Are postpartum haemorrhages common?

Yes, postpartum haemorrhages are more common than most families expect. And in my years on the labour ward, I have learned something steady and sobering. They can happen in quiet births. They can happen in textbook pregnancies. They can happen to women with no warning signs at all.

But here is the fuller truth. Most postpartum haemorrhages are treated quickly. Most women recover well. And good preparation saves lives.

Let’s walk through this carefully.

What Are Postpartum Haemorrhages?

Postpartum haemorrhages refer to heavy bleeding after childbirth. It is not the normal bleeding every woman has after birth. It is bleeding that exceeds what the body can safely handle.

In clinical terms, postpartum haemorrhages are diagnosed when blood loss exceeds:

Or when there are signs of instability such as a rapid pulse, low blood pressure, dizziness, pale skin, or collapse.

In practice, numbers matter less than how the woman looks and responds. I have stood beside women who lost less than a litre yet deteriorated fast. And I have cared for others who lost more but remained stable. We treat the woman, not only the measurement.

How Common Are Postpartum Haemorrhages?

Postpartum haemorrhages occur in roughly 1 to 5 in every 100 births. That means between 1 per cent and 5 per cent of deliveries. Some global data suggest higher rates in low-resource settings.

In busy maternity units, this translates to seeing it every week. Sometimes more.

But severe life-threatening haemorrhages are less common. Maternal death from postpartum haemorrhage is rare in well-equipped systems with rapid response teams. In settings without immediate access to blood transfusion or surgical care, the risk rises sharply.

In the United Kingdom, postpartum haemorrhage remains one of the leading causes of severe maternal morbidity. Globally, it remains a leading cause of maternal death.

So yes, postpartum haemorrhages are common. Catastrophic outcomes are not common in systems prepared to act fast.

Primary and Secondary Postpartum Haemorrhages

There are two types of postpartum haemorrhages. Many families are not told about the second type before discharge.

Type of Postpartum Haemorrhage When It Occurs What It Often Looks Like What Causes It
Primary postpartum haemorrhage Within 24 hours of birth Heavy bleeding soon after delivery. Soaking pads. Large clots. Rapid pulse. Uterus not contracting well. Tears. Retained placenta. Clotting issues.
Secondary postpartum haemorrhage 24 hours to 12 weeks after birth Bleeding increases again after it had slowed. Passing clots at home. Feeling weak. Retained tissue. Infection. Delayed healing.

I have seen women return to the emergency unit ten days after birth, pale and frightened, clutching a blood soaked pad. They thought the heavy flow was normal. It was not.

And this is why discharge education matters.

Why Do Postpartum Haemorrhages Happen?

In most cases, the uterus fails to contract strongly after birth. This is called uterine atony. When the placenta detaches, blood vessels are left open. The uterus must clamp down to close them.

If it remains soft, bleeding continues.

Other causes include:

We often teach junior doctors the four Ts: tone, trauma, tissue, thrombin. But at the bedside, it looks simpler. The uterus is soft. The bleeding does not slow. The pulse climbs.

Who Is at Higher Risk

Risk factors increase likelihood. But here is something families need to hear clearly. Around 40 percent of postpartum haemorrhages occur in women with no obvious risk factors.

Known risk factors include:

I always tell my patients with a prior postpartum haemorrhage this. Your risk is slightly higher next time. But with planning and preparation, outcomes are usually good.

Is Postpartum Haemorrhage the Same as Normal Postpartum Bleeding?

This is one area where families need clarity.

Normal postpartum bleeding, called lochia, changes over weeks. It starts red, becomes brown, then pale. It gradually reduces.

Postpartum haemorrhages are different. They involve:

Here is a clear comparison.

Normal Postpartum Bleeding Postpartum Haemorrhages
Gradually decreases over days Bleeding stays heavy or suddenly increases
Small clots Large clots repeatedly
Mild cramping Rapid pulse, faintness, pallor
Predictable pattern Sudden change or flooding

When I review women on the ward, I often ask them to describe what they see. Their language tells me more than any chart.

What Does It Look Like in Real Life?

A woman delivers well. Baby cries. Everyone smiles.

Then the midwife notices the pad filling faster than expected. The uterus feels soft under her hand. Blood pools beneath the woman’s hips.

The room changes. More hands arrive. Medications are drawn up. The uterus is massaged firmly. The bleeding slows.

And sometimes it does not.

In severe cases, we move fast. IV lines. Fluids. Blood transfusion. Theatre if needed. A balloon inserted into the uterus to apply pressure. In rare cases, surgery to control bleeding.

I have seen women recover fully within days. I have seen others require intensive care. Each case stays with you.

Can Postpartum Haemorrhages Be Prevented?

We cannot prevent every case. But we reduce risk by:

And strong systems matter. Clear communication. Rapid response protocols. Trained staff.

What Should You Watch For at Home?

If you are home after birth, seek urgent care if you notice:

Do not wait. Do not drive yourself if you are weak. Call emergency services.

I once reviewed a woman who delayed coming in. She thought she was overreacting. She was not.

Emotional Recovery After Postpartum Haemorrhages

Many women recover physically within weeks. But emotionally, it can take longer.

Some describe fear when they see blood again. Others replay the moment the room shifted from calm to urgent. Some feel gratitude. Some feel anger.

It is valid to talk about it. Debriefing helps. Trauma does not need to be dramatic to be real.

Is It Safe to Have Another Baby?

Yes, in most cases it is safe.

We document what happened. We plan carefully next time. We prepare medication and blood products early. We monitor closely.

I have cared for many women who had a postpartum haemorrhage in their first birth and went on to have uneventful second deliveries.

Preparation changes outcomes.

Why Honest Conversations Matter

Many online articles state the statistics. Few explain what it looks like in practice. Fewer speak about the quiet fear women carry home.

Postpartum haemorrhages are common. Severe complications are less common in well-prepared settings. Early recognition saves lives.

And the first person who often notices a change is the woman herself.

Trust your instinct. If something feels wrong, seek care.

Helpful Reading and References

Articles that appear on Ask Dr. Hilda column are based on people’s questions received over the mail, and they contain evidence-backed information and are critically reviewed by the medical professional (Dr Hilda) to ensure accuracy, reliability, and up-to-date clinical standards.

World Health Organization (WHO). WHO recommendations for the prevention and treatment of postpartum haemorrhage.
Read here: https://www.who.int/publications/i/item/9789241548502

World Health Organization (WHO). Consolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage.
Read here: https://www.who.int/publications/i/item/9789240115637

Mayo Clinic. Postpartum hemorrhage, risks and current management.
Read here: https://www.mayoclinic.org/medical-professionals/obstetrics-gynecology/news/postpartum-hemorrhage-risks-and-current-management/mac-20533920

Cleveland Clinic. Postpartum Hemorrhage (PPH): Causes, Risks & Treatment.
Read here: https://my.clevelandclinic.org/health/diseases/22228-postpartum-hemorrhage

Knight M et al. The UK Obstetric Surveillance System reports on severe maternal morbidity including postpartum haemorrhage.
(You can access the UKOSS reports via trusted academic databases and the RCOG or UKOSS official sites.)

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