E130: Postpartum Hemorrhage Basics

Postpartum bleeding is expected, but postpartum hemorrhage is a different conversation, and it is one every parent deserves to understand before they are tired, sore, and trying to figure out what “too much” even means. We walk through what normal blood loss can look like after birth, why it often appears worse than it is, and the real thresholds clinicians use when they are watching for danger.

We get practical about the why: uterine atony (a soft, boggy uterus that is not contracting), retained placenta or fragments, tissue trauma like lacerations, and clotting issues that can show up with conditions like preeclampsia or severe infection. I also explain who is at higher risk, why hemorrhage can still surprise low-risk families, and how delayed postpartum hemorrhage can happen days or even weeks after delivery.

Then we dig into what prevention and treatment look like in real time: frequent fundal checks and uterine massage, standard Pitocin after delivery, and additional tools like Methergine, Hemabate, misoprostol (Cytotec), and TXA. We also talk about next steps when bleeding will not stop, including bladder management, repairing tears, transfusion, Bakri balloon, the Jada device, D&C, and rare life-saving hysterectomy. You will hear a powerful birth story where the “big event” is the placenta, and the relief that comes when a high-risk history ends in a best-case outcome.

If this helps you feel more steady and informed, subscribe, share the episode with a friend who is preparing for birth, and leave a rating or review so more families can find it.

Visit our website, here: https://hatchednlatched.com/
Follow us on Facebook at Hatched & Latched
Follow us on Instagram at @hatchenlatched

Show Credits

Host: Angie Rosier 
Music: Michael Hicks 
Photographer: Toni Walker
Episode Artwork: Nick Greenwood 
Producer: Gillian Rosier Frampton
Voiceover: Ryan Parker

Transcript

Copy Transcript Copied

Welcome And Topic Setup

SPEAKER_00 0:10

Welcome to the Ordinary Doula Podcast with Angie Roger, hosted by Hatch and Last. Here, we explore the many layers of pregnancy, labor, birth, breastfeeding, and postpartum life through the lens of more than 20 years in a busy Doula practice, supporting thousands of families. Whether you are preparing for birth, navigating feeding, or adjusting to life of a new baby, this podcast is designed to offer practical knowledge, thoughtful conversation, and empowering support for the real experience of the parenthood.

SPEAKER_01 0:57

Hello and welcome to the Ordinary Do La Podcast. One more time. Glad to have you. Again, my name is Angie Rosier. I'm here with Hatched Unlatched. That's who hosts us, and I'm happy to spend a little bit of time with you here today. We like to talk about various topics on all angles, all corners, all facets of pregnancy, childbirth, labor, postpartum healing, recovery, and breastfeeding. So today, and it's funny, like if you were in my head, a lot of my topics kind of come to me because I'm experiencing something with clients around this time or in the last few months that makes me think about this a little bit more. So the topic that's been on my mind a little bit lately is postpartum hemorrhaging. So I do have an episode earlier on, I think it's episode 32, which is about estimated blood loss, which is regular blood loss after delivery. But I want to talk about hemorrhaging specifically and how that like might be different. So birth, um, we know like there's some bleeding in birth. I have I talked to a lot of people during the prep,

