Injuries: Post-Partum Hemorrhage
A postpartum hemorrhage is a condition in which a new mother has a very large amount of bleeding after her baby is born. It can occur after a vaginal birth, or cesarean section. After delivery, the uterus normally contracts (tightens) to control the amount of bleeding that occurs. In most cases, it occurs because the uterus did not contract as much as it should. This is called uterine atony. In this case, a physician, midwife, or nurse will place his or her hand (sometimes both hands) on the mom’s abdomen, over her uterus and massage it. Massaging the uterus will help it to become firmer and tighter. In some cases, the large amount of bleeding is caused from a piece, or pieces, of the placenta is still in the uterus. The mother’s physician or midwife will remove the pieces from the uterus.1 It can also happen due to a tear in the uterus, cervix, or vagina. The physician or midwife will locate the tear and repair it if this is the case.
A postpartum hemorrhage in a new mother is a serious condition, and can be life-threatening. It is extremely important that immediate actions be taken. The National Partnership for Maternal Safety created specific guidelines that should be followed in every maternity unit in the United States when a postpartum hemorrhage occurs.2
What will the doctor or midwife do to stop the bleeding?
There are medical treatments to stop a postpartum hemorrhage.
Catheters. If Mom’s bladder has a lot of urine in it, the uterus may not tighten. Her physician, midwife, or nurse will drain the urine out of the bladder with a small tube, or catheter. The tube may be left in the bladder and connected to a bag to allow the urine to flow out of the bladder. The amount of urine that the mother is producing can be measured as well. Extra intravenous catheters may be placed in the mother’s veins so that extra fluids can be given quickly. Blood transfusions may also be necessary. An oxygen mask may be placed on mom’s face, and her blood pressure and pulse will be monitored closely. Blood may be drawn from a vein and sent to the lab for testing (Complete blood count, platelets, blood clotting tests).1
Packing device. If cases in which the lower part of the uterus isn’t contracting, the physician or midwife may place a special balloon device, or packing inside of the uterus called a uterine tamponade.
Surgical intervention. In some situations, the bleeding is unable to be controlled, and surgery is necessary to remove the mother’s uterus.
Ensuring the mother’s safety
Every maternity department should have all of the supplies needed to care for a mother experiencing a postpartum hemorrhage in one place (on a specific cart, or in a kit), preferably located in the department so they can be accessed and used quickly.
Every maternity department should have a plan, or protocol regarding calling for additional assistance from other departments, such as the hospital’s blood bank and surgery department. A checklist should be kept with the contains specific instructions and guidelines for treatment of a postpartum hemorrhage. There should also be a written protocol for a blood transfusion in case of an emergency.
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- Cunningham, F., Leveno, K., Bloom, S., Spong, C., Dashe, J., Hoffman, B., Casey, B., Sheffield, J. (2013). Obstetrical Hemorrhage. In Cunningham, F., Leveno, K., Bloom, S., Spong, C., Dashe, J., Hoffman, B., Casey, B., & Sheffield, J. (Eds). Williams obstetrics (24th ed.). New York, NY: McGraw-Hill
- Main, E., Goffman, D., Scavone, B., Low, L., Bingham, D., Fontaine, P., Gorlin, J., Lagrew, D., Levy, B., (2015). National partnership for maternal safety: Consensus bundle on obstetric hemorrhage. Journal of Obstetrics and Gynecology, 126(1), 155-162. doi: 10.1097/AOG.0000000000000869