Postpartum hemorrhage is an issue that healthcare providers in the obstetrical field take very seriously, because even in developed countries, it remains one of the leading causes of maternal death related to childbirth. You'll notice that after delivery, your nurses and doctors do a lot to check your uterus and to check bleeding to make sure that you're not bleeding too much. During pregnancy, your body sends a lot of blood-flow to the placenta every time your heart beats in order to feed your growing baby. And this blood-flow doesn't immediately stop after the baby is born - these vessels continue to bleed. And if the uterus is tired, and doesn't cramp down over all those vessels and act like a tourniquet, then the mother can bleed too much or hemorrhage. Uterine atony (or the uterus being too tired and not cramping down) is the number 1 cause of postpartum hemorrhage.
There are a few things that increase a woman's chances of having uterine atony. Anything that is going to cause over-distension of the uterus can contribute to it. So if you had a lot of amniotic fluid, or if you had twins, or if you've had lots of babies before and your uterus has been stretched out multiple times, or maybe you just had a really, really, really long labor and your uterus is going to be plum-tuckered at the end - those are all things that your doctor will consider. And your risk for postpartum hemorrhage is largely circumstantial. And to address this, different medications can be given, and they all work on the uterus differently in order to get it to cramp down, and generally speaking, a woman's body will respond to these, and the bleeding will slow down.
Now, it also depends on the cause. A woman's body may not respond to these medications, because the underlying cause is due to something else, like retained placental pieces. And in these cases, the doctor sometimes has to do a D&C (like what you might think of if a woman has had a miscarriage in the past) in order to make sure the uterus is totally clean, and clear, and free of all placental pieces so it can actually cramp down. Another cause a doctor will consider are lacerations inside that are bleeding. And once those are repaired, then the bleeding will usually stop. There are other interventions that a doctor might try, and after investigating and looking at the overall picture, they'll decide what intervention is most appropriate for that woman.
Now if you've had a postpartum hemorrhage in the past, make sure that your doctor and nurses know about it when you go in to have another baby, and they'll be extra vigilant at watching you and making sure that you don't hemorrhage. Whether you have in the past or not, you'll notice that your nurses will come in every so often after you've had the baby, and in the midst of all the bonding, and breastfeeding, and excitement, they still need to make sure that you're safe and you're not going to bleed too much. The chance of bleeding too much is highest within the first hour and few hours after delivery, so they'll knead your belly. And what this does is stimulate the uterus to contract really tightly, and it helps to push any blood that's in there out, so that it won't stay inside, and form clots, and prevent your uterus from cramping down.
They'll also want to make sure that your bladder is kept empty, because the bladder sits below the uterus, and if the bladder starts to fill up, it can push the uterus up and off to the side. So for this reason, if a woman is unable to spontaneously pee on her own after delivery, they might have to insert a catheter and drain the bladder in order to prevent bleeding. If you have anymore specific questions about postpartum hemorrhage, talk with your doctor, and based on their knowledge of your circumstances, they'll be able to give you tailored information and advice. If you have more questions for me in the future, feel free to ask them on our Facebook page at https://www.facebook.com/IntermountainMoms, and recommend us to your friends and family too.