What Normal Bleeding Looks Like

SPEAKER_01 2:05

it's usually first-time parents, and they're really nervous. A lot of times it's the partner is kind of nervous about the bloody, gory part of childbirth. And really, like that's really not much of it. Like some people, I guess, think it's have in their mind it's a really gory experience. But really, and until even if we have a long ex well, not even long, but an average experience of 12 to 18 hours of labor, you're really not gonna see much blood until the very end, like when the when after after the baby's born, usually. So that's kind of something I think a lot of people are worried about is how gross it's gonna be. And uh, or or you know, they're nervous about blood, they don't like blood. And that really does come a lot at the end, and it's pretty minimal at that and pretty controlled for most in most cases, you know. So let's kind of talk about um knowing the blood loss is normal, right? And what the what bleeds is when the placenta leaves the wall of the uterus, like it kind of separates and peels off and it comes out. The placenta is also born, right? So after the placenta comes out and is born, if you will, that's when we look for normal bleeding, which is the most bleeding you're gonna get. There might be a tiny little bit of trickling um just prior to crowning or during the second stage pushing phase when um the tissues are stretching, there might be a little bit of bleeding then. But what we think of the bigger bleeding is gonna be after the placenta. Um, so blood loss is normal. And and that what was left behind where the placenta was is tons, like of hundreds of vessels that are intertwined and they separate and they come off and they need to stop bleeding. So we expect bleeding after every single birth, like every single one. There's gonna be some kind of heavier bleeding that dissipates quite quickly. It can hang on for up to six weeks as normal, but it will be dissipating, like just coming down and be decreasing over time for sure. So normal blood loss after vaginal delivery is anywhere from like 300 CC's to 500 cc's. That's kind of normal, closer on the 300 side. Um, cesarean birth, interestingly enough, people bleed a little bit more after cesarean birth. It can be over 500, 500 to 700 or more can be normal blood loss after a cesarean birth. And if you think um how to compare that, there's about 5,000 cc's of blood in our body at any one time. So we're losing a very small percentage of what we're losing on a normal vaginal um or even a cesarean birth. So um that's kind of hard to imagine how much 5C, 500 cc's is or 300 cc's is, but 500, if you take 500 ml cc's, it's all the same thing, or grams. Okay, it's all about the same, just measured uh for different capacities and stuff. Um, but 500 cc's is about two cups. So normal blood loss for an average normal um vaginal delivery is just over one cup of blood, and then it could be up to two for um in some cases and more for greater blood loss. So that's not a ton, but when you take any amount of liquid or fluid, and you especially we have bright red on white sheets, oftentimes, our linens are usually white, so it's a very stark contrast. So even just a little bit of blood, that stark, stark contrast, that bright color really gets our attention. So when you take that amount, say it is a cup of blood, and we spread it across pads, sheets, towels, the bed, the floor, maybe, and there's amniotic fluid mixed in with that as well. Keep that in mind. So not all the fluid you're seeing is blood, it's kind of watered down, a lot of it is. So it what looks like could be a lot of blood loss, probably isn't actual blood loss. Um, and a lot of people, um some births are just incredibly, I don't know, unpredictable as far as are messy. Some people were just laying in a pool of, and it's really not that much, it's a normal amount, but we might be laying in a pool of blood just because of the position of how we were when we gave birth and what was in place and what wasn't, or if pads slid, or the little plastic slider, they have the slider with a bag kind of on it in hospitals that catches blood. If anything was not quite placed right or got shifted out of position, it can lurk worse than it is. But things are designed to kind of capture and keep a lot of that um under control. So bleeding is normal. Um, they're set up for that, they're set up to even make it look great as far as like um not look alarming, but sometimes that's hard to hard to um control, all of that, of course.

Defining Postpartum Hemorrhage

SPEAKER_01 6:40

So hemorrhaging, let's talk about what a postpartum hemorrhage is. So that is any blood loss more than 1,000 cc's, 1000 milliliters. That is considered um a hemorrhage and is accompanied by signs of low blood pressure or person poor circulation. So sometimes we just get part of part of this picture. We might get someone who loses a higher amount of blood, maybe a thousand, twelve hundred cc's, um, and become unstable, like their vitals are not stable. And sometimes um they are stable. They might feel fine, their their vital signs might be pretty good, their blood pressure is normal, their heartbeat is normal. Sometimes they feel fine, um, and they didn't lose that much blood, but their their vitals aren't great too. I've been in a couple situations where that's happened where we're just kind of curious, like, why is she feeling so yucky? And and when her we look at the vitals, their high blood, sorry, low blood pressure, high heart rate, that heart is working, we're we're maybe losing blood somewhere. Um, so it can look a lot of different ways, it can happen a lot of different ways. Um, but what we're looking for is amount of blood loss and then this symptoms of what um hemorrhaging is like. So providers are gonna treat the patient, right? A great provider is gonna look at the patient, um, not just treat numbers that they see. They're gonna obviously pay attention to those numbers, but they kind of look at the whole picture and see what's going on.

