Tackling bleeding after childbirth

The maternal deaths occur during labor, childbirth or in the postpartum period (the period beginning immediately after the birth of a child and extending for about six weeks). Bleeding just after childbirth, medically known as Postpartum Haemorrhage (PPH) is responsible for these deaths. Most of these deaths are preventable by awareness, prompt recognition and care.

Bleeding usually starts immediately after delivery within 24 hours of childbirth. This is a period when everyone becomes busy with the newborn baby. Often, mothers get less attention in this period than they deserve. Bleeding can be quickly recognized by number and frequency of tampon used, physical signs and symptoms. A woman may feel dizzy, look pale and have low blood pressure with increased pulse rate. Tampon is usually soaked with huge amount of bright red blood than usual and they need to change tampon frequently.

In most cases, bleeding occurs due to failure of the uterus to contract after the delivery of the baby and placenta called uterine atony. Other causes include, retained placental tissue and/or products of fetus, trauma, ruptured uterus, lacerations or tears of the mouth of uterus, vagina, bleeding disorders, uterine abnormality etc.

Because two-thirds of women who develop PPH have no known risk factors, the best way of prevention is the preparation to handle it if it arises. Preparation starts after conception. Women should be encouraged to deliver babies at healthcare facilities. If a home delivery is planned, we have to make sure a skilled birth attendant is available. Distributing Misoprostol, a drug that can reduce bleeding can help to those women.

Birth attendants should be trained to recognize the problems early and manage it at first hand. During the final stage of labor, there are certain things that can help to prevent and manage bleeding. Encourage the woman to keep her bladder empty, limit induction or augmentation use for medical and obstetric reasons, do not encourage pushing before the cervix (uterine mouth) is fully dilated, do not use belly pressure to assist the birth of the baby.

 Here are some tips to prevent and manage bleeding:

• Routinely inspect the vulva, vagina, perineum and anus to identify genital lacerations.
• Routinely inspect the placenta and membranes for completeness.
• Evaluate if the uterus is well contracted and massage the uterus at regular intervals after placental delivery to keep the uterus well-contracted and firm (at least every 15 minutes for the first two hours after birth) and teach the woman to massage her own uterus to keep it firm.
• Monitor the woman for vaginal bleeding and uterine hardness every 15 minutes for at least the first two hours, encourage the woman to keep her bladder empty during the immediate postpartum period.
• Administration of Misoprostol or similar drug (Oxytocin) within 1 minute after birth of the newborn.
• Make delay in cord clamping (once the cord stops pulsating or within 2-3 minutes) and then delivery of the placenta by controlled cord traction followed by uterine massage.

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