Chapter 13: The birth of the placenta – stage 3 of labor
Watch for heavy bleeding before the placenta comes
When the placenta separates from the womb, there is usually a small gush of
blood. This is normal. Even bleeding a cup or more can be OK, as long as it stops
quickly. But constant bleeding while the placenta is still inside is not normal.
Bleeding too much after birth is the main cause of death in childbirth.
There are 3 ways a woman can lose too much blood (hemorrhage)
• Fast, heavy bleeding. The mother may lose a lot of blood at once, or
blood may flow heavily for several minutes. Often, she will quickly feel faint
and weak. This is a severe emergency.
• A slow trickle. This kind of bleeding is harder to notice. But any steady
bleeding, even just a trickle, means the mother is in danger.
• Hidden bleeding. This bleeding cannot be seen because blood collects in the
womb or vagina. This bleeding is also extremely
dangerous and is easy to miss. When there is
hidden bleeding, you may not see the blood, but
the woman may feel faint and weak. Her pulse will
speed up or slow down, and if she bleeds for long,
her blood pressure will drop. Her womb may also
rise in the belly as it fills with blood.
Most bleeding after birth comes from the place where
the placenta was attached to the womb. This blood is
bright or dark, and usually thick. Usually, if the woman
is bleeding before the birth of the placenta, part of the
placenta has separated from the womb, and part of it is
still attached. The placenta holds the womb open, so it
cannot contract and stop the bleeding.
Sometimes, bleeding comes from a torn vagina, a torn cervix, or a torn womb.
Usually this bleeding comes in a constant, slow trickle. The blood is usually bright
red and thin.
Heavy bleeding, or feeling faint or dizzy after a birth, are not normal. You must
act to stop the bleeding. Usually, bleeding will stop when the placenta comes out.
If you cannot find the cause of bleeding, get medical help.
Watch for signs the placenta has separated
The placenta usually separates from the womb in the first few minutes after birth,
but it may not come out for some time. Signs that the placenta has separated from
the womb are:
• A small gush of blood comes from the vagina. A gush is a handful of blood
that comes out all at one time. It is not a trickle or a flow.
A Book for Midwives (2010)