#50 Postpartum Bleeding

Normal blood loss for immediately after delivering your baby is one or two units of blood. In most hospitals, well trained and experienced doctors, midwives, and nurses can look at maxi pads or the blue pad under you to determine whether or not you are losing too much blood. Pads should be checked at least every 15 minutes and more often if necessary. Both your blue pads which you are lying on, and your maxi pads can be checked and weighed. The most accurate measure of a pad is to weigh it before and after the blood loss.

Before you leave the hospital, your doctor or midwife should discuss with you whether your blood loss has been normal or excessive. You should also know about your present hemoglobin level at the time of your discharge compared to what it was when you came in. It is important to know that it may take several days for your hemoglobin level to become accurate. That’s because the first phase of bleeding is a decreased blood volume, while the concentration of blood cells (hemoglobin level) remains the same at the beginning of blood loss.

The first phase of blood loss in blood volume. The second phase (after about three days) consists of replacement of the lost blood volume with body serum. Since it takes your body about three months to make a red blood cells, your hemoglobin will drop because only the non-hemoglobin portion of your blood will be replaced by your body at first.

Remember, hemoglobin and hematocrit are measures of concentrations of blood cells. As your phase one depleted blood is diluted with body serum, your hemoglobin will drop. So it takes about three days, assuming you are not still hemorrhaging, for the measurement of your hemoglobin and hematocrit levels to be an accurate representation of your current hemoglobin levels.

Today, with maternal mortality rates increasing for a variety of reasons, one of the causes of postpartum mortality remains postpartum hemorrhage. Bleeding to death from a postpartum hemorrhage is inexcusable and certainly avoidable. To get an accurate representation of your hemoglobin, you should return to your doctor’s clinic in two or three days after discharge.

Normal postpartum bleeding at home after a day or two will be as heavy as a period, and sometimes last for more than two weeks. If you’re at home and you fill one maxipad per hour (it drips blood when you hold it up) for two hours, call your doctor. If you can’t find your doctor, go to the emergency room and tell the receptionist, nurse, and provider that you have heavy bleeding so you don’t have to sit in the waiting room for hours. In fact, it might be advisable to take your maxipads with you so the person taking care of you does not have to guess how much blood you’ve lost.

In spite of the fact that the maternal mortality rate is increasing and with it postpartum hemorrhage as a contributing factor, you do not need to become one of those statistics. You simply need to know what is normal postpartum bleeding and what is not normal and when you need to seek help.