The Four Main Causes

SPEAKER_01 8:06

So there's kind of four different reasons hemorrhaging happens. And if you think about worldwide, all over the world, and for a you know, for centuries and millennia, this is the tough part historically and currently for moms. Um, when this hemorrhaging afterwards, you know, we look at a lot of third world countries that don't have some resources. This is something, it's a simple fix in a lot of cases that they may not have access to. Um, but we kind of look about why it happens. A lot of it is the tone. So the tone of the uterus. So you have this uterus who's baby-sized, whatever, however big that baby is, six pounds, ten pounds, whatever. This uterus accommodated that baby. It worked hard, it was contracting, um, and it pushed that baby out over a period of hours, um, or it had a cesarean, you know, however that baby was born. And one of the biggest, the most common reasons for hemorrhaging is that uterine tone is just kind of floppy, it's not toned. So the uterine atnee, they call it, when it's just kind of floppy and not firm, um, it accounts for most hemorrhage situations. If we just have our uterus that's kind of soft and boggy, we call it, it's not contracting. So the uterus is kind of like a fist that's squeezing down on the hundreds of blood vessels that were behind the placenta that are now bleeding, and they need to close. They need to like stop bleeding, they need to have some pressure on them, and the contractions afterwards are that pressure. So that's kind of what the uterus is doing. And if the uterus can't do that because it's floppy or tired or whatever, um, then that's when we get kind of nervous about hemorrhaging with along with blood loss. So uh we'll talk about preventative care in a moment, but they're always kind of doing some preventative care and checking in on that. Another reason that hemorrhages happen is the um presence of tissue. So that could be that the placenta or pieces or parts of it remained in the uterus. And so sometimes they'll have a little piece of placenta that doesn't come off, and they they do check placentas when they're once they come out. They're gonna check to see that they're complete, that all the pieces are there, all the lobes are complete, um, that it looks good. Um, we don't usually go in and look further than that, but sometimes they can if needs be. Um, but if there's pieces that are remaining, the uterus can't clamp all the way down and control the blood loss that it's working on. Another reason could be trauma to the tissues. Um, we could have lacerations, a first, second, third, fourth degree tear. We could have um epesiotomy that may have happened, we might have cervical tears inside, um, very rarely, but have our uterine rupture where the uterus doesn't stay intact. Um, and sometimes that will happen. That's what we're when we talk about V-BACs and doing a vaginal birth after cesarean, that's something that um we're concerned about happening. The reality is it doesn't happen very often, which is nice. And then another reason it could happen, a hemorrhage could happen, is clotting factors. So if there's challenges to the ability of the blood to clot, then we also might get some um higher levels of bleeding and or hemorrhaging. And some things that cause that are preclampsia, like just uh a patient having preclampsia, some people have bleeding disorders, they have um clotting disorders. So, or and other people have like infections, like a severe infection, whether it's somewhere else in their body, a uterine infection, chorio, um, then that could increase hemorrhaging or bleeding as well. So as we look at the whole situation, I guarantee you one thing your provider is has got top of mind. Top of mind is the amount of blood loss you're gonna have after delivery. That's um a really uh key point for providers is controlling that for this your safety, um, and they're gonna prevent that. They're gonna um be ready if it happens. There's lots of ways to do that. So, who is at risk for for hemorrhaging? We can

