“Pardon the Mess”

It’s interesting to see what the search terms people use to find your website or blog. The latest was, “does blood come out when you give birth?” Short answer: yes.

As always, this is not medical advice; and any bleeding should be discussed with a healthcare professional.

Leading up to labor, many women have a tinge of pink discharge occasionally. This is usually from the dilation or possibly effacement of the cervix. Occasionally it may be from other causes–a friend had this due to a yeast infection that irritated a spot on her cervix. She was of course concerned that she was spotting, but it ended up being not a concern. Any bright-red bleeding is a cause for concern.

When the baby is born, there will likely be some blood on the baby. If the woman has an episiotomy (a cut at the vaginal opening), then she will definitely bleed. Most women do not need an episiotomy, although some will tear. Most tears will be smaller and less damaging than an episiotomy, and most tears extending into the rectum are caused by an episiotomy. How much blood is on the baby depends on how much the woman bleeds when she gives birth.

My first birth was in the water, so the baby had his first bath at his birth, and he didn’t have any blood on him, although I did tear. My second birth was “on land” and there was minimal blood on the baby. The tears were minor “skid marks” not requiring any stitches at all.

After the baby is born, the placenta sheers away from the wall of the uterus, and the blood vessels that supplied the placenta begin to bleed (my second midwife called “the placental gush”). The uterus begins to contract, clamping down on the site where the placenta attached, minimizing the blood flow. If the uterus doesn’t contract enough, the woman may bleed too much and hemorrhage. While postpartum hemorrhage is a major cause of maternal death in the developing world, this is rarely a problem in the U.S.

Anything over 200-250 ml of blood loss (about 2 cups) is considered a maternal hemorrhage for a vaginal birth; the average blood loss for a C-section is about 500 ml. When women are pregnant, their blood volume increases by half, so a large amount of blood loss is not as traumatic as might otherwise be. Most midwives carry Pitocin to home-births, which when administered after the baby is born can stop a hemorrhage. Occasionally, a woman must transfer to the hospital for help, including potential transfusions (extremely rare). It is standard procedures in many hospitals to give a shot of Pitocin to the mom as soon as the baby’s shoulders are born, but according to the WHO guidelines for Safe Motherhood, this can increase the possibility of retained placenta, and have other adverse maternal reactions, so they do not recommend it as a matter of course.

With my first birth, I had postpartum hemorrhage, and my midwife gave me a shot of Pitocin in the thigh. I was quite weak afterwards (a few days later, I couldn’t walk more than a few blocks at a time). I’ve had problems with anemia, and try to remember to take iron fairly regularly. When I have tried to give blood, I was denied one time for low iron, and another time just barely made the cut. This latter time, I couldn’t do anything after giving blood because I was so tired. When I was pregnant with my second baby, I was more diligent to keep my iron intake up, as well as eating foods high in vitamin K (a natural blood-clotting substance). Anecdotally, I will say that these things helped me avoid excess blood loss in my second birth.

After the birth, the uterus begins shedding its very rich lining that sustained the pregnancy (this occurs regardless of whether you had a vaginal birth or a C-section). While the amount of time varies, it usually takes a couple of weeks to lose the lochia (as it is called). At first, it is red and heavy, like the blood of a period, and gradually lightens up until it is gone. Any recurrence of heavier bleeding or redder color indicate that you have probably done too much, and need to rest more.


One Response

  1. I love looking at search terms that bring people to my blogs. So interesting! (and often does provide food for thought for future posts or even ideas for new blogs…) I was interested to read your post about “the mess” since I had an article about the same subject accepted for publication in Midwifery Today (it should be out in June)!

    Molly 🙂

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