Post Partum Hemorrhage
The birth of the placenta is always accompanied by bleeding and a loss of up to 500ml (1pint) although it is usually under half of this. Excessive bleeding may occur if the placenta is large with a big baby or twins. Occasionally the power of the uterine muscle contractions is reduced after a long or difficult labour or the placenta fails to detach completely from the uterine wall and the uterus is unable to contract fully to constrict the blood vessels. The amount of retained placental tissue can be visualised by the midwife checking it after the birth and an ultrasound scan is used as confirmation. Contractions of the uterus are encouraged by using an injection of the hormones syntocinon or ergometrine or prostaglandin and with breastfeeding or homoeopathic remedies.
Blood loss from the cervix and vagina may arise from a tear in the cervix (more common in first labour) and usually stops spontaneously, or after stitching. Deep tears of a vaginal cut (episiotomy) may bleed until stitches are inserted.