Risk Factors And Surprise Cases

SPEAKER_01 12:00

not totally predict because sometimes it surprises us, but we know that when there's been a long labor, the that person could be at higher risk, and that uterus is just tired, right? It's just like I've been contracting for 48 hours or 60 hours or whatever the case might be. That uterus is tired, and so a lot of times once it gets the baby out, it just I'm tired and it gets soft and boggy at me, is what it's called. Um, also on quite on the opposite side of that is a very fast labor. If we have a uterus who works super hard and fast and furious, and we have a baby very quickly, it that uterus is a little bit shocked sometimes, and it's like, whoa, it just happened, and we might have extra bleeding in a case like that. Um, those who are being induced have a slightly higher chance of hemorrhaging. Um, that would be pitocin, sometimes, right? Using pitocin for long periods of time. Um, that's like kind of wearing out the uterus, same thing, making it kind of tired. Those who are on mag on magnesium sulfate for preclampsia, those who are having twins, we have a more distended uterus, it gets kind of tired. Those who have a distended uterus from polyhydraminose, which is um high fluids, if we have a ton of fluid, that uterus is kind of really stretched as a muscle, and then when we unstretched it, it's kind of it's like a really stretched-out rubber band, it's gotta take some time to come get back to its elasticity. If we have a very large baby, if we have a very small baby, having had a previous hemorrhage can be something that is of risk. And as I've been preparing this episode, um, I had a client in the last few weeks who um fit this category very well, and I'll talk a little bit about that. Also, another risk to postpartum hemorrhaging is a retained placenta. So that's a placenta that is reluctant to come out or won't come out, um, and the uterus is unable to do the um contracting and clamping down that it needs to do afterwards because the placenta is just hanging on. Um, so that's kind of tricky, and then infection, which we mentioned before. So um, so many hemorrhages happen with absolutely none of these risk factors in place. That's what's so interesting about hemorrhaging. It can happen shortly after delivery, it can happen a long time after delivery, it can happen up to weeks after. I've had clients who have a hemorrhage at four weeks postpartum. Um they thought everything was fine, they're sitting there with could be retained placenta, um, could be infection still at that point, but I have had people come back weeks later with a postpartum hemorrhage. Um I had a client not long ago um came back about nine days and she just was going to the bathroom in the morning, you know, recovering from childbirth, got to go to the bathroom, um, passed out with a hemorrhage and um had to come back to the hospital and get a blunt transfusion because of a hemorrhage that happened several days later. Um so that it it's that's what's so interesting. It can be uh somebody we expect that has these risk factors, and it cannot be anything that we expect, which is kind of interesting. That's why your birth team is always prepared for one, always prepared for one. And we give you warning signs going home too of something like that. So as you're in the postpartum recovery period, that doesn't mean you're totally out of the woods. With like most likely, yes, you are as we look at probability, but we know that it might still be able to happen. So treatment, let's talk about preventative and treatment as well. So

