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Abnormal Postpartum Bleeding: How to Recognize and Deal with It

Giving birth to a healthy baby and being a mother is an exhilarating feeling for many women. However, some postpartum complications can cast a shadow on the motherhood happiness. Postpartum bleeding is one of them.
abnormal postpartum bleeding

Bleeding after vaginal delivery

After delivery, it is normal to have vaginal bleeding and vaginal discharge. This is called lochia. It is usually a mix of uterine tissue, mucous, and blood. Its mechanism is natural. After you give birth your body makes use of the vaginal bleeding to get rid of the lochia from the uterus. This is part of the healing process and therefore, quite normal. 

In the first few days after delivery, the bleeding may be heavy. But it will gradually subside as the days go by and by the 6th week of your postpartum, it stops. 

What causes vaginal bleeding after childbirth?

Postpartum bleeding after vaginal delivery can be due to: 

  • Uterine atony. The most common cause of postpartum hemorrhage is uterine atony. This is a condition when the uterus, for some reason or the other, fails to contract after childbirth. This puts mother at risk of having postpartum hemorrhage (PPH). In fact, uterine atony is the leading cause of postpartum bleeding. 
  • Laceration. You may have postpartum bleeding owing to uterine, cervical or vaginal lacerations. Your physician may need to do a proper examination to rule out laceration as the cause of PPH. A uterine rupture may also cause postpartum bleeding. This is something your physician should be aware of and should check to see whether it’s the cause or not. There are several risk factors for uterine rupture and they include vaginal birth after caesarian section, uterine scars, trauma.
  • Retained or trapped placenta. A retained or trapped placenta is when the placenta is not expelled from the uterus. This usually happens when the placenta partially detaches from the lining of the uterus causing the uterus to contract improperly. So, all the blood vessels within the uterus continue to bleed as long as there is a retained placenta in the uterus. 
  • Placenta accreta. This is a condition when the placenta attaches too deeply into the uterine wall. There are two other similar conditions: placenta increta and placenta percreta. All these three conditions are differentiated by the abnormality (i.e. depth) of their attachment to the uterine wall. When placenta accreta occurs, it can cause PPH especially when the obstetrician attempts to remove the placenta.
  • Uterine inversion. This is a complication that occurs after childbirth when the uterus everts (turns inside out). When this happens, symptoms such as postpartum bleeding, low blood pressure, and abdominal pain may occur. A uterine inversion may occur if the uterine is weak or the umbilical cord is short. 
causes for bleeding after vaginal delivery

Bleeding after cesarean delivery

Common causes of bleeding after cesarean delivery include:

  • Uterian trauma
  • Placenta accreta
  • Uterine atony
  • Lacerations.

Postpartum bleeding: how much blood is normal?

After childbirth, you should expect to see some bleeding and spotting. And this may last for about 4-6 weeks. 

According to medical experts, excessive blood loss or postpartum bleeding is determined when a woman loses more than 500 ml of blood after vaginal birth and more than 1000 ml after a C-section. This can cause a lot of complications that can put your overall health at risk.

Heavy bleeding after giving birth is called postpartum hemorrhage. 

It’s most likely to happen within the first 24 hours after delivery. But it can happen anytime within the first 12 weeks after you’ve given birth.

Signs of abnormal postnatal bleeding

How do you know that you have abnormal bleeding? Many women may not know that they have heavy postpartum hemorrhage until they start to experience certain symptoms that accompany the condition such as weakness, nausea, rapid heart rate and dizziness. However, even before these symptoms show up, how do you recognize you have abnormal bleeding? 

  1. The amount of blood you are losing: bleeding that soaks more than one pad an hour. 
  2. Blood clots: the blood clots seem abnormally large (bigger than a plum), even to you.
  3. Type of flow of the blood: there is a continuous flow, which does not seem to stop. 

Other signs that may accompany abnormal postnatal bleeding include:

  • Low blood pressure (hypotension)
  • Dizziness
  • Weakness
  • Nausea
  • Increased heart rate
  • Faintness
  • Blurred vision
  • Chills
  • Restlessness
  • Rapid breathing
  • Pain and swelling in the vagina and nearby area if bleeding is from a hematoma.  

