Post-birth hemorrhage is one of the biggest fears parents birthing outside the medical establishment face. The idea of losing the baby is bad enough, but the thought of risking a young wife and mother over something hospitals care for routinely seems irrational at first glance. Of course, it's not that simple.
Why do we bleed?
During pregnancy, the uterine muscle expands a great deal. The placenta connects itself to the uterine wall with thousands of tiny blood vessels where the mother's blood transfers its nutrient stores to the baby's blood. Once the child is born, the placenta detaches itself from the uterine wall. If the uterus doesn't recognize that the placenta is no longer there, it can leave the passages open and the mother can "bleed out" causing dizziness, shock, fainting and, eventually, death.
So, a significant key to preventing blood loss is in making certain that the uterus and placenta release each other gently and the blood vessels involved close properly and quickly. The obvious way to do this is to just allow the birth to progress as naturally as possible. Once the baby is born there are a few vital mechanisms that tell the placenta to tell the uterus to shut off the blood flow and seal the blood vessels. The first is the switch over from fetal breathing to respiratory breathing, a very important change that is often misunderstood by many professional birth attendants.
Hopefully there's enough other umbilical cord clamping information on this site and on cordclamping.com to educate parents about the sanctity of the umbilical cord and its function in the process of helping the baby transform from fetus to child. Even the ACOG has withdrawn its educational bulletin that called for early cord clamping leaving American doctors without a sanctioned medical excuse for routinely clamping the umbilical cord before it has ceased pulsing. A great deal of attention has been focused on how important the umbilical transfer is to the child but the function of the umbilical cord in preventing post birth bleeding remains mostly speculation on the part of midwives and mothers who have lived through a few births.
Imagine the placenta's life cycle in 3 stages; the living, the transitional and the dead. The living stage begins the moment the first placenta cell joins forces with the uterine wall in providing nourishment to the developing embryo and ends when the transitional phase is over and/or when the dead phase begins, whichever comes first.
The transitional phase begins the moment the baby's face is first exposed to the air and lasts until the last placental connection to the uterine wall is broken. Once the placenta is no longer attached to the uterine wall it can be considered a "dead" fetal organ but many parents report babies flinching or grimacing when the placenta is brushed or prodded many hours after the pulsations have ceased. Some placentas seem to "die" more slowly than others and, due to a jelly-like substance that closes off the transfer of blood between baby and placenta shortly after birth, there is no danger in waiting hours or even days to cut the umbilical cord if your baby seems unusually "attached" to hir placenta.
When the umbilical cord is clamped and/or cut prematurely, the placenta can do strange things. It can send the baby's blood back into the mother's system (causing dangerous blood sensitization in some Rh- mothers) and/or it can abort the transitional phase altogether, leaving the mother's system pouring blood into a placenta that isn't there anymore. Shutting off the flow of blood into the uterus then becomes essential to saving the life of the mother.
Even if the cord is intact and the baby is breathing on hir own, the placenta may still need some time to break the connections it has formed with the mother's body. This is an important time in the birth process. Rushing the placenta by pulling on the umbilical cord (cord traction) is another common and (IMHO) dangerous standard of care in many modern hospitals and medwife birth settings.
Standard "active third stage management" protocols call for Pitocin within 1 minute of birth (before anyone knows if she's bleeding seriously or not), early cord clamping and cord traction. I call that insane and abusive but doctors and medwives around the globe practice and defend such practices every day. Studies have indeed concluded that this type of "care" is preferable to doing nothing at all after a hospital birth but the studies make for some very strange reading.
The most often quoted study on the matter, the Hinchingbrooke study by Rogers et. al, culled 1500 women considered "low risk" for hemorrhages and treated some with the above "jab, clamp and yank" routine and others with nothing until heavy bleeding was detected. 16.5% of women in the "do nothing" group suffered from hemorrhages, compared to 6.8% in the actively managed group. So 1 out of every 5 healthy, low-risk women are supposedly at risk of hemorrhaging each and every time they give birth.
I think that these numbers have been used to make points about the dangers of childbirth before hospitals made it "safe" for us. Thankfully, there is plenty of information out there assuring us that healthy women do not die at a rate of one mother for every 5 or 6 births under normal circumstances. In a study covering the entire history of the midwifery community on The Farm in Summertown, TN, USA, a total of nearly 1500 home births in all, bleeding complications occurred in less than 2% of the births and no maternal deaths were reported at all.
So, women at home do bleed after birth but not nearly as often as you might think. Reducing the risk by allowing the mother to control the birth and keeping her adrenaline level low is all most families will need to do. However, if you're fighting a serious fear or have had bleeding concerns in the past, you'll probably want to create a "birth plan" that addresses the possibility of a hemorrhage.
Even when all the connections do close properly and everything is fine there may still be around 2 cups of fluid lost during the process of birthing. That might not sound like a lot right now, but 2 cups of fluid can look like a lot more when it's flowing in a puddle around someone you love. Try to rely on the way the mother feels rather than simply how much blood she's lost. If you are supporting a woman after birth, pay attention to her color and demeanor rather than the puddle on the shower curtain. If she looks pale, seems disoriented or shocky, remind her to follow her birth plan.
A uterine massage after birth is commonly performed by practitioners to encourage the muscle to contract and close off any open blood vessels. Whether you bleed or not, 15 to 20 minutes after your birth you might want to remember to give your uterus a little "thank you" massage for all its hard work. You won't be able to feel this very special muscle at all in a couple of days and it has served you well for many months. No need to abuse yourself and force it down to "the size of a grapefruit" (unless you feel you must) just send love to your uterus through your hands and assure it that all its hard work is appreciated while you focus on stopping the blood flow.
