts of the body. For example, the female sex hormone oestrogen is made in a woman's ovaries. Oestrogen has many different effects on a woman's body. It makes the breasts grow at puberty and helps control periods. It is also needed to get pregnant.
randomised controlled trials
Randomised controlled trials are medical studies designed to test whether a treatment works. Patients are split into groups. One group is given the treatment being tested (for example, an antidepressant drug) while another group (called the comparison or control group) is given an alternative treatment. This could be a different type of drug or a dummy treatment (a placebo). Researchers then compare the effects of the different treatments.
antibodies
Antibodies are an important part of your immune system. They are proteins made by white blood cells (another part of your immune system). They help destroy bacteria and other agents that cause infections.
infection
You get an infection when an organism, such as a bacterium, a fungus or a virus gets into a part of your body where it shouldn't be. For example, an infection in your nose and airways causes the common cold. An infection in your skin can cause rashes such as athlete's foot. The organisms that cause infections are so tiny that you can't see them without a microscope.

© BMJ Publishing Group Limited ("BMJ Group") 2007. All rights reserved

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.

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