Originally Posted by SarahInCA
Dh and I have just finished reading Emergency Childbirth, and were talking tonight about hemorrhaging. The book says that if you lose more than two cups of blood, you need medical care. But I think of how much blood I lost in the days and weeks after my first two births, and it was much more than two cups. So, what is the timeline for these two cups? Ten minutes? Two hours? Two days?
We're also reading Unassisted Childbirth and haven't come across the answer there yet. We have some herbs and homeopathy for hemorraging, and I know about nursing and eating the placenta. I feel equipped to deal with it if it happens, but I am unsure how to know *that* it's happening.
The blood loss that constitutes pph (generally speaking) is the blood you lose during delivery itself, during the time while waiting for placenta, the blood that emerges with the placenta, and what you lose in the early minutes following placenta. As long as blood flow stops being constant (comes in little waves only, after that), then all the later bleeding is 'normal lochia' (after birth flow that you described from your other births).
So, there is no particular timeline, since placentas come sometimes within a few minutes, and sometimes not for about an hour (and sometimes more).
What matters is a) how much blood you are seeing and b) whether or not your uterus is firm (very firm) to the touch, between birth of baby and placenta delivery. See, the placenta can release and fall across the cervix, blocking the emergence of blood, but you can still be bleeding in there. So, by feeling your uterus with hand on lower belly, you can check to see if it is very hard and also where the top of it is located on your abdomen. It should be a hard ball whose top is centered at, or not far above, your navel. If it is softer, or feels like it is off to one side and several centimeters higher than your navel, then you could be bleeding (but not see the blood emerging if placenta is blocking the cervix).
I've seen moms lost almost nothing with birth of baby--and up to 2 cups with birth (usually, this means placenta separated just as baby was being born). ON average, I'd say most moms lose about 1/2 cup during baby's delivery...to hazard an educated guesstimate. Some lose barely 1/2 cup to 1 cup from start to finish of placenta--it really varies. Usually, if a mom loses 'more' with the baby's birth, her uterus will clamp down fast and then the other bleeding will be far less.
Along with observing blood, and feeling your uterus (also feeling whether or not you are having strong contrax after baby), how you feel generally is important. Many moms go through a shakey/cold period soon after birth-this can be a normal reaction of your body as it makes rapid adjustments to the loss of weight, warmth and fluids with the birth. Laying down and covering up well, drinking something warm, should help this pass off within a few minutes. But if you feel faint or dizzy, see spots or can't seem to hear quite right, then this can mean you are losing too much blood. Again, lay down, get warm and try to drink something warm and a bit sweet (sweetened tea, or just room temp juice, for instance). Make sure to feel your uterus and check for blood loss too.
Most often, just holding the baby skin to skin, and otherwise enjoying yourselves, will bring about all the normal biochemical events that cause the uterus to clamp down normally, release placenta and reduce bleeding pretty fast. If in any doubt, feel your uterus for firmness and location--and if still in doubt, check how you feel generally. Also, gentle massage of uterus (from the outside), and nursing or nipple stimulation will bring on contrax to help stop bleeding.
Technically speaking, pph can happen anytime from birth until up to about 2 wks afterward. You could do fine at birth/placenta, and start bleeding heavier again in a few hours, or days (usually this is because of over exertion and possibly if you retained some placenta or membranes). But I think I've given the basics of normal blood loss and signs of pph with the birth itself.
hope this helps!