This is a great question. Some bleeding during childbirth is totally normal, but too much can be life-threatening. In fact, postpartum hemorrhage –excessive bleeding during/after childbirth – is the #1 cause of maternal death during childbirth. There are several underlying causes of postpartum hemorrhage. Here are a few.
1. Genital Trauma
No one ever said pushing out a baby was easy, and sometimes tears (lacerations) happen. Vaginas are both highly sensitive and highly vascularized, so these tears can bleed like crazy. Improper repair can lead to chronic problems, such as chronic pain, painful sex (dyspareunia), and incontinence.
Old wives’ tales about women not feeling perineal pain after childbirth are generally rooted in racist & sexist stereotypes; women definitely feel pain down there, even after childbirth. The exception is if your character had an epidural, in which case she should already be numb.
2. Retained Placental Tissue
Sometimes, the afterbirth (placenta) isn’t delivered or is incompletely expelled. If your character has retained placental tissue, she’ll experience profuse and heavy vaginal bleeding, severe abdominal pain, fever, and foul-smelling discharge complete with chunks of tissue. The bleeding may last for days or even weeks after delivery if it isn’t treated. Untreated, retained placental tissue can lead to uterine scarring, infection, hemorrhagic shock, and even death.
Treatment ranges from breastfeeding (which stimulates uterine contractions) to complete removal of the uterus (hysterectomy). The longer the condition takes to be diagnosed and treated, the more likely there are to be complications.
Placenta acretta–a condition in which the placenta attaches too strongly to the muscular wall of the uterus–is a cause of retained placental tissue that may require emergent hysterectomy in order to stop the bleeding.
3. Uterine Atony
When the placenta tears itself away from the uterus, there’s bound to be some bleeding. Normally, the uterus deals with this by contracting strongly, clamping the blood vessels shut. It’s surprisingly effective. Providers can encourage this natural phenomenon with a uterine massage; literally grabbing the uterus through the abdomen and massaging until it turns into a hard knot.
Sometimes, however, the uterus does not contract as it should, and it continues to spew out blood at an alarming rate. This phenomenon is called uterine atony, and it is the most common cause of postpartum hemorrhage. It can also be fatal.
When this happens, the goal is to make the uterus contract as strongly and as quickly as possible. The great thing (for writers) about uterine atony is that there are effective treatments for the condition that don’t require complex medical equipment or knowledge. The first of these is a uterine massage – literally grabbing the uterus through the front of the abdomen and kneading it like a ball of dough. This encourages the uterus to contract into a little ball, cutting off the bleeding blood vessels. Breastfeeding also stimulates oxytocin production (the “love hormone”) that also encourages the uterus to contract.
If these steps don’t work, your character will need higher-level medical care. If uterine massage and breastfeeding fail, your character will be given a cocktail of drugs to try and make the uterus start contracting. If that fails, she’ll need an emergency hysterectomy.
A Note About Maternal Mortality
Pregnancy and childbirth are conditions that carry significant mortality rates. In 2020, the maternal mortality rate in the US was 23.8 per 100,000 live births (1). For comparison, the fatality rate of skydiving that same year was 0.39 per 100,000 (2). The mortality rate of influenza in 2018-2019 was 1.6 per 100,000 for people in their childbearing years and jumped to 22.1 per 100,000 for people over age 65 (3). In other words, a pregnant woman is about as likely to die from her pregnancy as an old person is to die of the flu.
Carrying and bearing a child changes a woman’s body forever and can literally cost her her life. No one should be forced into that situation against their will.
Works Cited
- Hoyert, Donna. “Maternal Mortality Rates in the United States, 2020.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 23 Feb. 2022, https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2020/maternal-mortality-rates-2020.htm#:~:text=In%202020%2C%20861%20women%20were,20.1%20in%202019%20(Table).
- “How Safe Is Skydiving?” United States Parachute Association, 2022, https://uspa.org/Discover/FAQs/Safety.
- Elflein, John. “Flu Mortality Rate in U.S. by Age.” Statista, 7 Oct. 2021, https://www.statista.com/statistics/1127799/influenza-us-mortality-rate-by-age-group/.