Postpartum Problems (cont.)

Although some bleeding is normal immediately after delivery, heavy bleeding or hemorrhage occurs in just 2% of births, most often after long labors, multiple births or when the uterus has become infected.

Postpartum hemorrhage is the third most common cause of maternal death in childbirth. It usually happens because the uterus fails to properly contract after the placenta has been delivered, or because of tears in the uterus, cervix or vagina. Soon after the baby and placenta have been delivered, you will be monitored to make sure the uterus is contracting as it should. If bleeding is severe, your midwife or doctor may massage your uterus to help it contract, or you may be given a synthetic hormone called oxytocin to help stimulate contractions. He or she will likely perform a pelvic exam to find the cause of the hemorrhage, and your blood may be tested for infection and anemia. If the blood loss is excessive, a blood transfusion may be recommended.

If hemorrhage begins a week or two after delivery, it may be caused by a piece of the placenta that has remained in the uterus. If so, the tissue will be removed surgically. Once you are home, report any heavy bleeding to your doctor immediately.

Uterine Infections

Normally, the placenta separates from the uterine wall during delivery and is expelled from the vagina within 20 minutes after giving birth. If pieces of the placenta remain in the uterus (called retained placenta), it can lead to infection.

An infection of the amniotic sac (the bag of water surrounding the baby) during labor may lead to a postpartum infection of the uterus. Flu-like symptoms accompanied by a high fever; rapid heart rate; abnormally high white blood-cell count; swollen, tender uterus; and foul-smelling discharge usually indicate uterine infection. When the tissues surrounding the uterus also are infected, pain and fever can be severe. Uterine infections usually can be treated with a course of intravenous antibiotics, which are used to prevent potentially dangerous complications such as toxic shock.

Infection of C-section Incision

Follow your health-care provider's instructions about caring for your C-section incision. Consult your doctor if you see signs of infection, such as red, swollen skin or draining pus. Resist the urge to scratch. Try lotion to ease itching.

Kidney Infections

A kidney infection, which can occur if bacteria spread from the bladder, includes symptoms such as urinary frequency, a strong urge to urinate, high fever, a generally sick feeling, pain in the lower back or side, constipation and painful urination. Once a kidney infection is diagnosed, a course of antibiotics -- either intravenous or oral -- usually is prescribed. Patients are instructed to drink plenty of fluids, and are asked to give urine samples at the beginning and end of treatment to screen for any remaining bacteria.

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