A shot of Pitocin is the standard remedy for PPH in a hospital setting and many midwives carry it to home births as well. Pitocin is a synthesized form of oxytocin, the hormone a woman's body increases during labor and nursing a baby. In a normal, low stress, joyful birth the woman's natural oxytocin levels are typically high but some women may still need an extra boost to stop the bleeding.
Here are a few ways to stop bleeding:
Nursing ~ A baby suckling your breast is a good way to send a message to your body that the baby is out and healthy. The stimulation of the nipples releases oxytocin (the real thing) into a woman's system. If the baby isn't interested in nursing right away, consider letting your husband help out ;)
Placenta ~ Another sure fire way of telling your body that the placenta is dead is to ingest a small piece of it. The hormones in the placenta tissues can stimulate very hard contractions if as much as a dime-sized piece is tucked into a cheek, under the tongue or (possibly less effective) swallowed. It's not that much different from cutting your finger and sucking the blood from the wound...
Blood boosting before labor begins ~ Many women add supplemental iron/Vitamin K-rich foods and/or herbs to their diets in order to maximize their bloods clotting potential during their third trimesters. You really should be eating your green leafies anyway.
The other half of boosting your blood's clotting abilities is avoiding blood thinners in the final weeks of pregnancy. Aspirin, white willow bark, Motrin, alcohol, even wintergreen and chocolate can cause the blood to flow more freely and should be used sparingly if at all right before birth. (If you just gotta have chocolate, you can always eat a few extra big salads to compensate :)
Herbs ~ There are several herbs that can be used to stop or slow excessive postpartum bleeding.
~ Cayenne pepper ~ One of the most useful herbs for childbirth, especially if the mother fears bleeding. 1/4 to 1 teaspoon of cayenne is considered a dose (it depends on how used to the stuff you are). One of the more popular ways to take it is in a honey/vinegar/cayenne (HVC) tonic with 1 Tbsp. of apple cider vinegar and 1 tsp. of honey diluted with 6-8 oz. of water.
A woman who swears by this (three kids and she's the daughter of a midwife) says that for birthing she mixes the HVC up in large batches (2 cups of honey, 2 cups of vinegar and 9 Tablespoons of cayenne) and drops 2 Tablespoons of it into 6-8 ounces of water. She claims to drink it all through labor as it relieves some pain as well. It goes down hot and comes out hot, so be prepared... but it's also good for hemorrhoids!
~ Motherwort tincture ~ can be taken once soon after birth. Repeated doses may cause the bleeding to continue. (Motherwort has been used to relieve afterpains as well).
~ Witch hazel bark tincture ~ to be used if the hemorrhage threatens before the placenta delivers.
~ Shepherd's purse tincture ~ but only if bleeding is severe because it can cause blood to pool in large, hard to pass clots.
Visualization ~ See your uterine wall and the tiny open vessels in your minds eye. See them closing and the blood flow stopping. Command the bleeding to stop. Choose to live.
(Personally, I think this is the best tool on the list...)
Homeopathics ~
~ Arnica ~ Usually used to help the body reabsorb the blood pooling in bruises, Arnica can be used to help the body stop post partum bleeding too.
Rescue Remedy ~ A Bach flower essence blend used to treat shock and calm nerves. Many women find it very useful during a stressful labor and throughout motherhood. Some women keep it on hand for their anxious partner's use as well.
Bleeding before labor begins can be even more terrifying than bleeding after birth but the same basic rules apply. Watch the mother's condition, monitor the baby's well-being, seek treatment if desired. A placental abruption can end the life of your infant, however, placentas have handled up to a 30% loss of function and still managed to nourish their passengers through labor. Knowing what to do when you see blood before the baby can be challenging but keeping an open connection to your little one and honoring their input is always a good first step and a little visualization probably wouldn't be a bad second step.
Kat writes:
I did not have any problem with bleeding after my birth, but my husband practices TCM, so we had a Chinese medicine called Yunnan Paiyao on hand just in case.
I think I would have taken placenta first, it just makes the most sense to me, and really, when are you going to get THAT opportunity again? Anyway, the YP is supposed to be some pretty amazing stuff. I've copied and pasted a little blurb I found about it on Elegant Earth Herbs.com but you can always do your own research. Also, even if you feel squeamish about mouthing a raw chunk of placenta, you might want to think about encapsulating the dried placenta to take as a restorative after birth.
From Elegant Earth Herbs.com:
"Chinese medicine offers nothing less than a miracle drug for wounds, pain and bleeding. Yunnan Paiyao is not a painkiller, but facilitates circulation, bringing oxygen to the injury.
Used during the Vietnam War, it not only was effective on gunshot wounds but open cuts and surgery. It can reduce recovery time for surgery by half because it mends injured blood vessels.
The ingredients of Yunnan Paiyao are still "officially secret" but the main ingredient is tienchi ginseng. It comes in a box of 16 capsules (these can be taken internally, or opened up and sprinkled on bleeding wounds) and one tiny red pill. The red pill is used for very serious injury (physical or emotional), followed later with the capsules."
Judith writes:
This (Yunnan Paiyao) is a good product but remember: please be very careful to get traditional Asian medicine from a reputable source. This "secret ingredient" thing (which is technically illegal in the US) has been used somewhat unethically by some packagers of "traditional" remedies within Asian countries...some samples are adulterated with western medicines such as antibiotics, caffeine, or unintentional contaminants.
Midwife archives on post partum hemorrhage
cbirth archives on bleeding
