The normal way the third stage unfolds
One of the most special moments as birth unfolds is that your body releases the highest amount of oxytocin when you see your baby for the first time. Oxytocin is the hormone that crosses the blood brain barrier bringing on strong labor contractions along with feelings of love and pain relief. When birth is undisturbed it allows the process of oxytocin and other important hormones to flow uninterrupted. As we uncover the truth about bleeding in the immediate postpartum, we will see how these moments hold much detail about the sacred and the science that birth entails.
Physiologically our bodies prevent bleeding. When we take a closer look at this special moment during birth we begin to see what this release of oxytocin does for mothers and why we should honor the time between the birth of the baby and that of the placenta. It is best said by Robin Lim “Until the placenta is out and the mother is stable, the birth is still in process and the sacred protective energy must not be disturbed”.
This is true because when your baby is born your placenta is released from the uterine wall. That release of oxytocin causes your uterus to continue contracting, shrinking muscle fibers and slowing down any bleeding. It is also important to remember limited interruptions support this hormonal flow for the physiological third stage to take place and for the mother who returning from the journey of birth to find her baby.
Preventing postpartum hemorrhage
The prevention of postpartum hemorrhage begins during pregnancy where we can focus on the mother as whole. Nourishment through nutrient dense foods, consumption of enough calories and protein for a plentiful blood supply, building her a strong support system, holding space for her emotional needs, and tending to the spiritual. It is also crucial during this time to facilitate a deep connection with the mother as not feeling loved by her support team can make her more vulnerable to bleeding after birth. In labor we should feed and hydrate mothers, limit exhaustion by encouraging rest, allow the passive descent of the baby to protect the mother from exhaustion during pushing, ensure the environment is warm, and support the hormonal process through limited disruptions.
Why women bleed after birth
Unfortunately there are many cultural practices we see that contribute to bleeding after birth. The separation of the mother and baby as a norm contributes to postpartum hemorrhage for many reasons. Separating a baby from a mother takes the mother out of the birthing mindset disrupting the hormonal flow and prevents the first moments of breastfeeding which encourage the release of oxytocin. More practices include the immediate clamping and cutting of the cord, not honoring the continuum of birth until the birth of the placenta, pushing when dilation is complete instead of waiting for the physiological urge to push, fundal massage before the birth of the placenta, and active management of the placenta birth. “This is how one can explain that most postpartum hemorrhages, and therefore many maternal deaths, have been for thousands of years the consequences of inappropriate cultural interferences. This is also how one can explain that in ethnic groups where the rituals are particularly invasive, there are still today skyrocketing rates of maternal deaths related to postpartum bleeding.” Michael Odent, MD
Postpartum hemorrhage occurs in about 5% of all deliveries. Women may bleed after birth for various reasons with retained placenta, lacerations in the birth canal, uterine atony, prolonged labor, and overstimulation of the uterus being the most common causes. There are also some prenatal conditions that can increase the likelihood of a woman being more susceptible to postpartum hemorrhage, although it is difficult to predict who may actually bleed after birth. With this it is important each woman is treated individually, including the way that any bleeding after birth is handled.
But what happens if I bleed too much after my home birth?
Traditional birth attendants work to keep a mother connected and focused on her new baby during any undesirable bleeding after birth. Turning our attention to potential causes of bleeding, we may ensure the mother’s bladder is empty and while staying grounded ourselves to explore other sources. With uterine atony being the most common reason for postpartum hemorrhage, applying pressure to the fundus to help the uterus contract can be a great way to slow down bleeding. If the placenta has yet to be born, it is best to avoid any kind of uterine massage. In this case certain herbal remedies may encourage bleeding to slow down and help facilitate the birth of the placenta while continuing to be mindful of this sacred process. Many times herbal tinctures will be given alongside other methods of controlling bleeding. Another common remedy is to give the mother a piece of the placenta to chew and swallow as it is known to help stop bleeding as well. There can also be clots that need attention. If retained placenta is the issue they can be removed manually or means for transport. With these approaches there are certain medications such as Pitocin (synthetic oxytocin) for example that can be administered if they are carried by your birth attendant.
If the bleeding persists it may become time to transport to the nearest hospital, and if at any point there were signs or symptoms of shock your birth attendant would call for additional help. Paying attention to how the mother is feeling is just as important to estimating blood loss. Birth attendants can also monitor the mother’s blood pressure and pulse which change rapidly when a woman is experiencing a hemorrhage. When transport is taking place the birth attendant may place an IV for fluids if available and continue to help the mother stay connected to her baby. It is also important to know there may be times when a laceration or tear may contribute to bleeding after birth. Even a light trickle of blood over time can suddenly become too much for a mother. In this case sutures and herbal remedies may be considered.
When considering birthing at home and the risk of postpartum hemorrhage
According to an article written by BMC Pregnancy and Childbirth, the odds of postpartum hemorrhage are significantly higher if a hospital birth is intended than if a home birth is intended. This raises questions about the mother’s wellbeing when considering the safety of hospital birth. Research in the UK and Canada have identified a lower risk of postpartum hemorrhage for families choosing home birth while Australia found no significant difference. It also points out how rare the complication of postpartum hemorrhage is while not losing sight of the severity when it does occur.
We can imagine why this may be the case when we look back at the causes of bleeding after birth. Specifically at the cultural practices that have become the norm. Rituals that consist of labor augmentation, episiotomy, cesarean sections and other reasons listed above. All of which are rituals in the hospital setting and while this study excludes cesarean births the chance of postpartum hemorrhage is 2.5 times more likely for families choosing hospital birth compared to planned home births.
In summary
There is much to uncover about bleeding after birth. While there may be clear answers to why a woman bled after birth, there is also so much occurring in the emotional and spiritual realm that could have attributed to this undesirable outcome. There is a holistic way to approach preventing postpartum hemorrhage during pregnancy and through honoring the physiological birth process. We can see it is not common for someone to experience postpartum hemorrhage, but the risks can be severe. The proper handling of this rare complication with a knowledgeable birth attendant can help a woman continue on the path of a smooth healing and recovery after birth. For women who do experience postpartum hemorrhage there should be extra tender love and care for her journey to replenish her as a whole.