Excessive bleeding after birth.Giving birth is a process and a half and everyone who goes through it deserves a medal. It usually does not end there though. Women still have to take time to heal from the bruising and stitches and this may take over a month. Sometimes things don’t go as expected and you may bleed too much or get an infection.
Losing blood after giving birth is normal and expected. Losing 500ml or more within the first 24 hours is known as primary post-partum haemorrhaging. Any more blood lost in excessive amounts after the first day onwards and goes on for about six weeks is known as secondary post-partum haemorrhaging.
It can occur if the uterus does not properly contract after delivering the placenta or if a little placenta is still left in the uterus. Another cause could be the blood is unable to clot properly or an injury to the cervix, vagina or uterus during delivery.
Infections can occur in the bladder, uterus, endometrial lining, vagina, kidneys or the urinary tract after delivery. Even those who have had a C-section delivery can develop an infection on the scar. Any infections would start to show about two days after delivery.
A placenta that is not properly expelled can also lead to an infection. This could be as a result of weak contractions or that the placenta is too high up in the uterus even after detaching it from the umbilical cord or if it is attached too deeply inside the uterus. Mastitis is another infection that could occur and is quite common. It can leave an abscess on the breast if it is not looked at.
Factors that predispose one to these post-partum conditions
- Expecting multiples
- Having given birth five or more times
- Developing pre-eclampsia or gestational hypertension
- Having placental praevia or placental abruption
- Developing an infection of the amniotic fluid or uterus during pregnancy
- Being overweight
- Being anaemic
- Getting a baby at an older age
- Having an extended or speedy labour
- Having a Caesarean section
- Having a cervical tear or a third or fourth degree tear
- Having a large baby or shoulder dystocia during delivery
- Having previously had a retained placenta or haemorrhaging
- Going into premature labour or having premature rupturing of membranes
- Developing umbilical cord problems that may lead to the placenta breaking off before it is to be delivered
Symptoms you should look out for
Once you give birth, the doctors and hospital staff will keep monitoring your blood loss and all other vital signs during the first 24 hours in hospital. Once you leave the hospital you have to keep an eye on the bleeding. If it gets worse then you need to get back to hospital. A sure sign to get you worried is passing very large blood clots or soaking up pads within an hour or less. Others include:
- Aching muscles
- Fatigue and lethargy due to excessive blood loss
- Abdominal pain
- Painful headaches
- Chills or a fever due to the infection that your body is fighting
- Difficulty urinating
- Vaginal discharge with a strong odour
- Bloody urine
- A spreading rash
- Red, sore, swollen skin or pus close to a Caesarean scar or vaginal tear
Diagnosis and treatment
Doctors will measure blood loss and check for an infection. They will also look for any placenta remains in the uterus. Blood and urine samples will confirm how far the infection has spread. Treatment for a retained placenta involves removing the leftover tissue under anaesthetic. Treating infections may involve antibiotics. Haemorrhaging can be treated using oxytocin medication that helps to contract the uterus.
Regardless of the type of infection, be sure to see a doctor within the shortest time possible so as to avoid bacteria getting into the bloodstream.