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Postpartum Hemorrhage | Pregnancy Power Hour
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Postpartum Hemorrhage

Postpartum hemorrhage (PPH) is significant blood loss after birth, a serious but manageable complication that your care team is prepared to address.

3 min read

Quick answer

Postpartum hemorrhage (PPH) is significant blood loss after birth, a serious but manageable complication that your care team is prepared to address.

On this page
  1. What it is
  2. What it tends to feel like
  3. What the evidence says helps
  4. Working with your care team
  • Also: PPH

What it is

Postpartum hemorrhage (PPH) is defined as significant blood loss after birth, specifically more than 500mL for a vaginal birth or more than 1000mL for a cesarean. This is a crucial topic for anyone preparing for birth, as it affects about 5-8% of all births globally. It’s important to understand that while PPH is a serious concern, it's also one that care providers are highly prepared to manage. Globally, it's recognized as a leading cause of maternal mortality, underscoring why awareness and prompt action are so vital.

The most common reason for PPH is what's known as uterine atony – this simply means the uterus doesn't contract effectively after the baby is born. These contractions are essential because they help to compress the blood vessels that were supplying the placenta, preventing excessive bleeding. When the uterus doesn't firm up as it should, bleeding can become heavier than expected.

What it tends to feel like

Experiencing heavy bleeding after birth can be unsettling, especially when you're already navigating the immediate postpartum period. While some bleeding is normal, PPH feels different. You might notice a sudden gush of blood, or a continuous, heavy flow that feels much more substantial than typical postpartum bleeding. It can be accompanied by feelings of lightheadedness, dizziness, or a general sense of weakness. As a doula, I often remind clients that their intuition is a powerful tool. If something feels off, or if the bleeding seems excessive to you, it's always worth mentioning to your care team. Your comfort and safety are paramount, and expressing your concerns helps them assess your situation effectively.

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What the evidence says helps

Fortunately, there are well-established, evidence-based practices that significantly reduce the risk and impact of PPH. One key strategy is the active management of the third stage of labor. This involves giving oxytocin shortly after your baby is born and using controlled cord traction to help deliver the placenta. Research, including findings from Cochrane, suggests this approach can reduce the risk of PPH by approximately 60%. It’s a gentle yet powerful intervention that many parents choose to discuss with their providers as part of their birth plan.

For those with specific risk factors, or if PPH does occur, other interventions are available. Tranexamic acid, when given within three hours of delivery, has been shown to reduce death from postpartum hemorrhage, as highlighted by the WOMAN trial published in The Lancet. Additionally, for settings where oxytocin might not be readily available, the World Health Organization recommends misoprostol as an effective alternative. Preparing your body for birth also plays a role; iron supplementation during pregnancy can help improve your hemoglobin reserves, offering a buffer if significant blood loss occurs. This is why discussions around nutrition and iron intake, similar to those we might have about managing Gestational Diabetes or Preeclampsia, are so important throughout your pregnancy.

Working with your care team

Understanding your individual risk factors is a collaborative process with your provider. Factors like carrying multiple babies, a prolonged labor, having a larger baby, a history of PPH in a previous birth, or conditions like placenta previa or accreta can increase your risk. Discussing these openly with your OB or midwife allows you to create a proactive plan. During our Power Hour consultations, we often explore how to have these conversations, ensuring you feel clear and confident in your decisions.

Your care team is your best resource for personalized guidance. They can help you weigh the options for managing the third stage of labor and address any concerns you have. Remember, you get to decide what feels right for you, supported by evidence-based information and the expertise of your medical professionals. Having a clear understanding of what to expect and what interventions are available can bring a lot of calm to the postpartum period.

Common questions

When should I go to L&D / call 911?+

If you experience sudden, heavy bleeding that saturates more than one pad in an hour, or if you feel dizzy, faint, or unusually weak, it's crucial to seek immediate medical attention. These could be signs of significant blood loss that needs prompt evaluation by your care team.

What is the most common cause of PPH?+

The most common cause of postpartum hemorrhage is uterine atony. This occurs when the uterus doesn't contract effectively after the delivery of the baby, which is necessary to close off the blood vessels that supplied the placenta.

Can PPH be prevented?+

While not always entirely preventable, the risk of PPH can be significantly reduced. Active management of the third stage of labor, which includes administering oxytocin and controlled cord traction, is shown to reduce risk. Antenatal iron supplementation also helps improve your body's reserves.

Brittany Nance

“Pregnancy is under-supported at every week. This is the kind of clear, calm guidance I give my one-on-one clients — and the questions worth taking back to your provider.”

Brittany Nance · Pregnancy Wellness Consultant · full-spectrum doula

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Written by Brittany Nance, Pregnancy Wellness Consultant· BADT Full Spectrum Doula · Founder, Pregnancy Power Hour
Last reviewed July 15, 2026

This is evidence-informed education from a birth-doula perspective, not medical advice. Always discuss your individual situation with your prenatal care provider.

On this page

  1. What it is
  2. What it tends to feel like
  3. What the evidence says helps
  4. Working with your care team

Keep reading

  • RelatedPostpartum PreeclampsiaPostpartum preeclampsia is a serious blood pressure condition that can develop after delivery, typically within the first few days but sometimes up to six weeks postpartum.
  • RelatedLochia — Postpartum Bleeding (first two weeks postpartum)During the first two weeks postpartum, lochia presents as a heavy red flow, gradually tapering, with clots up to golf-ball size often being a normal part of your body's recovery.
  • RelatedPlacental AbruptionPlacental abruption is a serious condition where the placenta prematurely separates from the uterine wall, requiring immediate medical attention.
  • RelatedThird Stage — Delivering the PlacentaThe third stage of labor involves the delivery of your placenta, a brief but important phase after your baby's birth where you have choices about its management.
  • RelatedAfterpains — Postpartum Uterine Cramping (first two weeks postpartum)During the initial two weeks postpartum, afterpains are the natural uterine contractions that help your body return to its pre-pregnancy state, often intensifying with breastfeeding.
  • RelatedLochia — Postpartum Bleeding (weeks 2 to 6 postpartum)During weeks 2 to 6 postpartum, lochia typically transitions from pink or brown to a lighter yellow or white discharge, signaling continued healing.