Heavy bleeding after childbirth

What is heavy bleeding after childbirth?

It's normal to have some bleeding when you give birth. But if you lose a lot of blood, it can make you ill. Bleeding sometimes happens if your womb doesn't shrink back to its usual size after you give birth.

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 also check your blood pressure and heartbeat. These things will help them decide if you're losing blood and need treatment.

Bleeding can happen soon after you give birth or up to six weeks later. If you're at home and you get heavy bleeding, call your doctor straight away.

What treatments work?

There are several things doctors can do that help prevent heavy bleeding after you give birth. After your baby has been born, you also deliver the placenta (afterbirth). At this stage, your doctor or midwife will gently pull on the umbilical cord, put a clamp on the umbilical cord and cut it, and drain blood out of the umbilical cord. They may also give you drugs to help your womb go back to its usual size, which helps to prevent bleeding.

Doing all these things can help prevent bleeding. Good research has found that about 5 in 100 women got heavy bleeding when doctors did all these things. About 14 in 100 women who didn't have treatment or who only had drugs got heavy bleeding.

Some women vomited or got a headache after treatment. But one study found that women whose doctors did all these things were happier about the birth than women who had no treatment.

There are several drugs that can be used to help your womb shrink back to its usual size after you've given birth. There's good research showing that an injection of a hormone called oxytocin (brand name Syntocinon) can reduce your risk of heavy bleeding after childbirth.

Several studies found that 12 in 100 women had heavy bleeding after an injection of oxytocin. About 24 in 100 women who didn't have it got heavy bleeding. There's a chance you could get high blood pressure after an injection of oxytocin. In the research, this happened to about 10 in 100 women.

Drugs called ergot alkaloids also help to shrink your womb. You have them as injections or tablets. Some studies have shown that they work just as well as oxytocin injections, but they have more side effects. Some examples of ergot alkaloids are ergometrine and ergotamine (brand names for ergotamine are Cafergot and Migril). A combined injection of oxytocin and ergometrine seems to work better than oxytocin on its own, but you may get more side effects.

About 1 in 10 women who take ergot alkaloids get high blood pressure. And about 1 in 10 women feel sick.

Another type of drug that can be used is called a prostaglandin analogue. These are similar to chemicals made by your body. They help tighten the muscles in your womb. Some research has found they help about as much as oxytocin. But they have more side effects. Prostaglandin analogues (with brand names) include carboprost (Hemabate) and dinoprostone (Prostin E2). They're usually given as injections. Side effects can include pain in your tummy, vomiting and diarrhoea. About 2 in 10 women get some kind of side effect.

Your doctor or midwife can massage your tummy after you give birth. Doctors think that this may help your womb go back to its usual size. But there hasn’t been any good research on whether it helps prevent bleeding.

Some researchers have looked at whether breastfeeding soon after giving birth can help prevent bleeding. It doesn't seem to make any difference, but breastfeeding is good for your baby in several ways, so your doctor or midwife might recommend it anyway.

What will happen to me?

It's rare for bleeding after childbirth to be dangerous. You can have a blood transfusion if you need it. Occasionally, doctors do surgery to stop the bleeding.

If you're having heavy bleeding and your placenta (afterbirth) hasn't come out on its own, you may need to have it taken out. This is done as a small operation under a general anaesthetic, so you'll be asleep.