How do you know you are hemorraging? - Mothering Forums
Unassisted Childbirth > How do you know you are hemorraging?
SarahInCA's Avatar SarahInCA 04:35 AM 10-19-2010
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.

Thanks!

MsBlack's Avatar MsBlack 10:14 AM 10-19-2010
Quote:
Originally Posted by SarahInCA View Post
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.

Thanks!

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!
SarahInCA's Avatar SarahInCA 06:15 PM 10-19-2010
Thank you SO much! That's exactly what I wanted to know. :-)
boogiebearlove's Avatar boogiebearlove 06:10 PM 10-20-2010
That is great information! I have been wondering the same thing.
Almi's Avatar Almi 03:16 AM 10-21-2010
Just wondering, what are the best things to take for PPH?
kittywitty's Avatar kittywitty 12:07 PM 10-21-2010
Well, I have pics of my pph and I can guarantee you it was far more than 2 cups! I had a bit of retained placenta and felt shaky and faintish pretty badly. So I transferred. When taking a bite of placenta didn't work and the herbs didn't work and I looked and saw the blood around me, I knew it was a pph.

What you do depends on what the cause is. Fundal massage does wonders if you aren't too faintish to do it on yourself (which I was) and it wouldn't hurt to use some shepherd's purse if the placenta is out and intact and you are still bleeding. Don't use it unless the placenta is out and intact, though. Double or triple check that one and use Placenta Out if it is not.
MsBlack's Avatar MsBlack 04:46 PM 10-21-2010
I'm glad you mentioned your experience, K-W--and yeah, pph is usually quite a bit more than 2cups lost between birth of baby and placenta. I've even seen moms lose closer to a quart (4cups) and be fine--the amount of blood loss that is 'normal enough' for a mom really really varies. For that reason, paying attention to how you feel, how your uterus feels and whether or not you are still bleeding steadily (whether a tiny trickle or more, if it's continuous it's not good), is much more important than trying to measure the amt of blood. Birth can be such a gooey mess--realize that you might see a red mess on the chux pads and it's not just blood--it's blood, amniotic fluid, possibly urine or meconium too. But it can look like it's all blood, because the 'dye' of blood is so very intense/concentrated--a small amount can make everything else look very red.

There is generally no mistaking that fainty/shocky feeling of losing more blood than you can handle! If you get this, FIRST lay flat, so you'll keep getting enough blood to your brain--which will help you think more clearly, as well as help your body keep doing what it needs to do.
dayiscoming2006's Avatar dayiscoming2006 05:46 PM 10-21-2010
This thread has been super helpful. I was wondering about this. I might have had a hemorrhage but I do believe it was caused by some really rough doctors. They have ZERO patience for a placenta in Romania. They started roughly massaging it out of me immediately after the birth. It was awful. Then they noticed I was bleeding too much I guess and gave me a D and C. Hubby said there was some leftover placenta in there and they scraped it out. It was just awful. And I was faint and lightheaded and could barely walk and was bleeding a lot still for a while after but no one said or did anything. Thankfully I ended up being OK. Thank God my husband brought me food and water. I would have gone hungry and thirsty otherwise.

Anyway, there's an example of it happening with improper care. I'm excited about this birth and hope I will be able to get my UC. I'm definitely planning on it. I don't feel safe in hospitals or around doctors.
tink79's Avatar tink79 06:09 PM 10-21-2010
I'm not a UC'er but wanted to add something because I hadn't seen anyone mention it, I hope you guys don't mind. I hemorrhaged after the birth of my twins and if they had let me sleep we might not have known until it was too late. I held and nursed my girls for a few minutes after they were born but had an overwhelming sleepy feeling that everyone, myself included, dismissed as just being tired from birthing twins. Wrong, I couldn't keep my eyes open, couldn't stay awake to even hold on to my babies, slept for I have no idea how long until they took me to another room where I was encouraged to get up to pee. At that point, all of the blood that had been pooling inside of me gushed and everyone began panicking when they realized what had been happening.