Prevention And First-Line Treatments

SPEAKER_01 15:20

if you have a baby in hospital, out of hospital, your providers are going to be checking the tone of the uterus. So kind of walking through what happens is if you've had a baby before, you know, if you haven't, please expect they'll do some um massaging of the uterus. It's called, I guess, called credae, where they will just like feel the uterus from the outside, so under your belly button, kind of, um, shortly after delivery, and they're gonna check it in hospital. They check it about every 15 minutes for an hour, and then they they go more infrequent, I think it's every 30 after that, and then every hour, and then every four hours. So they they do a lot of vigilant, um vigilant care of that directly after, because that's when we need the action to happen. The uterus just emptied itself, it now needs to come back to its regular size, which the clamp cramping, contracting, and the uterus clamps down on those blood vessels in time. So the blood goes away, the blood loss goes way down after the first few minutes, and then that uterus gets more firm and smaller. We want it to be going back down to its regular size. So you will hear, if you're in hospital, you'll hear a nurse will be filling your fundus, they call it the top of the uterus, which you know, when the baby's born is right under your ribs, but after the baby's born, it's like should be below your belly button, and they'll kind of note where that is if it's central, if it's off to the side, that's kind of what they're looking at. So doing that credae is an important step to keep the uterine tone. Um, a second step would be medications. Now, in a lot of cases, we just they just preventatively do medication anyway. They're gonna massage the uterus create every 15 minutes, and they'll also give Pitocin. So they'll give two bags of Pitocin is very standard to get after delivery. So that the credaying and the two bags of Pitocin is pretty standard preventative care for hemorrhaging. Now, if the blood loss is showing us, or the tone or any of those, or your vital signs for that matter, are showing us that hey, we need a little more attention on this. There are additional medications and um procedures and products that can help with that. Um, the next kind of line of defense is methrogen. So, methrogen is a medication that's just given uh through a shot in your leg, usually. They also give hemobate if needed. They'll give mice mesoprostol, which is cytotech that is placed rectally, and then they can also give TXA in your IV. So all of these things have different side effects and different ways to combat uterine tone and hemorrhaging. So that's a they can give all of those in some situations, um, but they don't jump on all of them, but they kind of give them in that order. We first create, we give pitocin. That's pretty standard. Then methogen, hemobate, cytotech, and cytotech sometimes trades places, TXA sometimes that trades places in the order that it's given as well. Um and then I want to chat about other interventions that could be done as well that are not pharmaceutical. Keeping the bladder empty. If you have a catheter because you had a um well, they take catheters out before the baby's born, but they may place a catheter afterwards to keep that bladder empty because the bladder can kind of take up space and get in away from the uterus coming back down to size. Um so keeping the bladder empty, if you didn't have a catheter or you did gave birth naturally, they might have you get up and go to the bathroom in the next couple of hours. Um, getting the retained placenta out or checking for that. So they whether that's an awful manual sweep, and and sometimes those are necessary, but they're very difficult, or they go in and feel with their fingers that the uterus is complete, and if there's any, sorry, that the uterus is completely empty, and if there's any bits of placenta, they'll kind of pull them out. Um repairing lacerations, right? Repairing any tissue separation that happened. Sometimes it's a little artery that's just bleeding and bleeding. It might not be the uterus itself, so they always identify the source of bleeding. So repairing, doing any tissue separation, you know, doing repairs there, giving IV fluids is going to be helpful. Um, they can give blood transfusions if needed. Um, they can do it's called a Bachri balloon. So this balloon, it's a balloon that goes in, a silicone balloon, it kind of just inflates and it gives pressure on the inside of the uterus. Um, some people will have that inserted for a while after delivery. Um there also is another um product called the JATA that's getting used quite a bit now. The JATA is kind of like an intrauterine vacuum, so it also controls postpartum bleeding, it stimulates um uterine contractions and it kind of sucks out. It's kind of cool, it gets put onto a suction tube and it can kind of pull out um any blood loss. So those are another couple of ways we can look at controlling um if we need to, but we don't jump

Devices Surgery And Last Resorts

SPEAKER_01 20:00

to those, that's kind of down the road. Um, also, like in worst case scenarios, we can do the operating room, whether that's doing a full D and C to make sure everything's gone. I have had um people in this case with severe hemorrhaging go into the operating room, and worst case scenario, they take the whole uterus out. And I have had that happen a couple times as well because we couldn't get the bleeding to stop. And probably one of my um most difficult cases in my career was um I had a client who lost, we have 5,000 cc's of blood, she lost 4,500. Um kind of a complicated delivery. She had what's called placenta acreta, um, or we thought she did. Anyway, she she had a lot of bleeding, and so her part of her issue is blood clotting factors were just done. They were out of her blood. There wasn't enough blood for the blood to clot. So she had a look, got a lot of blood products, and that was a very intense, intense situation. So when that's the case, the team's ready for that. They don't do it very often, they don't jump to that, of course. But I like you to know as we look at the whole picture, I'm just fascinated by every part of what helps keep you safe in emergent situations. Now, do these happen all the time? No, thank goodness. Um, are midwives at home prepared for hemorrhaging and those in birth centers? Yes. Now they're not prepared with all of the medications or the devices, nor an operating room, but in most situations they are prepared with what they need for hemorrhaging, um, normal and above normal hemorrhaging as well. But we do a transfer if we need something like an operating room, and we sure hope we don't, right? Um, and a lot of our our systems, because I mean, they know what to do, they they go into go mode when it when it's needed when someone's hemorrhaging, or they can't stop bleeding as they go through all these steps. And I've seen it so many times, so so so many times. Um, and it's cool to see the team come together and work like that, having your best interests.

