"But what if I bleed too much after my home birth?"
Click above to watch the video version of this blog post! The text below was used as my notes as I recorded this video.
This is a question that many women or their partners have when interviewing midwives.
As midwives we have a lot of tools at our disposal during home birth should bleeding occur. But honestly the most important step on this journey is AVOIDING bleeding at birth by preventing it.
How do we prevent bleeding? We can prevent or lessen the likelihood of bleeding during pregnancy with nutrition!
A woman who is well nourished is less likely to bleed. And if she does bleed, she has more blood to lose and is less likely to have ill-effects or any negative effects at all from bleeding during childbirth.
We can also prevent bleeding by guarding the environment during birth to optimize all of the normal physiology that needs to occur and that we have evolved with over millennia in order for our species to survive and not bleed to death at birth every time.
If the hormonal flow of pregnancy and birth are interrupted with high stress during pregnancy, or stress during birth in the form of loud noises, bright lights, feeling unsafe, cold, or having your baby taken from you as soon as it’s born, then bleeding is more likely to occur because you will have higher levels of adrenaline in your system, which counteracts the hormones - like oxytocin - which are necessary for your uterus to do its job of clamping back down, releasing the placenta, and helping your body keep its blood after birth.
The way birth normally works, is that the baby is born, the mom is holding the baby and smelling the baby’s head and skin and kissing the baby, talking to it, and this rush of oxytocin happens for both the mama and the baby. If the baby starts nursing, there is even more oxytocin that happens. Anything that interferes with or distracts the mom from this process, even someone just talking to her and saying “Good job” can pull her out of this otherworldly symphony of hormones that is happening.
Oxytocin causes the uterus to contract and the layers of muscle there act as ligatures to stop the veins from bleeding that have been supplying the baby with blood and nourishment. This also causes the placenta to sheer off the wall of the uterus because as you can imagine if there were a thing the size of a plate attached to the wall of the uterus but then the wall of the uterus started to shrink down and contract, this thing that was attached would need to start peeling off that wall.
The placenta then sits in the lower uterus or in the yoni and can be expelled by gentle pushing effort from the mom. The uterus continues to clamp down and is able to do so because there is no longer anything in the uterus preventing it from being able to clamp down.
Different women can lose different amounts of blood during birth as “normal.” Some women who have expanded their blood volume adequately can lose up to a liter or more of blood during birth and be totally fine afterward. Other women for whatever reason are less OK with losing part of their blood volume and they may only be able to lose a cup or about a quarter of a liter at birth before they start feeling woozy, lightheaded, or even passing out/fainting.
Just to give you a frame of reference, when you donate blood, you give about half a liter of blood. Some hospitals consider a woman to have hemorrhaged if she loses about half a liter of blood during birth, even though she has expanded the actual amount of blood in her body quite a bit during pregnancy and has “extra” to lose. And most women who have a cesarean birth automatically lose about a liter of blood during that surgery.
So obviously it’s kind of relative and different for each unique woman, but if you lose too much blood for YOU during birth you will feel like absolute crap after you give birth, which I’m sure you can imagine is not the best way to start your motherhood journey.
This is why it’s really important to prevent too much blood loss after birth by lowering stress during pregnancy, encouraging super amazing nutrition during pregnancy, and then protecting the birthing space so each woman can experience the amazing flow of hormones necessary to avoid bleeding too much after birth.
If we take all the right steps but a client still bleeds too much after birth, we have some tools we can use in order to help stop the bleeding. I don’t use pharmaceuticals like synthetic oxytocin (aka Pitocin) or synthetic prostaglandins (like Cytotec or Misoprostol) at home births because there are so many other tools that have less risk, and I feel if drugs really are needed, it’s best to call 911 and for an EMT or a doctor to administer those. Usually that is not necessary though.
We have a handful of herbs that are really AMAZING for stopping bleeding after birth, including cottonroot bark, shepherd’s purse, witch hazel, yarrow, blue and black cohosh, motherwort. These herbs are in tincture form and which ones we will use depends on what is causing the bleeding.
Another big factor in making sure bleeding doesn’t become too severe is making sure the woman’s bladder is empty. This seems so simple but can be easily overlooked. A full bladder sits in front of the uterus and prevents it from being able to clamp down as it should. Emptying it can resolve this issue.
We also make sure the woman has eaten and drank recently, and give her a yummy potent postpartum tea or electrolyte drink that has plenty of sugars and salts in it in order to help fuel that muscle of the uterus if it’s tired from a long or fast labor and that is why the bleeding is happening.
Making sure the uterus isn’t filling with clots and if it is, emptying those clots out or instructing the mom on how to do so is important so the uterus can keep clamping down and getting smaller as it needs to. Also just making sure the uterus is firm regardless.
There’s also nipple stimulation to stimulate oxytocin, and putting a piece of the placenta into the mom’s cheek area so her body starts absorbing those hormones from the placenta and triggering the normal functioning of the uterus.
Finally, the power of thoughts. Telling the mom that her uterus is becoming tightly contracted and her body is keeping its blood can really help the body to snap back into normal function. Women are in such an in-between almost hypnotic state after birth that it’s very impactful to plant these types of affirmations in an emergency situation. The mom should also tell herself these affirmations, because she is the most powerful one in the room when it comes to her own body and the power of her mind.
If none of this works, and the bleeding is still too much and doesn’t wane or slow, or if the mom passes out or loses consciousness, we will call EMS and transport to the hospital. This is very very rare. Usually all of our other tricks work. So, we’re not staying home at all costs and risking anyone’s life. If there’s an emergency that we aren’t able to handle at home, we transport to the emergency facility for allopathic care.
I hope you learned a thing or two about bleeding after birth!
If you have further questions, comments, or concerns, please email me! I’d love to hear from you :)
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