Having a baby can be a beautiful thing until something goes wrong. The tragedy is that many high-risk conditions can be managed appropriately if the patient is cooperative and the healthcare provider is competent and well trained. Unfortunately, almost 600 pregnant women die in the U.S. each year from complications and the most common complication is significant blood loss after birth or postpartum hemorrhage (PPH).
PPH occurs when there is a blood loss of 500 cc or greater for a vaginal delivery and 1,000 cc after a cesarean section (C-section). Or, if you were admitted with a hemoglobin of 12 and it drops by ten points to 11, there should be a high index of suspicion for PPH as well. Therefore, if you feel lightheaded or dizzy, have palpitations or an increased heart rate after delivering a baby, inform the hospital staff immediately.
The most common cause of PPH is uterine atony or lack of contractions after the baby is delivered. Any pregnant condition that stretches the uterus significantly — such as having twins or a higher gestation, excess amniotic fluid (aka polyhydramnios), a prolonged induction of labor (greater than 24 hours) — increases the risk of PPH. Retained products of conception, such as the placenta, also places the patient at risk for developing PPH.
Other risk factors for PPH include:
- Women with a known placenta previa
- African-American women
- Hypertension or preeclampsia
- Mothers with infants weighing greater than 8.8 pounds (or 4,000 grams)
- Mothers with greater than seven children
- Women with a history of hemophilia
If you have any of the risk factors listed above, please be proactive and discuss the possibility of a PPH with your healthcare provider.
Specifically, you want to know:
- How many PPHs have they handled?
- Does the hospital do mock emergency drills (especially if your hospital is not a teaching hospital) as practice?
- Will your hospital have blood readily available upon your admission in labor?
- Will the proper labs be ordered at your time of admission? This is very important. Your blood type as well as your ability to clot blood (aka coagulation studies) should be ordered at the time of your admission, NOT when you’re bleeding to death. Most women die because their clotting factors could not be replaced fast enough.
Please do not be intimidated about having these discussions. They could very well save your life. Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
*This blog post was originally published at Dr. Linda Burke-Galloway*