A High-Risk Placenta Success Story

SPEAKER_01 21:58

Um, and and one of the Reasons this has been on my mind a lot. I've had a client over the last few months who she has a lot of the risk factors, not all of them, but a lot of risk factors. Um and has had kind of the the one that's the toughest for her, she has a history of postpartum hemorrhaging. She's had, I think, three hemorrhages and retained placentas. And she was meeting with she's low risk and by age and um health, everything else, except these sticky placentas and um the blood loss she normally hemorrhaging, she or usually experiences with delivery. So for this last baby she had, she was with um maternal fetal medicine doctors. So she's with in a high risk category, and every time I was with her, as during labor and with nurses, um, they would always look at her chart and say, wait, why are you with MFM? Um, because MFM does our high-risk stuff and she's low risk in most cases. But the particular MFM doctor was with her is amazing, and he has helped her with three or four of her babies previously, and helped her, even though he knows her history, he helped her come up with a really um respectful plan. Now, their what they kind of wanted was for her to get an epidural so that she'd be ready, OR prepped if they need to go to the OR for removal of the placenta, which they had done before, um, so that she um, you know, could be kind of ready and comfortable for whatever they needed to do afterwards. But with this particular baby, she wanted to go and medicated and prepared to do so and had a really great conversation with her MFM who said, Yeah, let's let's try that. And we had plan A, B, and C because they historically have had to go in and do that manual sweep to get the retained placenta out. Um, I think she's been in the OR sometimes and had pretty high blood loss with transfusions before. So, you know, blood loss gets so high, and then we're in the territory of needing a blood transfusion, which she has had a couple of times. So with this particular baby, we're all kind of watching it really closely. Um and her doctor said, although she doesn't have placenta acrita, and acrita is where the placenta, which is such a good grower, it just puts down roots in the uterus and plants itself there, but sometimes it can grow outside the uterus. Um, and it has little tendrils, especially when someone's had a cesarean before, or if there's or any uh uterine surgery, actually, when there's um a weaker spot in the uterus, the placenta can grow outside of it. That's called a kreta. And then it it doesn't come out very well at all at that point, and sometimes that's looking much more likely like a hysterectomy situation. Um so he said, you know, she acts like she has her her placenta acts like it has a Kreta, but it doesn't. So he was ready, super supportive, and oh my gosh, he was so awesome during delivery. I mean, the mom was of totally amazing. She did what she wanted, she gave birth unmedicated, totally natural, um, not a drip of Pitocin. When she, you know, they were look searching for an induction date for her, and she had spontaneous, awesome labor. Um, and her this MFM allowed her to deliver, he was very midwife-like, actually, during this delivery. She was kneeling on the end of the bed. He and a and an OB resident were kind of kneeling at the foot of the bed, um, and she was able to squat down and kind of be on our haunches and delivered how she wanted to deliver, which was awesome. Now, here's the cool part of this story. Well, we were all prepared, like getting the baby out, usually that's the big event, right? But with this particular client, um, we were the big event was the placenta. So, yep, baby's here, she takes the baby, and now she's nervous because now um we're going into plan A, B, and C, seeing what the placenta does. Um, and and it was hard. This part is hard. We had all the medications in the room. We had a Jada device outside the door, the OR was ready, the team was all ready for everything. They started actively managing. It's called active management of third stage labor, um, which is the deliver the placenta. A lot of times we want to sit and wait for it, right? Like we want to like be patient and wait for that placenta to come out. We don't want to pull on it or tug it, but doing the uterine tone like curdain can help. Um, and her placenta, they started the care of it, which was challenging. Um, and she asked for fentanyl during this time. That was kind of her plan A was to do fentanyl and then work up to other things as needed. And this placenta came out in 13 minutes, which was phenomenal. Um, it came out and it was complete. Um, it looked amazing, even for being post-dates. Her blood loss was very minimal, like 200 cc's, where she had hemorrhaged three times before. And I loved watching this while the whole team was ready for something else. This was best case scenario. And she was so exuberant, like so excited, ecstatic. Yes, she was holding her little baby in her arms, who she had given birth to unmedicated in the way that she wanted, but what she kept saying is like, I can't believe it. I can't believe that like she was so much more happy about the placenta um coming out the way it did than the baby, and both were remarkable in her case. And I remember her partner laughing, he said, You seem more excited about the placenta than you are about the baby. But in her case, that was her hurdle. That was the thing to get over.

