After your baby is born and your placenta detaches, it is normal to have some bleeding from the placental site, and sometimes from any perineal trauma you may have.
Blood loss of up to 500mL is a normal part of the birth process, and usually does not require any further intervention unless you are feeling unwell due to that loss. However, if your blood loss is more than this or if you are bleeding quicker than expected, your midwife or doctor may recommend that they intervene to prevent a large blood loss (postpartum haemorrhage).
The first intervention to help slow bleeding is to massage your uterus through your belly. This can be uncomfortable or even painful, but it helps your uterus contract to minimise blood loss.
There are several medications that can be given to help contract your uterus or to support blood clotting.
The first line medication is synthetic oxytocin, sometimes called ‘synto’ in Aotearoa. This medication helps your uterus to contract, and is also used in induction processes. It can be given as an injection into your thigh or arm, or through your IV line if you have one. It can also be administered mixed in saline as an IV infusion over four hours, which is useful in keeping your uterus contracted over a longer period.
The next medication usually offered is either ergometrine on its own, or mixed with synthetic oxytocin (called ‘syntometrine’). This also works by helping your uterus contract. It can raise your blood pressure, so it is not usually used if you have high blood pressure.
Another medication sometimes given to help your uterus contract is carboprost, which is given as an injection, and can be given up to eight times if your bleeding is ongoing. This medication has a side effect of causing diarrhoea, so if you need this medication, then you will often be offered another medication called loperamide as a tablet to help counteract this side effect.
The other medication often given to control postpartum bleeding is tranexamic acid (‘TXA’). This medication works by preventing blood clots from breaking down, so when a clot forms over the bleeding placental site, TXA will help keep that clot in place and prevent longer term bleeding. It is also useful if your bleeding is from perineal trauma, as when the blood clots at the trauma site it will keep the clot in place for longer to aid healing.
These medications are available in hospital, at primary units, and your midwife may carry most of them if you are birthing at home.
If these interventions do not slow your bleeding to safe levels, you may need to be transferred to theatre for further intervention.
If you have a bleed over 500mL at home or at a primary birthing unit, your midwife will likely recommend that you transfer in to hospital for further monitoring. You may be offered a blood test at least six hours after birth to check your haemoglobin level, and treatment from there will be guided by that level – you may be offered an iron infusion or a blood transfusion if that is appropriate for you.