Bleeding after birth became more common and less dangerous
More women bleed heavily than twenty years ago. Fewer of them need a transfusion, and far fewer lose a uterus.
ACOG defines hemorrhage after birth as a cumulative blood loss of greater than or equal to 1,000 mL or blood loss accompanied by signs or symptoms of hypovolemia within 24 hours after the birth process.
Across an estimated 76.7 million US hospital deliveries between 2000 and 2019, 2.3 million (3.0%) involved postpartum hemorrhage. But the rate moved a great deal inside that window.
An independent dataset gives the same current figure: bleeding during or after birth was coded in 4.3% of hospital deliveries in 2018 and 2019, which is 297,005 deliveries.
Now the part that almost never gets reported alongside it. Among the women who did hemorrhage:
| What happened to them | Then | Now |
|---|---|---|
| Received a blood transfusion | 5.4% in 2000, rising to 16.7% by 2011 | 12.6% in 2019 |
| Needed a hysterectomy | 1.4% in 2000, rising to 2.4% by 2009 | 0.9% in 2019 |
Over the same twenty years, the share of deliveries to women with at least one risk factor for hemorrhage rose from 18.6% to 26.9%. So more women arrived at birth at risk, more women bled, and yet fewer of the women who bled came to serious harm.
"Do I have any risk factors for heavy bleeding, and does that change where or how I should deliver?"
"What is your plan if I bleed, and who is in the room for it?"