Warning Signs Recovery And Closing

SPEAKER_01 27:19

So, a question here is can we prevent this? We can't always prevent it. We can't always predict it. Um, they there are some preventative measures, but even when people go home, they're still at risk. So reducing risks, providers are gonna always want to reduce risk by doing that crudeing, make sure the uterine tone is good. Um, that's why we give pitocin in hospital. Um also monitoring blood loss carefully. They're gonna do that wherever you have a baby. Check the placenta, make sure it's complete. This is a normal, normal stuff that we're what we're looking at is what could happen later today and tomorrow and next week and stuff. Um, so we keep an eye on the uterus closely for recovery. And for those who are in postpartum recovery, taking it easy. Like, don't just jump back into real life. That placenta, where the placenta was, the uterus is working really hard to keep um, to heal, really, to heal. So um taking it easy and taking your recovery seriously can help. So doing early treatment before severe things happen. So this is why when they say when you go home, right, call your provider if you are having bright red bleeding, filling a pad more than an hour, clots larger than a golf ball. Um, and providers are gonna hopefully know in your chart if you've had a previous hemorrhage. Um, know your anemia status before birth, because this can make people anemic and tired, and um, there's some ramifications, some health ramifications on small and large scale about afterwards about um when people hemorrhage. So recovery and and after significant blood loss is a real thing as well. So, yes, we're recovering also from childbirth, however that happened, whether it was vaginal or cesarean, um, and now we have probably an iron deficiency, anemia, fatigue. Um, when we have high blood loss, that can impact milk making. So we might have breastfeeding challenges, um, we might be scared, right? My mom, who almost died, she was in ICU, who lost almost all of her blood and had a hysterectomy. She was in ICU for a week after that. Um, so feeling emotional. She had, you know, if you have to have a blood transfusion, that particular mom from years ago had a lot of blood products, like a lot, like 26 units when it was all said and done of blood products to save her life. So recovery is slower sometimes. Our body's rebuilding its stores of our red blood cells. Like we have to rebuild those and build all that back and get our iron stores back where they are. So that is tough. Yes, you have a baby to take care of and birth to recover from, and then blood loss can be a different thing. So hemorrhaging is more blood loss than normal. Not incredibly common, but it is one of the most challenging health, you know, maternal health things people face throughout the world. So this is why we seek immediate care. Call your provider, call 911 after passing large clots, um, bleeding that come be suddenly becomes much heavier. It can go fast. Sometimes it can go really, really fast. Um, if you're feeling faint, have a rapid heart rate, can't catch your breath, feeling dizzy, um, getting fever. Um, there's a lot of things that can indicate that this may be happening. And so it's always best to check. It's always best to check you're not bothering your doctor or your provider. Um, they want you to call in on those things. So this isn't something that just we watch for the first, yes, we watch immediately after birth, but that's not the only time we're gonna keep an eye on that. We want to watch it for quite a while, actually. So um a lot of people don't know if they experience a hemorrhage, what was happening with my client who went in at nine days postpartum. Gosh, she was scared, she was so nervous, didn't know what was happening. She had her four-year-old around, and her husband was confused, bleary in the middle of the night, you know, and she's bleeding like crazy and passing out, and the ambulance comes. Like, there's some emotional stuff to deal with that too, and it can happen kind of fast. Um, and so everyone recovers different physically. We also recover different emotionally. And for for some people, these emotionally challenging experiences can linger, right? They can definitely linger, and there's some ramifications to that. So this could add to medical or birth trauma, even if it's not right there at your birth. So that's definitely something you can address and kind of work through with those who are trained to work through that. So, a couple of myths I want to just dispel that hemorrhaging doesn't just happen after high-risk deliveries or pregnancies or cesareans. It can happen after any birth. Um, do you