Kim Ledgerwood felt her eyelids grow heavy. “I’ll just close my eyes for a moment,” she thought. She had just given birth. What’s a tiny second? She wouldn’t miss anything. Then a sharp sting on her face brought her back to the delivery room. “You need to stay awake, Kim!” Her gynecologist spoke loudly, shaking her by the shoulders after the slap. “Stay with us!”
Ledgerwood had just given birth to a healthy baby, but was now hemorrhaging. A nurse brought her mother and sister out of the room. Her husband, Kent, stood by, staring at the pool of blood around the white sneakers of the staff trying to help her. He would later tell his wife that there was so much blood that he didn’t think it was possible for her to live.
Looking back, Ledgerwood said he didn’t know that postpartum hemorrhage (PPH)Severe bleeding after childbirth was the leading cause of pregnancy-related death worldwide.
I also didn’t know that maternal death rates, also called maternal mortality, were increasing in the United States. According to the World Health Organization, maternal death is one that occurs for a reason other than an accident or chance during pregnancy or within 42 days following the end of pregnancy.
Maternal mortality in the United States
Maternal mortality rates more than double in the decade between 2009 and 2019 in the US. They continued to rise until 2022, when rates finally refused.
Maternal mortality rates rose by nearly 40% during the pandemic. And in 2021, the Centers for Disease Control and Prevention (CDC) reported a rate of 32.9 deaths per 100,000 live birthsIn 2022, rates fell slightly to 22.3 per 100,000 births, but were still higher than all previous years.
The United States has the higher maternal mortality rates among all developed countries. “Compared to all high-income countries, the mortality rate in the U.S. was twice the average,” Nagtalon-Ramos said.
The alarming thing is that many pregnancy-related deaths, including PPH, are preventable.
Maternal mortality in people of color
The increase during the pandemic occurred across all racial and ethnic groups, but people of color have higher rates of maternal mortality compared to white people.
Research shows that Black, American Indian, and Alaska Native women are… Most likely of dying from pregnancy-related causes compared to white women. By 2022, Maternal mortality rate among black women was 49.5 deaths per 100,000 live births, which was significantly higher than the rates for all other groups.
Jamille Nagtalon-Ramos, EdD, MSN, WHNP-BC, FAANPnurse practitioner and adjunct professor of nursing at Rutgers University, said disparities such as lack of access to health care and insurance coverage are among the reasons for higher maternal mortality rates among people of color.
Postpartum hemorrhage is the leading cause of maternal mortality
Millions of women suffer from PPH. More than 1 in 10 Maternal deaths in the U.S. are caused by severe postpartum bleeding, which usually occurs immediately but can occur up to 12 weeks after the pregnancy ends.
Blood loss can cause blood pressure to drop, and when organs don’t get enough blood flow, the body can go into shock and die.
Some common causes of HPP are:
- Uterine atony: when the uterine muscles do not tighten properly after childbirth
- Deep cuts or tears in the birth canal.
- Placental disorders: conditions that affect the placenta.
- Coagulopathy: a blood clotting disorder.
A delay in treatment can lead to poor outcomes, so the sooner PPH is discovered, the better.
Treatment options for postpartum hemorrhage
The first step in stopping PPH is to find the cause of the bleeding so it can be stopped. This may require examining the uterus, pelvic tissues, vagina, and vulva for bleeding, sometimes by performing surgery that opens the abdomen (called a laparotomy).
The following methods can be used to stop bleeding:
- Removal of any placenta that is in the uterus.
- Ligation or sealing of bleeding blood vessels
- Uterine massage or medication
- Intrauterine devices such as catheter, balloon or vacuum system
- Hysterectomy (removal of the uterus)
Nagtalon-Ramos said underestimation of the amount of blood loss during delivery by health care professionals is a common reason for delays in treatment. “Incorrect estimation of blood loss by health care professionals during delivery and the immediate postpartum period is the main reason for delayed response to treatment and management,” Nagtalon-Ramos said.
Risk factors for postpartum hemorrhage
About 6 out of 10 PPH occurs in women with known risk factors. And some types of PPH can be prevented, such as bleeding resulting from uterine atony or a blood clotting disorder. Therefore, attending regular prenatal checkups, knowing the risk factors, and good communication between the health care provider and the patient can help reduce the risk of PPH.
In addition to having had a previous HPP, Risk factors For PPH the following are included:
- A history of five or more previous births
- A story of gestating several babies at the same time
- High blood pressure or preeclampsia
- Blood clotting disorders or other blood-related disorders.
- Intrahepatic cholestasis of pregnancy (ICP)
- Living with obesity
- Having an induced labor
Signs of HPP
Vaginal bleeding that does not decrease over time or heavy bleeding that soaks through a sanitary pad every hour and does not decrease in the postpartum period is a sign of PPH.
Other warning signs of HPP may include:
- Rapid heartbeat
- Wet and moist skin
- Dizziness
- Confusion
- Feeling faint or confused
- Nausea or vomiting
- Pale skin
If you think you are bleeding too much after giving birth, do not wait for your regular follow-up appointment four to six weeks after delivery. Contact your doctor or call 911 right away.
The reality of maternal mortality is frankly unacceptable. And the prognosis if you suffer from postpartum hemorrhage depends largely on your doctor and your support team. However, knowing the risk factors and signs of postpartum hemorrhage can help save your life.
This educational resource was created with the support of Organon, a member of the HealthyWomen Corporate Advisory Board.
Articles from your site
Related articles on the Web
