Postpartum hemorrhage: How much bleeding after delivery is normal?

Following delivery, we expect women to experience a fair amount of bleeding. In fact, women typically bleed up to a half-quart of blood following a normal delivery and up to a quart of blood after a cesarean section (C-section). However, about 3 to 5 percent of new moms experience excessive blood loss, or postpartum hemorrhage.

While that percentage is relatively small as it pertains to overall deliveries, postpartum hemorrhage remains a common complication that can occur during delivery; in fact, we see women with this condition on a weekly basis. Because that’s so, we want to make sure women understand the common causes, why they might be considered at higher risk, and potential treatment options.

What causes postpartum hemorrhage?

About 70 to 80 percent of the postpartum hemorrhage cases we see are the result of the woman’s uterus not contracting after delivery, a condition called uterine atony. In a normal delivery, the uterus contracts substantially once the placenta is removed, which prevents bleeding from blood vessels that previously supplied blood to the placenta.

Other postpartum hemorrhage risk factors include:

● Genital tract lacerations: Tissue damage or trauma of the lower genital tract that occurs during the birth process

● Retained placental fragments: Retention of the placenta or fetal membranes within the uterus following delivery

● Clotting defects: Delayed formation of blood clots after delivery occurs

The majority of women who experience a postpartum hemorrhage have at least one risk factor for postpartum hemorrhage. However, 40 percent of women will not have any identifiable risk factors. The most common risks we do see are:

● Abnormalities of the labor process, such as prolonged labor or need for labor induction

● A uterus that is overdistended from a large baby, a twin or triplet pregnancy or from excess levels of amniotic fluid

● A first-time childbirth or history of many prior children

Related reading: The ‘fourth trimester’: Why women need health care after delivery

How we treat excessive bleeding after delivery

Treatment for postpartum hemorrhage varies depending on the cause of the excessive bleeding. However, because most cases are due to a uterine atony, we typically use medication that helps the uterus contract and limits excessive blood loss. Additionally, we can use techniques that physically compress bleeding vessels within the uterus, such as intrauterine balloons. We also can use medication to prevent breakdown of clots, which can help to minimize excessive bleeding. 

In rare cases, medication and minimally invasive techniques don’t work. As a result, we might need to perform a hysterectomy, or a removal of the uterus. This also usually involves a transfusion of blood to replace the blood that has been lost.

How to reduce the risk of postpartum hemorrhage

During pregnancy, women’s bodies prepare for blood loss at delivery by producing extra red blood cells, a process that requires significant amounts of iron. Therefore, women can prepare for the possibility of postpartum hemorrhage by taking supplemental iron. Healthy iron levels allow for the creation of new red blood cells and prepare the body to withstand excessive blood loss should it occur.  Women should speak with their doctor regarding which iron supplements are best for them. Additionally, postpartum hemorrhage can be prevented with the use of a medication called oxytocin, which is given routinely right after delivery to help the uterus contract and prevent excessive postpartum bleeding. We also massage the uterus after childbirth, which can promote uterine contraction.

Postpartum hemorrhage often can’t be predicted prior to delivery. However, with the right treatment methods and preventive measures in place, complications related to postpartum hemorrhage often can be avoided or reduced.

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