A Natural Process and A Leading Cause of Maternal Mortality Worldwide
Isha Gupta
July 2024
The birth of a baby is often a tremendously joyous occasion as parents welcome a new member to their family. Pregnancy and childbirth are accompanied by drastic changes to physical and mental health. Even after their baby is born, women can experience health effects as their bodies adjust to the postpartum period. A common experience is postpartum bleeding, also referred to as lochia.[1] New mothers experience bleeding from the vagina after childbirth due to shedding and restoration of the womb lining.[2] Experiencing some bleeding is a normal part of the postpartum period. However, excessive blood loss, also referred to as postpartum hemorrhage, is a critical maternal health concern to be aware of, given that it is a leading cause of maternal mortality worldwide.[3]
Women may experience postpartum bleeding regardless of if they had a vaginal delivery or Cesarean section.[2] Postpartum bleeding can last a few weeks.[1] The bleeding could temporarily get heavier and be accompanied by cramps, particularly during breastfeeding, due to the related uterine contractions.[1, 2]
Hospital and postpartum pads help effectively manage heavier bleeding, and women can use menstrual pads as their bleeding subsides.[2] Also, women who gave birth vaginally could potentially consider creating and using padsicles, an innovative term for chilled or frozen sanitary pads. Padsicles could help them reduce pain, swelling, and bruising, while simultaneously, managing bleeding and promoting healing.[4] New mothers are advised to refrain from using tampons and menstrual cups, until they have their postnatal checkup and their healthcare provider approves, in case there are wounds, tears, or cuts around the vagina, and to prevent infection while the body is healing.[1, 2]
Women should promptly seek a medical professional if they lose so much blood that they have to change their pad in less than an hour, and if the bleeding does not subside over time.[2] Also, profuse large blood clots could be a sign of the uterus having difficulty shrinking back to its original size.[2] Additionally, women experiencing postpartum bleeding should seek medical attention if they experience dizziness, irregular heartbeat, or signs of infection such as fever and chills.[2]
Postpartum hemorrhage is characterized by blood loss of 500 mL or more.[3] Postpartum hemorrhage usually occurs within 24 hours after childbirth.[5] However, it can also occur up to 12 weeks after birth.[5] Therefore, it is very important for new mothers to be aware of the signs and monitor their blood loss, in order to prevent adverse outcomes including death. Along with persistent and excessive bleeding, postpartum hemorrhage can be accompanied by symptoms of decreased blood pressure such as blurred vision, dizziness, or feeling faint.[5] Other signs of postpartum hemorrhage include pale skin, nausea, vomiting, and worsening abdominal or pelvic pain.[5] A common method that medical professionals determine the amount of blood loss among new mothers is by weighing their blood-soaked pads.[5] Additional diagnostic tests for postpartum hemorrhage include blood tests to measure red blood cells and clotting factors as well as ultrasounds of the uterus and related organs.[5]
One of the most common causes of postpartum hemorrhage is a soft and weak uterus, referred to as uterine atony.[5] Another common cause is uterine trauma, which can occur due to damage caused to the uterus, cervix, vagina, or perineum during childbirth.[5] The use of medical tools such as forceps and vacuum extraction during childbirth can increase women’s risk of uterine trauma.[5] Postpartum hemorrhage can also occur when the entire placenta does not separate from the wall of the uterus, referred to as retained placental tissue.[5]In addition, postpartum hemorrhage can occur in women who have coagulation disorders or conditions like eclampsia, because they can interfere with their body’s clotting ability.[5] Diverse factors can influence the risk of postpartum hemorrhage, including having more than one baby simultaneously, giving birth to a large baby, prolonged labor, and older maternal age.[5]
There are diverse ways postpartum hemorrhage could be treated. Each woman should be given a personalized treatment plan based on her personal root cause and the particular amount of blood she has lost. For instance, if postpartum hemorrhage is caused by uterine atony, then specific medications such as oxytocin or prostaglandins like misoprostol could help induce contractions.[5] Other ways postpartum hemorrhage is treated include uterine massages to help uterine muscles contract, removing retained placental tissue, and repairing tears or lacerations on the vagina, cervix, or uterus.[5] Additionally, the uterus could be packed with sterile gauze.[5] Moreover, a balloon could be utilized to put pressure on uterine walls.[5]In rare cases, a surgeon might need to make an incision in a woman’s abdomen to effectively determine the source of her postpartum hemorrhage, known as laparotomy, or surgically remove her womb, known as hysterectomy.[5] Furthermore, women suffering from postpartum hemorrhage may need blood transfusions to replenish the blood lost.[5]
Postpartum hemorrhage could be a painful and even traumatic experience for new mothers and it could be a stressful experience for their loved ones.[3] Furthermore, in many communities around the world, bleeding during and after childbirth is considered impure and to be caused by evil spirits, similar to stigmas surrounding menstrual bleeding.[3] Negative socio-cultural perceptions and taboos could influence delays in seeking medical attention, especially since women and their community members may end up ignoring excessive blood loss until new mothers become unconscious.[3] Combating misinformation and raising awareness of both natural postpartum bleeding and postpartum hemorrhage is crucial for improving new mothers’ health and well-being. Early detection and treatment of postpartum hemorrhage helps lead to healthier outcomes and save women’s lives.[5]
Postpartum bleeding is a common experience among new mothers. Nevertheless, it is essential to effectively understand and distinguish normal postpartum blood loss and postpartum hemorrhage.[6]It is important for women to feel safe and comfortable sharing concerns about their health after childbirth so that serious maternal health concerns like postpartum hemorrhage can be addressed efficiently.
References
[1] National Health Service. (2024, April 25). Your body after the birth. National Health Service. https://www.nhs.uk/pregnancy/labour-and-birth/after-the-birth/your-body/
[2] Watson, S. (2018, July 23). Is Postpartum Bleeding Normal?. Healthline. https://www.healthline.com/health/pregnancy/is-postpartum-bleeding-normal
[3] Akter, S., Forbes, G., Vazquez Corona, M., Miller, S., Althabe, F., Coomarasamy, A., Gallos, I. D., Oladapo, O. T., Vogel, J. P., Lorencatto, F., & Bohren, M. A. (2023). Perceptions and experiences of the prevention, detection, and management of postpartum haemorrhage: a qualitative evidence synthesis. The Cochrane database of systematic reviews, 11(11), CD013795. https://doi.org/10.1002/14651858.CD013795.pub2
[4] Higuera, V. (2019, December 18). Padsicles: How to Make Them, How To Use Them, Why We Love Them. Healthline. https://www.healthline.com/health/pregnancy/padsicles
[5] Cleveland Clinic. (2022, January 3). Postpartum Hemorrhage. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/22228-postpartum-hemorrhage
[6] Fletcher, S., Grotegut, C. A., & James, A. H. (2012). Lochia patterns among normal women: a systematic review. Journal of women’s health (2002), 21(12), 1290–1294. https://doi.org/10.1089/jwh.2012.3668