So, if you happen to be incredibly, abnormally sleepy, please don't dismiss it as normal after birth tiredness. If you do nap, make sure someone can keep an eye on you and make sure that everything is coming out normally and that you are maintaining some normal alertness. I had clots that prevented the 'flow' until I stood up so no one knew what was going on.
Sheryl1678's Avatar Sheryl1678 06:57 PM 10-21-2010
I hovered/knelt over a bowl after the delivery and until the placenta was delivered to eliminate the guesswork. It can be difficult for an experienced midwife/doctor to measure especially if you are over water (tub birth/toilet).

Anyway, I can't tell how much blood is in a toilet/chux pad so I just collected and measured to eliminate the guesswork. You also know when you are ready to stand up and get cleaned up etc...when the bleeding slows down. If it continued or was steady as the other posters mentioned, it may have been cause for attention.

Good luck!
MsBlack's Avatar MsBlack 10:55 PM 10-21-2010
Quote:
Originally Posted by tink79 View Post
I'm not a UC'er but wanted to add something because I hadn't seen anyone mention it, I hope you guys don't mind. I hemorrhaged after the birth of my twins and if they had let me sleep we might not have known until it was too late. I held and nursed my girls for a few minutes after they were born but had an overwhelming sleepy feeling that everyone, myself included, dismissed as just being tired from birthing twins. Wrong, I couldn't keep my eyes open, couldn't stay awake to even hold on to my babies, slept for I have no idea how long until they took me to another room where I was encouraged to get up to pee. At that point, all of the blood that had been pooling inside of me gushed and everyone began panicking when they realized what had been happening.

So, if you happen to be incredibly, abnormally sleepy, please don't dismiss it as normal after birth tiredness. If you do nap, make sure someone can keep an eye on you and make sure that everything is coming out normally and that you are maintaining some normal alertness. I had clots that prevented the 'flow' until I stood up so no one knew what was going on.
That is a good point! Of course, a woman will eventually be sleepy after birth, but not usually for a few hours. By then, you would know how your bleeding was going. I would pretty definitely find it odd if a mom wanted to sleep much sooner than a 2-3 hrs later. Even after a long hard labor, most moms get a big rush of adrenaline during birth, so their need for sleep is delayed awhile.
StrongBeliever's Avatar StrongBeliever 01:18 PM 10-22-2010
Wow, thanks MsBlack for all the awesome info. I also experienced some hemorrhaging with the UC of my DD. If I could guess, I would say I lost well more than 2 cups of blood, most of which came after the delivery of the placenta. I'd say the steady flow stopped not long after... Maybe ten minutes. I held a bite of placenta in my mouth(but couldn't swallow it) and massaged my uterus. I didn't have any abnormal sleepiness, but I was pretty faint and shakey for a few days afterward(didn't get medical attention). We were pretty careful about being super observant for any signs of me being "unable to handle it". I ate LOTS of blackstrap molasses immediately following birth and in the days following... I don't know where I got the idea for that, I think I was assuming all of the iron an minerals would help make up for the blood loss. I think you are right about judging the severity based on how mom feels... I felt faint and shakey, had a few dizzy spells, but was up and about the next day making homemade bread by hand and taking care of new baby and my toddler by myself.
Almi's Avatar Almi 09:39 PM 10-22-2010
Great info, everyone. Much appreciated.


Quote:
Originally Posted by kittywitty View Post
What you do depends on what the cause is. Fundal massage does wonders if you aren't too faintish to do it on yourself (which I was) and it wouldn't hurt to use some shepherd's purse if the placenta is out and intact and you are still bleeding. Don't use it unless the placenta is out and intact, though. Double or triple check that one and use Placenta Out if it is not.
Why not use shepherd's purse if all of the placenta is not out? Just curious.

Where can you get Placenta Out and shepherd's purse (online)?


EDIT: I found a site that sells Placenta Out, but it contains shepherd's purse anyway...? So is it worth it to also get just shepherd's purse (extract)?
boogiebearlove's Avatar boogiebearlove 12:21 PM 10-23-2010
Quote:
Originally Posted by tink79 View Post
I hemorrhaged after the birth of my twins and if they had let me sleep we might not have known until it was too late. I held and nursed my girls for a few minutes after they were born but had an overwhelming sleepy feeling that everyone, myself included, dismissed as just being tired from birthing twins. Wrong, I couldn't keep my eyes open, couldn't stay awake to even hold on to my babies, slept for I have no idea how long until they took me to another room where I was encouraged to get up to pee. At that point, all of the blood that had been pooling inside of me gushed and everyone began panicking when they realized what had been happening.