always know if you're losing too much blood? No, you may not. Um, so that's why it's good to kind of keep an eye on things and reach out to a provider. So, kind of kind of the the takeaways here is that this is rare. Hemorrhaging is pretty rare, but it is serious. Your body knows what to do. Your uterus does its thing, it stops the bleeding, it gets the baby out, stops the bleeding by contracting, and and when the blood clots naturally and normally, um, everything should be great. But sometimes those systems need help for various reasons. And postpartum hemorrhaging is something that obstetric teams or matern um midwife teams are trained for, something they anticipate, um, something that they can manage most all the time. So, kind of understanding your role is to understand the risks, um, the signs of that, and then seek out treatment and help when needed. Um, so I just want to end by helping people know again, just the normal stuff. Birth is incredibly powerful and many times unpredictable. That's part of what I love about it. It's such an impactful, powerful event, and we can never say exactly how it's gonna go. Um, the unpredictability is the spontaneity of it is so fun for me in my mind, especially when it's on the on the positive side of things. But I love seeing how a story plays out and saying, wow, um the body is capable of so much. This human mind and spirit are capable of so much, and wow, this can happen, that can happen. Um, and most of it is always very good and positive and remarkable, just like this amazingly successful um delivery of the placenta. I've been checking in on that mom pretty carefully afterwards as well, because I know she's not out of the woods yet. Um, she's not, you know, to the she's not in this space where I'd be feeling that she's totally safe from any postpartum hemorrhaging, although her placenta delivered beautifully and she had minimal blood loss that delivery, which is unusual for her. So keeping an eye on her. So your health care team, they're not expecting the worst, um, but they're prepared, right? They're prepared for those unpredictable things. Um, and as you understand, you can advocate for yourself, you can help do some help the preventative things happen, help do some vigilance on your end afterwards. But the more you understand birth and postpartum, um, the less nervous that we'll be, and we can take action when things happen. So hopefully this is helpful to you. Hopefully, you have normal minimal blood loss, 200cc, 300cc. Great. Listen for that, ask about that. Sometimes that helps make sense in your postpartum recovery. Some people have a hemorrhage and don't even know it. Um, you know, they'll look in their chart and like and see that they had a 1500 um blood loss, 1500cc blood loss, and they don't even know it. So um I think it's helpful to explain that to people, kind of ask what your blood loss is. Is it normal? Is it high? Did you hemorrhage? Did you not? If you do, you know, what are they going to do about it? Um, because that can impact breastfeeding, recovery, fatigue, all of that afterwards. And hopefully your your your own information will become empowering to you. That's that's what I think birth should be all about. It's having positive, empowering birth experiences that we um live through, which we almost always do, of course. But this has historically been a challenge in childbirth. Hopefully that helps you and I wish you the very best, whether you're helping people have babies, whether you yourself are having babies. Um I hope it's a a good positive experience for you, because that's kind of what what that's kind of what it should be, in from my point of view. Thanks for being with us here today on the Ordinary Dealer Podcast. This is Angie Yerosier, your host, signing off. We are hosted by Hatch and Latch. Go over and check out Hatch and Latch and see. Um, we have some virtual classes there to take. Um, we have services, birth, postpartum lactation for those who are local to our area and would love to connect with you in any way that we can. Hope you have a great day and please remember to reach out and make a human connection with someone. Um, we are important to each other and we need each other. Please reach out to someone today. See you next time.

SPEAKER_00 35:47

Thank you for listening to the Ordinary Doula Podcast with Angie Roger, hosted by HatchtonLabs. You can find episode credits in the show notes and more information by visiting HatchDonLabs.com. If this podcast has been helpful to you, please leave a rating wherever you listen to a podcast. Or your support helps us to continue having thoughtful conversations about birth, breastfeeding, and other part of life.