Hesperian Health Guides
After the Birth
Contents
Bleeding
Watch the mother’s bleeding closely and continue to check it often. Lift off any covers and also check if blood is pooling under her bottom. There is often a small gush of blood when the placenta is born. This is OK. But any big gush or smaller but ongoing flow of blood is an emergency.
For too much bleeding:
- Birth the placenta
- Help her urinate
- Rub the womb
- Give medicines to stop bleeding
Rub the womb
Rub the woman’s womb after the birth of the placenta every 15 minutes or so, and anytime you notice bleeding. Rub hard and deep, until the womb feels like a hard, round ball in the center of the belly, below the belly button. If the womb is off to one side, the bladder is full and the woman should urinate.
If the bleeding continues, rub harder, squeezing the womb between two hands. It will hurt, but should work.
If the bleeding still does not stop, you can put one hand inside the vagina, make a fist, and then use the other hand to press the womb into your fist.
Medicines to stop severe bleeding
Most bleeding can be stopped with oxytocin or misoprostol.
- Inject 10 units oxytocin in the muscle on the side of the woman’s thigh. (For how to give injections, see Medicines, Tests, and Treatment – in development.)
OR
- Give 800 mcg misoprostol dissolved under the tongue for 30 minutes..
Heavy bleeding can also be prevented by using these medicines. For this reason, some health workers give either 600mcg of misoprostol one time only or one shot of oxytocin immediately after every birth, especially if they can easily get medicines. If you are worried about heavy bleeding and can give one of these medicines, do so.
Signs of severe blood loss
Get medical help for any of these signs and, on the way, treat for shock.
- Lightheadedness
- Weakness
- Passing out
- Confusion
- Cold, clammy skin
- Fast or rising pulse
- Low or dropping blood pressure
Check for tears
Small tears heal on their own. Long or deep tears will heal better with a few stitches. A stitch will also stop the bleeding if a blood vessel in the vagina has torn.
Gently put a clean, gloved finger into the cut to see how deep it is. If you know how to sew, use only a few stitches. For a deep tear, use a couple of dissolvable stitches in the muscle before you sew the skin together. Do not leave a pocket to collect pus. For more on sewing, see the information on stitches (sutures), but if you are not experienced at sewing, it is almost always best to let a tear heal on its own.
If the tear is all the way into the rectum, the round sphincter muscle must be sewn together before the tear is sewn. Someone experienced in this kind of suturing must sew this or the woman may never be able to hold in her feces.