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When you notice that you are bleeding excessively and continuously, this is a major sign that you are experiencing postnatal bleeding. It’s understandable to think that it’s normal. But when you start to experience other symptoms like increased heart rate, rapid breathing and nausea on top of the heavy bleeding, this is a sure sign that something is definitely wrong. 

What is the treatment for postpartum bleeding?

treatment for postpartum bleeding

There are several ways to treat postpartum hemorrhage. The choice of treatment, however, depends on the cause and severity of the postpartum bleeding.  

Some treatment options for postpartum bleeding include:

Medication. Uterotonic medication is usually the first choice of treatment for postpartum hemorrhage. Oxytocin is usually the recommended as uterotonic medication.

Uterine massage. When your doctor notices heavy bleeding after delivery, he may attempt to stop it by massaging your uterus. This helps the uterus to contract which consequently stops the bleeding. 

Balloon tamponade. A uterine balloon tamponade is also quite effective at stopping postpartum bleeding. The way it works is a balloon known as the Bakri balloon is inflated inside the uterus to add pressure so as to stop the bleeding. 

Surgery. There are two types of surgical procedures a doctor may recommend to stop postpartum bleeding: 

  • Hysterectomy  – a surgical operation to remove the uterus.
  • Laparotomy – a surgical operation that involves opening up the abdomen to determine the cause of the bleeding and to attempt to stop it. 

Blood transfusion. This method involves adding new blood to your body to replace the lost blood, intravenously. 

Uterine artery embolization. With this method, a radiologist conducts special tests to determine which blood vessel is bleeding. The radiologist then injects small particles into the vessel to stop the bleeding. 

Removal of the placenta. This method involves removing remaining pieces of the placenta from the uterus either manually or using special tools.

Consult your doctor to decide on the best treatment option for you.

Getting back to normal

foods rich in iron after postpartum bleeding

During your postpartum recovery,it is important that you avoid any kind of strenuous activity or exercise especially after having a postpartum hemorrhage. It is recommended to take lots of rest. 

Also, watch what you are eating and drinking. Eat foods that are rich in iron such as:

  • Red meat and seafood
  • Dark green leafy veggies such as spinach
  • Pumpkin seeds, nuts and chickpeas
  • Lentils
  • Beans, peas.

The reason why it is important to eat a diet rich in iron is that after postpartum bleeding, your body becomes deficient of iron, a condition known as iron deficiency anemia. You need to increase the levels of iron in your body because iron plays an important role in the production of hemoglobin. 

It is equally important to add foods rich in vitamin C to your diet as it helps your body to absorb the iron. Foods you need to avoid include dairy products because they contain calcium. 

Calcium can make it hard for your body to absorb the iron. Also, add high fiber foods to your diet like whole grains and fruits to avoid constipation. 

Lastly, take care of your mental health and well being. Many women who have had postpartum bleeding often suffer from postpartum depression. If you experience postpartum depression, talk to someone or join a support group of women who have had a similar experience. Nothing can be more helpful towards your recovery than the support of family and friends. You’ll be surprised just how quickly you will recover both physically and mentally. 

If you want to keep track of your periods and not necessarily to avoid getting pregnant, but just to know what is going on with your health during that time of the month, get the Flo app period tracker. It does more than help you keep track of your monthly cycle. It also helps you prevent period-related symptoms and tells you how you can treat certain health conditions such as polycystic ovary syndrome and premenstrual dysphoric disorder.  

https://www.healthline.com/health/pregnancy/complications-cesarean-section#bleeding

https://www.webmd.com/women/vaginal-bleeding-after-birth-when-to-call-doctor#1

https://www.mayoclinic.org/diseases-conditions/iron-deficiency-anemia/symptoms-causes/syc-20355034

https://www.stanfordchildrens.org/en/topic/default?id=postpartum-hemorrhage-90-P02486

https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0011920/

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