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Postpartum Hemorrhage: Causes and Risk Factors

Medically reviewed by Mary Rani Cadiz, MD · Obstetrics and Gynecology

Written by Lorraine Bunag, R.N. · Updated Jun 15, 2021

Postpartum Hemorrhage: Causes and Risk Factors

Postpartum hemorrhage or excessive bleeding during childbirth is a serious complication. It can happen in cesarean deliveries and even in normal vaginal deliveries. What are the causes and risk factors of postpartum hemorrhage? And is prevention possible? Find out here.

postpartum hemorrhage causes and risk factors

What Causes Postpartum Hemorrhage?

To better understand the main cause of postpartum heavy bleeding, it’s important to understand some key events during labor and delivery:

  • In labor and delivery, the uterus contracts or “squeezes” to help push the baby out.
  • After the baby is born, the uterus continuously contracts to expel the placenta.
  • Once the placenta is out, the uterine muscles should still keep on contracting.
  • These contractions help stop the bleeding by compressing the blood vessels and area where the placenta was once attached.

However, there are cases wherein the uterus doesn’t contract strongly enough to stop the bleeding. This condition is called “uterine atony’ and it’s the most common scenario with postpartum hemorrhage.

Another possible reason for excessive bleeding is when bits or pieces of the placenta remain inside the womb. A mother may also bleed heavily if she has a tear in the tissues  of her vagina, cervix, or uterus.

Now that you know about the \common causes of postpartum hemorrhage, it’s time to learn about the risk factors.

Conditions Affecting the Placenta

Aside from the retained placental tissues inside the womb, other problems related to placenta could also result to postpartum hemorrhage. 

Placental Abruption

Placental delivery usually takes place after the baby’s birth. However, there are instances when the placenta detaches before the baby is born.

This condition is called placental abruption and it’s dangerous for both mother and child. Mothers can suffer from heavy bleeding while babies may be deprived of oxygen due to lack of substantial blood flow. 

Placenta Previa

One of the postpartum hemorrhage risk factors is placenta previa.

Placenta previa happens when the placenta implants at the lowest part of the uterus, covering the cervix or lying near the cervical opening. This may cause severe bleeding when giving birth or at any time during pregnancy.

Placenta Accreta

Another condition that can result in heavy bleeding after childbirth is placenta accreta.

In this condition, the placenta attaches itself  so deeply into the wall of the uterus that it doesn’t separate. So the placenta or a part of it remains attached to the uterus.

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Conditions During the Pregnancy

Women could also suffer from heavy bleeding if they have the following conditions:

  • Multiple-baby pregnancy (twins, triplets, etc.)
  • Multiparity or when the mother has already given birth to many children
  • Overdistended uterus. This happens when the womb is larger than normal due to too much amniotic fluid or because the mom is carrying a huge baby.
  • High-blood pressure conditions during pregnancy, such as preeclampsia and eclampsia.

Conditions During Labor and Delivery

The following situations in labor and delivery could also be considered postpartum hemorrhage causes and risk factors:

  • Having a C-section. According to reports, women who gave birth via C-section may have a higher risk of suffering from heavy bleeding during childbirth as cesarean delivery is usually done in the background of an emergency situation, example is dystocia or non-reassuring fetal status .
  • Prolonged or quick labor. Being in labor for too long or having a quick labor also heightens the risk of postpartum hemorrhage.
  • Use of forceps or having vacuum-assisted delivery. The use of forceps or vacuum to help deliver the baby can result in lower genital tract tears, which could lead to heavy bleeding.
  • Receiving general anesthesia. Results of one study revealed that women who have general anesthesia are 8.5 times more at risk of suffering from postpartum hemorrhage compared to women who received epidural anesthesia. This is because general anesthetics may result to longer relaxation of the uterus. Uterine contraction is needed to decrease blood loss. Please remember that if you’re having a C-section delivery, you may receive general anesthesia depending on the situation as assessed by your anesthesiologist and obstetrician.
  • Taking certain medications. Drugs that induce labor or medications that can stop contractions can also cause heavy bleeding.

Besides the conditions and situations mentioned above, heavy bleeding is also possible for women who have blood-clotting disorders or infections.

Some reports likewise include obesity as one of the risk factors for postpartum hemorrhage.

postpartum hemorrhage causes and risk factors

How to Prevent Postpartum Hemorrhage

As of now, the most effective way to prevent postpartum heavy bleeding is an approach called AMTSL or  “active management of the third stage of labor”.

The Four Stages of Labor and Delivery

Generally, what happens in the third stage of labor is the delivery of the placenta.

The components of AMTSL are the following:

Administration of Uterotonic Agents

An example of a potent uterotonic agent is Pitocin, which is a form of oxytocin.  Uterotonic agents induce contractions to help stop bleeding.

In AMTSL, it’s common for the doctor to administer Pitocin during or soon after the delivery of the baby’s anterior shoulder.

Brandt Andrews Maneuver

To prevent postpartum hemorrhage, the doctor or midwife will most likely use the Brandt Andrews Maneuver. This is a method of extracting the placenta after the baby is born.

In this method, the healthcare provider puts controlled gentle traction on the cord using one hand, while the other hand pushes the anterior uterus backward (traction-countertraction movement).

Uterine Massage

The last component of AMTSL is performing a uterine massage after the baby is born.

Massaging the uterus will help it contract which helps stop bleeding. Furthermore, uterine massage will also help the mother expel any blood clots left inside her womb.

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Key Takeaways

Most of the postpartum bleeding hemorrhage causes and risk factors are non-modifiable. But it doesn’t mean that you cannot do anything to reduce your risk of heavy bleeding after childbirth.

Always prioritize proper care during your pregnancy. This way, if any concern arises, you’ll be able to get early treatment.

Also, talk to the doctor about your risks and work on a strategy that could reduce or eliminate them.

Finally, in the hospital during the delivery of your baby, remember to stay calm and listen to the advice of your trusted healthcare providers.

Learn more about Giving Birth here. 


Hello Health Group does not provide medical advice, diagnosis or treatment.

Medically reviewed by

Mary Rani Cadiz, MD

Obstetrics and Gynecology

Written by Lorraine Bunag, R.N. · Updated Jun 15, 2021

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