So, if you happen to be incredibly, abnormally sleepy, please don't dismiss it as normal after birth tiredness. If you do nap, make sure someone can keep an eye on you and make sure that everything is coming out normally and that you are maintaining some normal alertness. I had clots that prevented the 'flow' until I stood up so no one knew what was going on.
Very good point! Thanks for sharing!
minkajane's Avatar minkajane 03:10 PM 10-24-2010
Great info! I love the idea of kneeling over a bowl so you can measure. I definitely plan on doing that now. That's my big worry. I had a partial placenta previa at 9 weeks, which seems to have resolved now (14 weeks) but that probably means I have a low-lying placenta, which slightly increases my risk of hemorrhage. My plan is to have Placenta Out on hand, as well as some cohosh or shepherd's purse.

I'm a vegetarian, but I'm going to make an exception in the first few days after the birth and drink as much beef broth as I can, as well as molasses to build back up my iron stores.
kittywitty's Avatar kittywitty 03:55 PM 10-25-2010
Quote:
Originally Posted by Almi View Post
Great info, everyone. Much appreciated.




Why not use shepherd's purse if all of the placenta is not out? Just curious.

Where can you get Placenta Out and shepherd's purse (online)?


EDIT: I found a site that sells Placenta Out, but it contains shepherd's purse anyway...? So is it worth it to also get just shepherd's purse (extract)?
Shepherd's purse aids with clotting (or so I read, correct?). Simply clotting does not stop the bleeding that will continue from a boggy uterus or if a piece of placenta is in there preventing proper clamping down. Page 128 of Heart & Hands explains this. I did not remember that with my UC, so I did not take enough Placenta out. The shepherd's purse I did take gave me huge clots but did nothing about the retained fragment of placenta. Make sure you check the placenta for completeness if you think you may have a retained piece or the placenta is not clamping down. BEFORE the shepherd's purse.

Some links:
http://www.mothering.com/discussions.../t-998416.html
http://books.google.com/books?id=79Z...gelica&f=false
http://www.midwiferytoday.com/articl...partumcare.asp

I think I got my Placenta Out at In His Hands.
Almi's Avatar Almi 03:37 AM 10-28-2010
Okay, thanks. I did order some Placenta Out, and it came today! =D
basje's Avatar basje 03:11 PM 10-28-2010
I had a massive pph after my UC, she was born in the sack which I broke after she was out so it was unclear to me how much blood there was because the blood and the amniotic fluid mixed together. I tore (three second degree) which so there was also a little blood from that. I did feel a little dizzy and tired so I called an ambulance instead of doing the flight of stairs down to the car on my own.

I went to L&D after she was born to have the tearing fixed, and I still hadn't delivered the placenta four hours later (which I wasn't super worried about but of course the doctors were). After delivering the placenta I was stuck on a chucks pad and watched by a nurse for 45 minutes. It was at that point that I hemmoraged 2 quarts in three minutes. Oddly I felt fine when it happened... warm, comfortable, awake, aware- I am not sure if this is because I was on the edge of death or that the IV fluids made me feel good. The nurse looked up from her chart said, "Oh shit" and I looked down and said, "Yeah that's can't be good" and then half of the staff from L&D rushed in.

