At normal vaginal birth and immediate postpartum, it is common to lose up to a half liter of blood. After cesarean birth, one liter of blood loss is the average. After birth, your uterus needs to contract around the major blood vessels that supplied the placenta to close them off and prevent excessive bleeding. 

The first few days, bleeding can be like a heavy period. Then, it tapers to a moderate period, after which it becomes lighter and changes color over several weeks from shades of red, then pink to brown. The body is healing the former placental site, shedding the internal scab there, and extra tissue and blood that was lining your uterus during pregnancy. 

Postpartum hemorrhage usually occurs immediately, or up to the first 24 hours post birth, and remains a major cause of maternal death in the US and around the world. It must be taken seriously. Currently, there is substantial evidence in support of what is termed ‘active management of the third stage of labor,’ to reduce the risk of severe excess postpartum bleeding. It includes the use of:

  •  The synthetic hormone oxytocin (referred to as Pitocin in the US) via intravenous or intramuscular injection

  • Early cord clamping with waiting 1-3 minutes until baby gets at least most of the cord blood

  • Controlled traction on the cord along with counter pressure on the uterus to effect placenta delivery within the first 5-30 minutes after birth

  • Uterine massage to make sure it is firmly contracted

  • Assessments every 15 minutes for the first two hours. 


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