Chapter 14: The first few hours after the birth
Prevent heavy bleeding
After the birth, it is normal for a woman to bleed the same amount as a heavy
monthly bleeding. The blood should also look like monthly blood — old and
dark, or pinkish. The blood comes out in little spurts when the womb contracts,
or when the mother coughs, moves, or stands up.
Very heavy bleeding is dangerous. To check for heavy bleeding in the first few
hours after birth:
• feel the womb to see if it is contracting. Check it just after
the placenta is born. Then check it every 5 or 10 minutes
for 1 hour. For the next 1 to 2 hours, check it every
15 to 30 minutes. If the womb is hard, it is contracting
as it should. Leave it alone between checks. If it is soft,
see page 236 to learn what to do.
Feel if the womb
is getting hard.
• check the mother’s pads often for too much bleeding
—500 ml (about 2 cups) is too much.
• c heck the mother’s pulse and blood pressure every hour.
Watch for signs of shock (see page 239).
Check the mother’s genitals for tears and other problems
Use a gloved hand to gently examine the mother’s genitals for tears, blood clots,
or a hematoma (bleeding under the skin). Also check to see if the cervix has
prolapsed (dropped down to the vaginal opening).
If the mother has a tear
If you do not know how to sew a tear, if there is nowhere nearby
where she can go to have the tear sewn, or if the tear is small, it can
probably heal without sewing.
Ask her to rest in bed for 2 weeks with her legs together
most of the time. She should move her legs regularly, but she
should not climb up or down steps or steep hills. Someone else
should do the cooking and cleaning for the family. To speed
healing, she should also eat plenty of healthy food.
To learn how to sew a tear, see page 356.
If the mother has a hematoma or pain in the vagina
Sometimes a woman may have a large amount of bleeding into the skin in her
vagina, called a hematoma. The skin in this area is often swollen, dark in color,
painful, and soft. Sometimes the mother feels dizzy and weak as if she were
bleeding too much, even though the womb is hard and there is only a little
bleeding from the vagina. Pain in the vagina can be a sign that she is bleeding
into a hematoma.
A Book for Midwives (2010)