Postpartum Hemorrhage: Image

Postpartum Haemorrhage (PPH)

How to diagnose, prevent, and treat postpartum haemorrhage at home during unassisted childbirth

Published 12 January 2020, last updated 18 July 2022

**REMINDER. This is not medical advice and should be taken as a guide only. Please consider if this is right for you before acting on any information**

What is Postpartum hemorrhage?

Postpartum hemorrhage is usually defined as more than normal loss of blood after birthing a baby. Loss of blood more than 500ml, (minor) or 1000ml (major). It usually happens immediately after the placenta is delivered, but occasionally can happen while the placenta is still inside (retained placenta), or some time in the 24hrs after the birth.

Postpartum hemorrhage can turn life threatening for the mother very quickly, so stay alert and watch for signs. If you lose too much blood, you can go into shock or die unless the blood volume is restored.

However, do not be too worried. Hemorrhages are not common, and are even less common at home, but it is always good to be prepared.

You usually have time to treat or transfer.

What causes postpartum hemorrhage?

After the baby is born, and the placenta comes out, the uterus contracts to seal the blood vessels where the placenta was attached. If something prevents the contractions from happening strongly, quickly and efficiently, you will continue to bleed excessively.

The most common reasons are due to retained placenta as it means the uterus cannot contract down with part or whole of the placenta in the way.

Other reasons:

Tired uterus (usually from prolonged labour or extra large uterus due to huge baby, twins, excess amniotic fluid)
Precipitous labour (your body doesn’t realise quick enough that baby has already been born and that it needs to contract the uterus)
Lack of oxytocin (fear environment or baby is taken away)
Abrupt placenta removal by cord traction or manual removal, or in the case of a partial previa where the placenta ejects itself too soon
"Managed" and hurried 3rd stage by rushing the placenta out
Pre-existing blood clotting disorder
Also, sometimes you can actually be bleeding from a tear in the cervix, vaginal tissue or uterus

Signs and Symptoms of Postpartum Hemorrhage

It is my belief that the overall blood loss is not so important as the effects you as the mother are having. One mother may feel faint at 500ml< loss, while another mother may only suffer ill effects after 1500ml loss. It also depends on how much blood volume you had to begin with. A petite mother cannot afford to lose very much.

(For a visual example, a can of coke (330ml) poured on a puppy pad or sheet mimics normal blood loss. 2 -3 cans is excessive.)

"A haemorrhage could be considered as any blood loss that exceeds that mother’s physiological capacity to accommodate it without any accompanying morbidity." - Billie Harrigan

Signs and symptoms:

Pale, clammy skin
Feeling faint, nauseous or dizzy
Pre-existing risk factors of placenta accreta or previa
Uncontrolled bleeding (small gushes are normal as you move. But a steady trickle is not good, and if blood is pouring out, that is really bad)
Increased heart rate
Weak pulse less than 60bpm
Lowered blood pressure
If you've caught the blood in a receptacle and measured it, or estimated blood volume lost to be equivalent to 500ml-1000ml or more
If birthing in a pool, see visual here
Or in a bath, visual here
Lots of bleeding before the baby is born (this could be placental abruption, if birth is not imminent in less than 3 minutes, rush to emergency)
Excessive abdominal pain or distension near pubic bone with or without visible bleeding (this could be uterine rupture, transfer to emergency asap)
Grey lips (means you're not getting enough oxygen, call 000 asap)

Shivering: This one is an anomaly, as often after birth, due to the sudden hormone change, and change of intensity, you may start shaking/shivering intensely. It is often NOT a sign of PPH, but should be taken into consideration, if other signs are present. You should be kept warm and offered sweet fluids.

Prevention is better than cure

Before birth:
If you are doing all the things you can before birth, you have plenty of time to choose different options, and try different things.

Do eat a varied diet high in nutrients essential for increasing blood volume, and consume iron, herbs, and foods that help tone and strengthen your uterus and blood vessels

During birth:

Do create the right environment, relaxed, comfortable, and led by you.

Don't push before you are ready. Don’t rush the baby out. Wait for your body to push on its own, and work with your body’s pushes, not against them.

Do have a relaxed “3rd stage” where you have time to enjoy your baby, and the placenta comes out whenever you feel it is ready.

Do have a "holistic physiological management" or "expectant management" of the placenta NOT "active management". Don't pull the cord to “help” the placenta detach.

