Recovering after a postpartum haemorrhage, PPH, also called heavy bleeding after birth

This leaflet explains:

• What a postpartum haemorrhage is.
• What symptoms you may experience during recovery.
• How to care for yourself at home.
• When to seek medical advice.
• What follow-up care may be offered.

What is a postpartum haemorrhage?

• A postpartum haemorrhage (PPH) means heavy bleeding after birth.
• Some bleeding after having a baby is normal, but sometimes there is more bleeding than expected.
• A PPH can happen after a vaginal birth or caesarean birth.
• Your medical team treated the bleeding and monitored you closely while you were in hospital.
• You should recover well with rest, support, and follow-up care.

Common symptoms after a PPH

After losing a large amount of blood, it is common to feel:

• Very tired.
• Weak or shaky.
• Dizzy or light-headed.
• Emotional or upset.
• Short of breath with activity.
• Pale.

You may also develop anaemia.

Anaemia happens when your body does not have enough healthy red blood cells.

These symptoms should slowly improve over time.

You may be advised to have iron tablets, an iron infusion or a blood transfusion by your medical team whilst you are in hospital or sometimes after you are discharged.

Your medical team should explain why treatment is being recommended, what the benefits and risks are, and what options are available.

This may be advised based on your blood count and your symptoms.

When should I seek urgent medical advice?

Contact emergency services (999) if you have:

• Gushing of blood from the vagina which does not stop.
• Severe abdominal pain.
• Severe dizziness with fainting.
• Chest pain.
• Severe shortness of breath.

Contact Maternity Assessment Centre if:

• Heavy bleeding (soaking standard sanitary pads every hour).
• Large blood clots (such as the size of an egg or a gold ball).
• Fever or flu-like symptoms.
• Bad-smelling vaginal discharge.

Bleeding after birth

It is normal to have vaginal bleeding after birth.

This bleeding is called lochia.

The bleeding should gradually reduce over time.

Contact Maternity Assessment Centre if:

• Your bleeding becomes very heavy.
• You pass large clots.
• Your bleeding has a bad smell, or.
• Your bleeding suddenly increases again.

Looking after yourself at home

Rest and recovery

Your body needs time to recover.

Try to:

• Rest whenever possible.
• Accept help from family and friends.
• Avoid doing too much too soon.
• Increase activity slowly.

It may take several weeks before your energy improves.

Eating and drinking

Eating well can help your body recover and replace lost iron.

Try to:

• Drink plenty of fluids.
• Eat regular meals.
• Include foods rich in iron and protein.

Foods high in iron include:

• Red meat.
• Green leafy vegetables.
• Beans and lentils.
• Eggs.
• Fortified cereals.
• Dried fruit.

Vitamin C can help your body absorb iron.

Foods rich in vitamin C include:

• Oranges.
• Strawberries.
• Tomatoes.
• Peppers.

Iron tablets and medicines

You may be given iron tablets to help treat or prevent anaemia.

Take them exactly as advised.

Iron tablets can sometimes cause:

• Constipation.
• Dark stools.
• Mild stomach upset.

Drink plenty of water and eat fibre-rich foods if constipation becomes a problem.

Avoid drinking tea when taking iron tablets (this may reduce the benefit) and try to take them with orange juice to help you absorb this as well as possible.

Speak to your GP if side effects stop you from taking the tablets.

Emotional wellbeing

A postpartum haemorrhage can be frightening.

Some women may feel:

• Shocked.
• Anxious.
• Tearful.
• Low in mood.
• Worried about future pregnancies.

These feelings are common.

Please ask for support if you are worried about how you feel. You do not need to wait until things feel very hard before asking for help.

Feeding your baby

You can usually continue breastfeeding after a postpartum haemorrhage.

You may find breastfeeding more difficult at first because of tiredness or delayed milk supply.

Please ask for support if you are worried about feeding your baby. You do not need to wait until things feel very hard before asking for help.

Support is available from:

• Midwives.
• Infant feeding teams.
• Health visitors.

Being open and honest about your care

After a PPH, you may have questions about what happened. Your midwife or doctor should explain what happened, what treatment you had, and what care you may need next.

A postpartum haemorrhage can be a recognised complication after birth, but it can still be a really worrying time for you and your family and we are sorry that this happened.

Your medical team should:

• Explain what happened.
• Answer your questions honestly.
• Say sorry for the distress this may have caused.
• Explain the treatment you received.
• Discuss your recovery and follow-up care.
• Give you the opportunity to talk about any concerns.

You can ask questions at any time. If there is anything you do not understand, please speak to your medical team.

As part of good clinical care, we also review the care provided during labour and birth to ensure that all recommended steps and communication were followed appropriately. This includes checking whether any additional discussions or support processes were needed at the time of your care.

If we find that we need to explain anything more to you, we will contact you. This may be by letter or by a follow-up conversation (this can take some months).

What happens next?

Your recovery will continue after you go home.

You may be offered:

• Follow-up appointments.
• Blood tests to check iron levels.
• Iron treatment or medicines.
• Extra support from your GP or maternity team.

Please contact your community midwife or GP if you are worried about your recovery.

Future pregnancies

You should go on to have healthy future pregnancies after a postpartum haemorrhage.

You do not have to wait until you are pregnant again to ask questions. If you are worried about a future pregnancy or birth, you can ask for an appointment to talk about it. Your community midwife can help you arrange this with the right person.

Your future maternity team can discuss planning care that is right for you in a future pregnancy.

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