Throughout history, blood loss after delivery and its associated complications have accounted for more maternal deaths than any other reason except infection. This is no longer the case when a woman is cared for by a competent clinician supported by a reasonably modern health care system. Overall, approximately 6% of women will have an estimated blood loss of 500 cc or more (that’s about a pint) associated with childbirth. Most of this blood is lost from the inside of the uterus where the placenta was attached. Most often this occurs immediately after the delivery of the placenta. In these cases, instead of contracting and reducing the blood flow to the placental attachment site, the uterus goes flaccid, a condition known as “uterine atony”. If quickly diagnosed, your midwife or doctor will spring into action and with a combination of hand skills and medications facilitate and encourage the uterus to contract.
There are other factors which may contribute to blood loss. Occasionally the wound left by an episiotomy or laceration may tear in to larger blood vessels. Such wounds produce so much blood so quickly that it may take a while to “ligate” the bleeding vessels with sutures. Bleeding may also occur beneath the visible surface. In these situations, blood may pool in pockets producing “hematomas”. Most hematomas stabilize (by clotting) spontaneously. But some may need to be opened and the bleeding vessels tied off with suture. In either case, blood has escaped from the bloodstream. Hematomas most often occur in the spaces on either side of the vagina deep in the pelvis. A woman with a hemtoma may feel an increasingly painful pressure in the vagina or buttocks.
If a woman is suffering the more severe consequences of hemorrhage, a decision may be made to treat her with a blood transfusion. For those women, a doctor or midwife may feel that without a transfusion the possibility of a further decline in health (for example, an infection) could cost a new mother her life. There is no substitute for blood. Although intravenous fluids and plasma may help by preventing shock, it is the oxygen-carrying capacity of red blood cells which keeps our bodies alive.