Conditions that threaten women’s lives in childbirth & pregnancy

Haemorrhage - heavy uncontrolled bleeding

One of the main causes of life threatening emergencies in childbirth is postpartum haemorrhage (PPH). This is excessive bleeding following the birth of the baby. Most commonly it occurs within 24 hours of the birth and greater than 500mls (approximately one pint) of blood is lost (primary PPH). Secondary PPH can also occur where there is abnormal bleeding from 24 hours to six weeks after the baby is born.
 
Causes of PPH include failure of the womb to contract properly after the baby is born, problems with the placenta, for example retained placenta, placental abruption (abnormal detachment from the wall of the womb), placenta praevia (the placenta may be partly or completely covering the cervix/birth canal) or placenta accreta (where the placenta grows too deeply into the wall of the womb). Secondary PPH can be caused by retained pieces of placental tissue or infection.
 
Post-Partum Haemorrhage
If haemorrhage occurs it commonly happens within 24 hours after the birth. Amy (after an emergency caesarean) and Lisa (after a vaginal birth) started bleeding within minutes of giving birth to their daughters. Mandy started haemorrhaging during the night after her baby was born.
 
However, Sophie did not haemorrhage until several weeks after the birth of her second baby, which was caused by some retained placenta in her womb. (Normally after birth the placenta is delivered whole but sometimes pieces are left behind and can cause problems).
 
Some of the women we interviewed had a PPH unexpectedly after childbirth, whereas other women had big bleeds as a result of problems with their placenta that doctors had picked up on scans and were already aware of. So for example Kerry and Farkhanda were already in hospital being monitored when the bleeding started.
Women described feeling unwell, faint, dizzy, lightheaded and as if they were “falling back” or fading away from the room. Some women were unaware that they were haemorrhaging but were aware of a sudden sense of urgency and lots of activity around them. Sometimes women were passing in and out of consciousness.
Women who were aware of the amount of blood they were losing were often very frightened. Kerry, who bled due to placenta praevia said, It was all, “Am I going to die? Am I going to bleed to death?”
 
Treatment for post-partum haemorrhage usually involves internal compression of the womb to stop the bleeding, IV drips and blood transfusions, and sometimes more complicated procedures to block bleeding blood vessels under X-ray guidance. If the bleeding cannot be stopped and becomes life threatening, a hysterectomy is performed. Internal compressions were used to stop the bleeding for Natalie and Michelle. Sophie was taken into theatre where she was given a blood transfusion (under general anaesthetic) and doctors removed the bits of retained placenta that were causing the bleed.
In some cases, doctors and midwives were unable to stop the bleeding and it was necessary to perform a hysterectomy (operating to remove her womb) to save the woman’s life. For more on women who experienced a hysterectomy after their haemorrhage, see ‘Hysterectomy’.
 
While blood loss, if not stopped, could be dangerous for all women, the speed and severity of the bleeding varied. Some women started to lose blood very rapidly and the crash teams were called, while other women were monitored over a period of hours.
Some women knew about the possibility of haemorrhage after childbirth and so when they started to feel faint, had an idea what might be happening to them. Other women had no idea about the possibility and wished they had known more, so they could have prepared themselves mentally.
Once doctors had managed to stop the bleeding, the women were transferred to postnatal wards, or allowed to go home. The length of recovery time women experienced varied greatly depending on the amount of blood they had lost, if they needed a hysterectomy, or if they had other illnesses. Natalie and Amy did not lose vast amounts of blood, they were given blood transfusions and the bleeding was stopped quite quickly. Even so, they felt very weak for some time afterwards.
Women who had a haemorrhage and did not need to have a hysterectomy or further surgery generally did not feel they had lasting effects once they had recovered from the blood loss. Natalie lost 3 and a half litres of blood and had a blood transfusion and felt weak for a while, but did not have any long lasting effects. Amy also felt weak and took iron supplements to try and get her iron levels back up again.
 
In terms of future pregnancies, these women were advised that if they were thinking of getting pregnant again, they would be considered high risk, and would need consultant led care.


Last reviewed April 2016.
Last update April 2016.

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