My advice, take an iron supplement from 35 weeks on (I suggest Floridex) every day! And if you think you're a little dizzy and close to the hospital, leave the babe at home and get some blood and/or plasma.
cdot's Avatar cdot 02:02 AM 10-31-2010
Okay, this may sound like a stupid question, and I do have Hearts and Hands, but I haven't looked through it that much. Anway, How do you know if you have a retained placenta? Can you tell just by looking at the placenta after delivery? Both of my other children were born in hospitals, so I was never able to see the placenta.
minkajane's Avatar minkajane 02:23 AM 10-31-2010
Quote:
Originally Posted by cdot View Post
Okay, this may sound like a stupid question, and I do have Hearts and Hands, but I haven't looked through it that much. Anway, How do you know if you have a retained placenta? Can you tell just by looking at the placenta after delivery? Both of my other children were born in hospitals, so I was never able to see the placenta.
Retained placenta means it takes longer than normal to come out, or it doesn't come out without assistance (manual removal, D&C, etc). It doesn't usually look any different once it does come out.
Almi's Avatar Almi 07:08 AM 10-31-2010
Maybe I'm off on what you mean, minkajane, but I just wanted to clarify that I think cdot was talking about checking over the [unretained] placenta after it comes out, to see if it has any missing pieces or not, not looking at any pieces of previously retained placenta that come out.

Well anyway, yes, cdot, you just double and triple check the placenta after it comes out, it should be like a big, symmetrical pancake with no missing chunks.
cdot's Avatar cdot 04:21 PM 10-31-2010
Yes Almi, that is what I meant. That's what I thought, but I wanted to be sure. Thank you



Rejoicing's Avatar Rejoicing 07:26 PM 11-03-2010
I have had 3 friends/aquaintances hemmorage to the point of almost dying at birth. 2 were in the hospital, one at home. The first one actually didn't start hemmoraging until after she had already had the baby and left the delivery room. Her and her husband both noted that it was more blood than they remembered from their previous births, and they called in the nurse-the rest was all a crazy blur. The second one was a placenta acretia(sp.) situation. The third was a homebirth. My next door neighbor actually. She said she felt a little light headed, but before she knew anything was happening she passed out. Her mw knew what was going on and saved her life. I don't think she had time to realize she was hemmoraging, it happened that fast for her. So be sure you have tools on hand to deal with a hemmorage, and be sure your birth partner knows what to do ahead of time. Also pay close attention to how you feel after birth.
sortahippie's Avatar sortahippie 04:06 PM 12-02-2010

Retained placenta also refers to a small piece of the placenta or sac that is retained in the uterus when the rest has already delivered. Sometimes it is an accessory (extra) lobe, or just a piece of trailing membranes. If you have never seen an intact placenta, it may be hard to tell if yours is intact. However, if you have unusually heavy bleeding after delivery of the placenta, if your uterus feels large and boggy (it should feel like a firm-to-hard knot around your belly button), if your heart rate rises above 100 for an extended period, if you feel dizzy/lightheaded, and/or if you develop a fever after delivery, then retained placenta could be a culprit.


kittywitty's Avatar kittywitty 08:44 AM 12-03-2010
I was pretty placenta-knowledgeable and did not notice the missing piece when I had my pph with #4. They pulled out a small piece but I was woozy and preoccupied with baby and missed the small piece of placenta that must have been gone and caused my bleeding.
greenmama66's Avatar greenmama66 11:28 AM 12-03-2010


Quote:
Originally Posted by tink79 View Post

I'm not a UC'er but wanted to add something because I hadn't seen anyone mention it, I hope you guys don't mind. I hemorrhaged after the birth of my twins and if they had let me sleep we might not have known until it was too late. I held and nursed my girls for a few minutes after they were born but had an overwhelming sleepy feeling that everyone, myself included, dismissed as just being tired from birthing twins. Wrong, I couldn't keep my eyes open, couldn't stay awake to even hold on to my babies, slept for I have no idea how long until they took me to another room where I was encouraged to get up to pee. At that point, all of the blood that had been pooling inside of me gushed and everyone began panicking when they realized what had been happening.

So, if you happen to be incredibly, abnormally sleepy, please don't dismiss it as normal after birth tiredness. If you do nap, make sure someone can keep an eye on you and make sure that everything is coming out normally and that you are maintaining some normal alertness. I had clots that prevented the 'flow' until I stood up so no one knew what was going on.


True- I had a PPH with my twins and don't even remember my midwife giving all those pitocin shots. I felt like I was passing out/dying. I had no idea what happened until midwife came back the next morning and told me what had happened. It can be common after twins because of the large space placenta occupies (I had one huge huge placenta).


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