Childbirth involves blood loss. There’s no way around it. How much blood a woman loses is the potentially dangerous variable. Postpartum hemorrhage accounts for the majority of maternal deaths worldwide. Fortunately, in the United States where maternity care is more readily accessible, most postpartum hemorrhages are not fatal. But they do happen, regardless of where you give birth.
So what do we know about postpartum hemorrhage?
- Women with pregnancy induced hypertension
- Women who experience a prolonged second stage of labor
- Women who are induced or have their labors augmented with Pitocin
- Women whose babies are delivered via vacuum extraction
- Women with “large for gestational age” infants
The most common reason for postpartum hemorrhage is “uterine atony,” or failure of the uterus to contract in a normal fashion following delivery of the baby and/or placenta. Possible causes for uterine atony include:
- Overdistended uterus (due to multiple gestation, overly large fetus, excess amniotic fluid)
- Fatigued uterus (due to induced/augmented or prolonged labor, infection, use of uterine tocolytics—drugs used to stop labor or pre-term labor—such as magnesium or calcium channel blockers)
- Obstructed uterus (due to retained placenta, placenta accreta, or a full/swollen bladder)
(Source: eMedicine’s Pregnancy, Postpartum Hemorrhage)
I’m not a doctor, midwife, medical professional, researcher, or “expert” of any kind. But I love to learn and try to uncover the truth wherever I can find it. So, for what it’s worth, here is a compilation of what I have uncovered while digging through scholarly articles and research, looking for possible ways to naturally prevent postpartum hemorrhage. I can’t guarantee any of these things will work, but my hunch is that each of them could contribute at least a bit of prevention.
1. Minimize your risk factors
This is sort of self-evident, but I wanted to mention it anyway. Do what you can to prevent pregnancy-induced hypertension, avoid Pitocin when possible, stay upright and mobile to shorten your labor and delivery, be sure to empty your bladder frequently during labor and afterward.
2. Take measures to reduce obesity and cholesterol levels
There is some evidence that elevated cholesterol levels can interfere with the uterus’s ability to efficiently contract. Similarly, obesity may lead to poor uterine contractility:
Obese women delivering vaginally had increased risk of prolonged first stage of labour and excessive blood loss. [Uterine muscle tissue] from obese women contracted with less force and frequency and had less [calcium] flux than that from normal-weight women. (Source: Poor uterine contractility in obese women)
Both elevated cholesterol and obesity seem to negatively impact calcium signaling… which leads me to the next point…
3. Optimize low calcium levels
The uterus (like all muscles) cannot properly contract without calcium. Calcium and magnesium must remain in a delicate balance for pregnant and laboring women. Too little magnesium can lead to pre-term labor, but laboring women given large intravenous doses of magnesium for preeclampsia (or other issues) can experience excessive postpartum blood loss if they are not administered calcium to counteract the magnesium’s muscle relaxing effect (Source). The blood also cannot properly coagulate (to prevent excessive blood loss) without calcium (Source). Midwives have long utilized calcium-containing herbs such as red raspberry leaf and nettle to aid in labor progress and postpartum recovery. Many “Laboraid” (homemade electrolyte drink) recipes also contain crushed calcium tablets. It seems highly appropriate to ensure that the body has sufficient calcium while in labor and immediately afterward.
Some of the highest dietary sources of calcium are: yogurt, sesame seeds, milk, spinach (and other dark leafy greens), cheese, and blackstrap molasses (Source). Blackstrap molasses is also a great source of iron (anemia is another risk factor for postpartum hemorrhage) and other beneficial vitamins and minerals, so taking 1-2 tablespoons a day during pregnancy provides multiple benefits. Antacids are not a good source of calcium since they neutralize the stomach acid necessary for calcium absorption. Simple ways to improve calcium absorption include:
- Getting moderate physical exercise. (Source)
- Getting enough vitamin D through safe sunlight exposure or supplements. This is also important because low vitamin D levels have been linked to muscle weakness (remember the uterus is a muscle), impaired muscle performance, and increased likelihood of cesarean section (Source).
- Reducing or eliminating calcium-depleting foods from your diet: soft drinks, excess animal protein, alcohol, caffeine, and refined carbohydrates.
4. Boost vitamin K levels during the last weeks of pregnancy
Just as calcium must be present to prevent excessive blood loss, so must vitamin K. Vitamin K got its name from the German word koagulation because of its crucial role in “keeping our blood clotting ability at the exact right level” (Source). Symptoms of low vitamin K levels include anemia and hemorrhage. For this reason, many midwives recommend alfalfa (naturally high in vitamin K) supplements during the last weeks of pregnancy. They understand that boosting vitamin K levels can help prevent hemorrhage. Heightened vitamin K levels will also benefit the baby (by crossing the placenta in small amounts) and improve the vitamin K content of the mother’s colostrum, thereby naturally reducing the infant’s risk of experiencing vitamin K deficiency bleeding (Hemorrhagic Disease of the Newborn). Some excellent dietary sources of vitamin K include: kale, spinach, collard greens, and swiss chard.
5. Keep the lights low following delivery?
I’ve blogged in the past about melatonin’s role in labor progress. Research indicates that melatonin synergizes with oxytocin to produce forceful uterine contractions. Our bodies increase production of melatonin in darkness, and most humans’ melatonin levels peak in the wee hours of the morning. Daylight and artificial light reduce melatonin production. This is likely part of why most women go into labor during the night. I have previously encouraged low lighting during labor, but I never considered how low lighting may be important immediately following labor as well. It is often the case that all the lights go on as mother and newborn are examined immediately following delivery. Could that excessive lighting interfere with the uterus’s ability to contract postpartum? I really don’t know. But it couldn’t hurt to keep the lighting low until the uterus has contracted safely down and bleeding appears minimal, right?
Melatonin production will also be inhibited by cortisol—the stress hormone. Reducing stress and increasing relaxation would likely also facilitate the melatonin-oxytocin synergy. Other ways to increase melatonin production include getting sufficient sunlight during daytime hours, meditation, and calcium and magnesium may also facilitate the increase of night-time melatonin levels.
6. Consider pomegranate seed extract?
Recent research has shown promise for the use of pomegranate seed extract as a stimulant of uterine contractions. It could prove especially helpful in aiding prolonged labors and/or reducing blood loss caused by uterine atony. Dr. Sajeera Kupittayanant explains, “We added the extract to uterus tissue samples from animals and found that the muscle cells increased their activity. Our work suggests that the increase is due to a rise in calcium, which is necessary in order for any muscle to contract” (Source). Pomegranate juice has a reputation for lowering cholesterol (and we’ve already discussed how reducing elevated cholesterol levels can improve uterine function), though more research is needed to determine whether pomegranate juice or the fruit itself would have a uterine-stimulating effect similar to that produced by the seed extract.
Whether or not the juice will promote uterine contractility, drinking it during pregnancy has been shown to protect infants from brain injuries caused by low oxygen and reduced blood flow (Source). It might be beneficial (in many ways) to drink pomegranate juice during pregnancy and labor. And, while safe dosing has not been established for the use of pomegranate seed extract as a uterine stimulant, it might be something to discuss with your doctor or midwife, if you would prefer to avoid Pitocin as a preventative or treatment measure for postpartum hemorrhage.
Have you used or heard of any of these preventative measures? Any other tips you know of?
** Be sure to check out my follow-up post: Preventing postpartum hemorrhage: a follow-up. **