# Postpartum Hemorrhage

Source: https://www.pregnancypowerhour.com/conditions/postpartum-hemorrhage
Last updated: 2026-07-15

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

## 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.

## 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](/conditions/gestational-diabetes) or [Preeclampsia](/conditions/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](/conditions/morning-sickness) 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.