Postpartum hemorrhage is a dangerous risk for moms after delivering a baby
OB/GYN doctors and labor and delivery nurses should be alert and prepared to avoid a life-threatening complication
Postpartum hemorrhage (vaginal bleeding of the mother after giving birth that does not slow or stop) is one of the leading causes of injury and death for mothers after pregnancy. In the United States, the rate of this potentially deadly condition increased by 26% between 1994 and 2006.
This condition is dangerous because women can lose huge amounts of blood extremely quickly because of the changes to their metabolism and physiology during pregnancy.
As a Texas medical malpractice lawyer, I have investigated cases where OB/GYN doctors and labor and delivery nurses did not consider or prepare for the risk of postpartum hemorrhage, and it led to serious injury and even death for their patients.
Fortunately, there are not an abundant number of patients who have postpartum hemorrhaging at any given hospital. On the other hand, that presents a temptation for doctors and nurses to go through the motions and not actually think about the risks and prepare for them.
By being aware of the risks, signs, and symptoms, you can have informed conversations with your OB/GYN and labor and delivery nurses about postpartum hemorrhages. This will hopefully help get them to think about your unique risks as a patient.
Prenatal risk factors for postpartum hemorrhage
Experts recommend that OB/GYN doctors should think about preventing maternal hemorrhaging during prenatal visits.
Proper prenatal care includes identifying and preparing for mothers with special considerations, including placenta previa (where the placenta lies unusually low in the uterus), placenta accreta (where the placenta attaches too deeply into the wall of the uterus), and bleeding disorders.
In addition, when patients have severe anemia (low iron levels), experts recommend that OB/GYNs give oral iron and, if that is insufficient, order IV iron sucrose, which is helpful in reaching the correct blood levels of hemoglobin and hematocrit.
If your doctor mentions anything about placenta disorders or iron deficiency during your prenatal care, ask about your risk of having a bleeding problem after you delivery your child, and what can be done to minimize the danger to you.
Considerations upon hospital admission
When a mother is admitted to the hospital labor and delivery unit, the OB/GYN physician and nursing staff should immediately think about the patient’s risk for hemorrhaging after the baby is delivered. There are three tiers of risk.
You can help your OB/GYN doctor and nurses by making sure to provide complete information about your past medical history so they will be aware about all of your risk factors.
Low Risk: Patients with no previous incision of the uterus, current singleton (one baby) pregnancy, four or fewer previous vaginal births, no known bleeding disorder, and no history of having postpartum hemorrhaging.
Medium Risk: Patients who have had a prior cesarean birth or uterine surgery, current pregnancy with more than one baby (twins, triplets, etc.), more than four prior vaginal births, chorioamnionitis (an inflammation of the fetal membranes caused by a bacterial infection), previous history of postpartum hemorrhaging, or large uterine fibroids.
High Risk: Patients who have placenta previa, suspected placenta accrete or percreta, hematocrit < 30 and other risk factors, platelets less than 10,000, active bleeding (more than the expected bloody show) upon admission), and a known coagulopathy (blood disorder that reduces the ability to form clots).
Maternal bleeding after birth can be a dire emergency
In all the excitement that comes with a new baby coming into the world, the OB/GYN physician and labor and delivery nurses need to pay close attention to the mom to see if there is a bleeding problem.
The amount of blood loss is a major indicator of how serious the situation is. That means, of course, that the nurses should be measuring the volume of any bleeding. Unfortunately, this does not always happen.
The California Maternal Quality Care Collaborative shared a story about a mother who experienced bleeding after birth. This mom asked the nurses how much blood she had lost, but they could not tell her because they did not weight the blood, but rather dumped it from a bed pan into a portable toilet. Later, when this patient was alone in her room, she started bleeding again and noticed enormous clots. The nurses and doctors were unprepared, and had to rush her back to the operating room.
In addition, experts recommend the preventative measure of giving every woman in the third stage of labor oxytocin and a fundal massage (a massage of the uterus that helps reduce bleeding and cramping) for at least 15 seconds.
When a new mom has any unusual bleeding, it requires immediate attention and possibly an emergency trip to the operating room.
We are here to help
If you or someone you care for has been seriously injured because of postpartum hemorrhage or bleeding, call our 281-580-8800, for a free consultation with an experienced medical malpractice lawyer at the Houston office of Painter Law Firm.
Robert Painter is a medical malpractice lawyer at Painter Law Firm PLLC.
A physician has to supervise the care and prescriptions of nurse practitioners and physician assistants under written, signed agreements [...]read more
On 4/1/2018, the new law will end the current practice where doctors can secretly enter a DNR order against patient and family wishes [...]read more
A physician has to supervise the care and prescriptions of nurse practitioners and physician assistants under written, signed agreements
On 4/1/2018, the new law will end the current practice where doctors can secretly enter a DNR order against patient and family wishes
This article was originally published in the September/October 2017 edition of "The Houston Lawyer" magazine
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