The three main keys to avoiding postpartum hemorrhage are good nutrition and supplements as needed, knowing the mother, and not rushing the delivery of the placenta. I always require that mothers keep a five-day diet diary. As soon as possible I recommend changes in their dietary habits if they are needed. I encourage the use of liquid chlorophyll, red raspberry and nettles. I also make a tincture of nettles, yellowdock, alfalfa and red raspberry, which I have on hand if it is needed.
The second key, knowing the mom, means making sure I have recent blood work for this pregnancy. I check hemoglobin and hematocrit and platelet count. I want to know if the mother's blood will clot properly after the placenta detaches.
As to not rushing the placenta, almost all postpartum hemorrhages are caused by being in a hurry to delivery the placenta. I believe hemorrhage is caused by the intervillous spaces not having a chance to contract and help control the flow of blood. Overmanipulation of the uterus can also cause lobes to be left on the uterine wall which result in uneven contraction of the uterus. These lobes need to be manually removed to prevent postpartum hemorrhage and infection.
Uterine atony is also a major reason for postpartum hemorrhage. It can be caused from a long labor or a precipitous labor, either of which can induce uterine fatigue and facilitate possible partial separation of the placenta. I also ascertain whether the mom has not displaced her uterus by not emptying her bladder, either shortly before pushing an/or after delivery of the baby.
-Margaret Scott, CPM in Midwifery Today Issue 49
Reprinted from Midwifery Today E-News (Vol 1 Issue 35, Aug 27, 1999)
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