At Balanced Birth Support, our doulas walk alongside families through every stage of pregnancy, birth, and postpartum. While our goal is always to nurture confidence and calm, we also believe in providing clear, evidence-based education — so that you can feel empowered, not alarmed.
Today, we’re talking about postpartum hemorrhage — what it is, why it can happen, and when to reach out for help.
What Is Postpartum Hemorrhage?
Postpartum hemorrhage (PPH) means excessive bleeding after childbirth — usually defined as more than 500 mL (about two cups) after a vaginal birth, or more than 1,000 mL (about four cups) after a cesarean birth.
But it’s not just about the number — it’s about how your body responds. Your care team pays close attention to your pulse, blood pressure, and how you’re feeling to determine what’s normal for you.
Why It Happens
There are four main reasons bleeding may become heavier than expected after birth, known as the “Four T’s”:
- Tone: The uterus doesn’t contract firmly after delivery (the most common cause).
- Tissue: A small piece of placenta or membrane remains inside the uterus.
- Trauma: A tear or laceration in the cervix, vagina, or perineum.
- Thrombin: A rare blood clotting issue that prevents normal clot formation.
Risk Factors Before, During, and After Birth
Having one or more risk factors doesn’t mean you’ll experience a hemorrhage — it just means your care team will be extra watchful.
Before Birth:
- Low iron or anemia
- Placenta previa or accreta
- Multiple pregnancy (twins or more)
- Previous postpartum hemorrhage
During Birth:
- Long or very fast labor
- Induction or augmentation with Pitocin
- Use of forceps or vacuum
- Large baby
- Cesarean birth
After Birth:
- Retained placenta
- Infection
- Overstretched uterus (from multiples or excess amniotic fluid)
How Postpartum Hemorrhage Is Managed
If a postpartum hemorrhage occurs, your care team responds quickly and efficiently — often within moments. Most cases are treated without surgery.
Step 1: Uterine Massage and Support
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Firm massage helps the uterus contract.
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Emptying the bladder can also help the uterus tighten and stop bleeding.
Step 2: Medications That Help the Uterus Contract
Your provider may use one or more of the following:
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Oxytocin (Pitocin): Commonly given right after birth as prevention.
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Misoprostol (Cytotec): A tablet that can be given by mouth or rectally.
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Methergine: Helps the uterus contract (not used with high blood pressure).
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Hemabate: A strong uterotonic (not used if you have asthma).
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Tranexamic Acid (TXA): A newer, highly effective medication that helps blood clot; now recommended worldwide for early treatment of hemorrhage.
Step 3: Devices and Procedures
If bleeding continues despite medication, your provider may use:
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A Bakri balloon — a soft balloon placed in the uterus and inflated to apply gentle pressure.
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Uterine compression stitches (like the B-Lynch suture) during cesarean birth.
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Uterine artery embolization, a procedure that blocks the bleeding vessels while preserving fertility.
Step 4: Surgery (Rare)
In very few cases, surgery may be needed. This could include tying off major blood vessels or, as a last resort, a hysterectomy to save the parent’s life. Fortunately, these cases are uncommon thanks to modern medicine and rapid response protocols.
What to Watch for After You’re Home
Your bleeding should gradually lighten over the days and weeks after birth. Still, it’s important to pay attention to your body and trust your instincts.
Call your provider right away if you:
- Soak through a pad in an hour or less
- Pass clots larger than a golf ball
- Feel dizzy, weak, or have a racing heartbeat
- Notice pale or clammy skin
- Experience worsening pain or cramps
- Develop a fever or foul-smelling discharge
Go to the emergency room immediately if:
- You’re bleeding heavily and feel faint or lightheaded
- You pass out or cannot stand without feeling dizzy
- Bleeding suddenly increases after it had slowed down
The Role of Your Doula
Your doula is not a medical provider, but they are a watchful, calm, and compassionate support who knows what to look for.
If something seems off, your doula will encourage you to get medical help right away — while staying by your side, helping you remain calm, and supporting your partner and family. They will explain calmly what is happening and help make you feel as safe as possible.Our doulas are trained to notice changes in your recovery, advocate for you, and ensure that your physical and emotional needs are met every step of the way.
You’re Not Alone in This
While postpartum hemorrhage can sound overwhelming, it’s important to remember that it’s rare, manageable, and treatable. With skilled medical providers and a supportive doula by your side, you’ll never have to face it alone.
At Balanced Birth Support, our doulas provide continuous, compassionate care — helping you feel informed, confident, and cared for before, during, and after birth.
Ready to feel supported in your birth and postpartum journey?
✨ Learn more about our doula care services or schedule a consultation today.