Holistic PPH rate 1.7% vs Active PPH rate 11.2% (reference Fahy et al 2010)

Do take herbs during labour for uterus strength, and more herbs after the placenta is out, as a preventative

Do drink electrolytes or naturally sugary drink straight after labour eg orange juice to promote energy for the uterus to contract

Do eat 50g dates immediately after birth as this is proven to reduce postpartum bleeding (reference)

...But sometimes you need a cure

During birth, in a suspected hemorrhage, time is of the essence.

When planning for hemorrhage at birth, you want something i.e herbs that will give immediate results, since complications from hemorrhage happen very fast.

Have on hand what you need, and act quickly and decisively.

Make sure any birthing partners know in advance what your wishes are, and what to do in the event that you pass out.

What to do in a unassisted postpartum hemorrhage

If you do not have a plan, or anything on hand, please call 000 ASAP.

Prior to the placenta coming out, you should assess, or be assessed for blood loss, and if all is well, the placenta should be allowed to deliver naturally and slowly.

Herbal remedies and tinctures

Angelica: used to release placenta or if placenta is still inside with heavy bleeding

Motherwort: pain management and prevention of hemorrhage (taken after birth and before bleeding becomes excessive)

Rescue Remedy (flower blend): for shock, panic, anxiety

Shepherd's purse: creates strong contractions to stop PPH (after placenta out)

Wombstringe (herbal combo by Wishgarden): contraction-creating blend for excessive bleeding

Cottonroot: creates contractions before or after placenta is out.

Dosages: as on the bottle, or put drops under tongue and hold 10-20 seconds. Repeat in 1 minute if no change.

Helichrysum Essential oil: helps constrict blood vessels. Apply a few drops to abdomen and inner thighs.

Eating small piece of placenta, holding placenta in your cheek, or sucking on cord (be aware that placenta is a choking hazard if you pass out, and is impossible to do if the placenta is still inside you)
Massage the uterus and scrunch it, and hold it down towards the pelvis to manually contract it (You should do this yourself if you are able, as it can be very painful)
Empty the bladder to give the uterus room (peppermint oil in toilet or on thighs is one of 15 ways to help promote the bladder to release)
If bleeding does not stop or respond to other methods, use bimanual aortic compression (video)
Start replacing fluids lost via electrolyte drinks, and healthy foods
Drink electrolytes or naturally sugary drink straight after labour eg Orange Juice to promote energy for the uterus to contract
Encouraging immediate placenta removal

Angelica:

If the bleeding becomes excessive BEFORE the placenta is out, you will need to help the placenta out in order to let the uterus contract to stop the bleeding.

Give the angelica herb tincture to encourage the placenta to release itself. If it has been a few minutes and the bleeding has not lessened and the placenta has nor released, you may need to physically help the placenta out.

Controlled cord traction - Upright positioning, gentle uterus massage and firm pressure followed by gentle cord traction will help the placenta out.

Please remember: Because you, and your birth partner/s are likely unskilled in assessing blood loss, your behaviour and feelings are also super important to monitor.

If you go into shock, or look like you will, you should lay down, and your birth partner should treat you for shock by keeping you warm and putting your feet up. Remain this way, while continuing to attempt to stop the bleeding, until further help arrives, or the bleeding stops, or you stabilise.

If you CANNOT get the bleeding to stop or slow, and you are at all concerned, please transfer.

Hopefully you will never need to do this. But if you are desperate, please get the help you need. An emergency is an emergency and it is okay to seek assistance when you as the mother determine that you need it.

You may need an IV of fluids or blood transfusion to regain your health.
Your doctor may also need to put pressure on the vessels inside the uterus, sew up blood vessels in the uterus or cervix, physically remove any retained placenta, or provide a synthetic shot of oxytocin to help the uterus contract - all things you cannot do at home if it progresses beyond what you can do.

Thanks for reading! If you have more questions about unassisted birth and how to resolve common complications, you may like to check out our FAQ page.

You can also follow us on Facebook to keep up with all things birthy

Postpartum Hemorrhage: Text

Postpartum Haemorrhage (PPH)

Thanks for reading! If you have more questions about unassisted birth and how to resolve common complications, you may like to check out our FAQ page.

You can also follow us on Facebook​ to keep up with all things birthy

You can also follow us on Facebook to keep up with all things birthy