As if giving birth isn’t difficult enough, about 14 million women each year lose a significant amount of blood within 24 hours of delivery.
“Because a mother’s entire blood volume can pass through the uterus in just eight to 11 minutes at term, heavy bleeding can escalate rapidly,” Dr. Kameelah Phillips, a board-certified OB/GYN and founder of Calla Women’s Health on the Upper East Side, told The Post.
“Without prompt treatment, PPH can lead to severe complications.”
Postpartum hemorrhage is the leading cause of maternal death worldwide, accounting for about 70,000 deaths annually.
It’s more common than it used to be, increasing from 2.7% of births in 2000 to 4.3% in 2019. Hailey Bieber, 28, recently recalled her “scary” experience with PPH after giving birth last year.
Phillips warns of two complications during childbirth that can lead to PPH — and highlights an innovative treatment method.
Inside PPH
A woman’s uterus is the supportive home for her growing fetus — and when it’s time to evict the little one, the uterus contracts forcefully during labor to make it happen.
The uterus continues to contract after delivery to expel the placenta — which provided nutrients and oxygen to the baby — and to clamp off the blood vessels that supplied the placenta.
That’s supposed to minimize bleeding — but if the contractions aren’t strong enough, PPH can occur.
Some bleeding is normal. PPH is generally defined as blood loss over 500 milliliters (mL) following vaginal birth and over 1,000 mL after a cesarean section.
PPH risk factors include being black, over 30 and obese and having anemia, high blood pressure, a prior cesarean delivery, placental abnormalities and unusually long labor.
“Recognizing early warning signs early is critical,” Phillips said. “Your healthcare team will be looking for heavy or uncontrolled bleeding, large blood clots or a drop in your blood pressure.”
Understanding the four Ts
Healthcare providers have a mnemonic for the four main causes of PPH, known as the four Ts, which stand for tone, trauma, tissue and thrombin.
Tone refers to uterine atony, the most common cause of PPH, responsible for roughly 70% of cases. It occurs when the uterine muscles don’t contract properly after childbirth.
Trauma to the birth canal, such as lacerations or a ruptured uterus, accounts for about 15% to 20% of cases.
Tissue, including fragments of the placenta or blood clots that remain in the uterus and prevent it from contracting adequately, has been linked to 10% of cases.
And finally, thrombin is needed for normal blood clotting. Very few PPH cases are due to clotting disorders.
Shoulder dystocia
Shoulder dystocia falls into the “trauma” category because it often requires forceful maneuvers.
“This is when, after the baby’s head is delivered, one or both shoulders get stuck behind the mother’s pubic bone, making it difficult for the rest of the body to come out,” Phillips said.
“This can happen [with] larger babies, mothers with diabetes or a history of shoulder dystocia,” she added. “It can also happen spontaneously [in] women with no risk factors.”
Though shoulder dystocia can occur without warning, there is a crucial visual clue that doctors look for.
The “turtle sign” is a rare yet urgent indicator signaling an emergency.
“This is when the head retracts back against the perineum after the head is delivered, much like a turtle pulling into its shell,” Phillips explained.
Retained placenta
If a placenta is not delivered within 30 minutes of the baby’s birth, it is considered a retained placenta.
A retained placenta — or even just some of its remaining tissue — can prevent the uterus from contracting effectively and can lead to serious infection.
“Before leaving the hospital, you will be advised to look out for heavy vaginal bleeding, foul-smelling discharge, fever or chills,” Phillips said about infection clues. “Other important signs include severe cramping or pain in the lower abdomen.”
Introducing the JADA System
PPH treatment focuses on stopping the bleeding, with methods like uterine massage to stimulate contractions, medications to help contract the uterus or balloon devices that apply pressure to the uterine walls.
In severe cases, the mother may need a blood transfusion, surgery to extract retained placental tissue or a hysterectomy to remove the uterus altogether.
One tool that has seen widespread adoption in recent years is the JADA System. The US Food and Drug Administration first cleared it in 2020.
“The JADA System works by using low-level vacuum to encourage the uterus to contract as it naturally should after birth,” Phillips said.
“In a clinical study, the median time to control bleeding was just about three minutes, and about 94% of participants experienced successful treatment.”
Hailey Bieber revealed that a JADA device helped stop her “really bad” bleeding after giving birth to son Jack Blues Bieber in August 2024.
She told Vogue in May that the treatment lasted hours.
“I wanted to hold my baby. I wanted to be with him,” she remembered of that tense time.
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