One of the least talked about aspects of pregnancy and birth is the postpartum bleeding, also known as lochia. Many women don’t know what to expect and are unaware of what is considered “normal” bleeding. As a result, some women (and even healthcare providers!) don’t know how much bleeding is a problem and whether they are experiencing something more serious—life-threatening, even—like postpartum hemorrhage.

In fact, postpartum hemorrhage occurs in up to five percent of women who give birth and is one of the biggest concerns for postpartum moms. Here’s what you need to know:

What Is Postpartum Hemorrhage?

Postpartum hemorrhage (PPH) is when excessive bleeding occurs after birth.

But let’s back up a bit first: It’s normal for women to lose about ½ quart of blood during a singleton vaginal birth (1 full quart is normal for cesarean birth). But losing more blood than this can be considered postpartum hemorrhage.

When is the most common time to hemorrhage?

PPH usually occurs after the placenta detaches from the uterus, but what’s really scary is that it can happen up to 12 weeks after giving birth. And when this happens, the resulting loss of excess blood can cause low blood pressure, anemia, shock, and even death.

Bottom line: When postpartum hemorrhage happens, it’s vital to catch it early and get treatment right away.

What Causes Postpartum Hemorrhage?

When the placenta detaches from the uterus after birth, it leaves behind an open wound. When things go as planned starts contracting down to its original size immediately after the placenta is birthed. (Breastfeeding can help with this process, since the milk letdown also stimulates uterine cramping.) The same contractions that got your baby out will help this process. As the uterus contracts, it slows the bleeding of this fresh wound. Sometimes, though, the uterus doesn’t contract strongly enough after birth, and this can cause hemorrhage.

Other postpartum hemorrhage causes include:

  • Retained placenta
  • Tear in the cervix or tissues of the vagina
  • Tear in a blood vessel in the uterus
  • Hematoma in the vulva or vagina
  • Blood clotting disorders

Risk Factors for Postpartum Hemorrhage

Having postpartum hemorrhage risk factors doesn’t mean that you will definitely experience a postpartum hemorrhage, but having one or more risk factors may increase your chances. Risk factors include:

  • Placental abruption: When the placenta detaches from the uterus before birth (either fully or partially).
  • Placenta previa: When the placenta attaches over, partially over, or too close to the cervix.
  • Overdistended uterus: The uterus is larger than normal due to excess amniotic fluid, or a large baby.
  • Multiples
  • High blood pressure
  • Having many previous births
  • Prolonged labor
  • Infection
  • Obesity
  • Use of forceps or vacuum-assisted delivery
  • Being of Asian or Hispanic ethnic background (Studies suggest there may be a genetic predisposition for defects of uterine contraction in the postpartum state in these individuals, placing them at higher risk for hemorrhage but more research is needed.)

But postpartum hemorrhage can happen to anyone—even those without known risk factors. Because of this, it’s vital that you’re equipped with the knowledge you need to recognize the signs and that you have a competent and responsive healthcare team in place.

Signs of Postpartum Hemorrhage

The signs and symptoms of postpartum hemorrhage can be tricky to notice, especially when you’re busy caring for a new baby. Here’s what to look for (and what your doctor should be looking for, too):

  • Uncontrolled bleeding (bleeding that soaks more than one pad every hour and is not slowing)
  • Decreased blood pressure
  • Increased heart rate
  • A decrease in the red blood cell count
  • Swelling and pain in the vagina and nearby

If you have any concerns about your bleeding, talk to your doctor immediately or head to the emergency room.

How is Postpartum Hemorrhage Diagnosed?

As mentioned earlier, there are a few different causes of PPH, so it’s important for doctors to find the exact cause in order to treat it properly. Doctors will perform a physical exam and lab tests to check:

  • Pulse and blood pressure
  • Red blood cell count
  • Clotting factors in the blood

They will also assess blood loss. Many doctors and nurses will assess blood loss by sight, but this is an outdated and inaccurate method. Believe it or not, the more effective and precise method of gauging blood loss is by gathering the sponges and pads collecting blood and weigh them on a scale.

Postpartum Hemorrhage Treatment

The main goal of treating PPH is to stop bleeding. Your healthcare practitioner may do this with:

  • Uterine massage to stimulate uterine contractions
  • Medicine, like Pitocin, to stimulate uterine contractions (some hospitals are making a Pitocin shot a new “standard” of care to prevent postpartum hemorrhaging)
  • Removing pieces of the placenta that remain in the uterus
  • Bakri balloon or a Foley catheter to put pressure on the bleeding inside the uterus.
  • In very severe cases, surgery

The secondary goal is replacing blood and fluid that was lost. They do this with:

  • IV fluids
  • oxygen
  • blood transfusion if necessary

Additionally, practitioners work to prevent PPH in a number of ways, according to a 2007 article published in American Family Physician. Here are some natural prevention techniques for PPH:

  • Getting baby latched quickly after birth, since nipple stimulation can help release oxytocin, which contracts the uterus.
  • Addressing pregnancy anemia before birth
  • Eliminating routine episiotomies
  • Uterine massage (mentioned above)

Does Postpartum Hemorrhage Go Away?

PPH is very serious and requires immediate medical attention. It will not go away or resolve on its own. But with proper treatment, you can recover quickly and completely.

When there is excessive blood loss, there is more of a chance of causing anemia. To prevent anemia, boost your iron stores with these suggestions such as eating the right kind of iron-rich foods and avoiding foods that inhibit iron absorption.

Bottom Line: You Can Never Be Too Prepared

Though statistics are on your side, it’s vital to be informed. This way, if the worst-case scenario occurs, you and your support team will know how to advocate for your health. Before delivery, ask your provider how they handle postpartum hemorrhage. Make sure that they are up to date on the most current practices, like weighing clothes soaked in blood.