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Managing Postpartum Hemorrhage: Modern and Traditional Approaches

Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality worldwide. Effective management is crucial to ensure the health and safety of the birthing person. This article discusses various methods for managing PPH, including the use of the placenta, pharmaceutical interventions, and herbal remedies, drawing insights from renowned midwifery experts Ina May Gaskin and Anne Frye.

Using Placenta to Stop Postpartum Hemorrhage

The use of the placenta to control PPH is a traditional practice that has gained attention in modern midwifery. Both Ina May Gaskin and Anne Frye advocate for this method in their respective works.

  • Ina May Gaskin discusses the use of raw placenta in her book “Ina May’s Guide to Childbirth.” She recommends placing a small piece of the raw placenta in the birthing person’s cheek to absorb oxytocin and promote uterine contractions, which can help reduce bleeding. Gaskin notes that this method has been traditionally used by midwives in emergency situations where other medical interventions may not be immediately available.
  • Anne Frye provides detailed instructions on using the placenta in “Holistic Midwifery: A Comprehensive Textbook for Midwives in Homebirth Practice, Volume II.” Frye explains that the placenta can be prepared by cutting a small piece (about the size of a postage stamp) and placing it inside the cheek or under the tongue of the birthing person. This method is recommended as a quick and natural solution to help control bleeding, especially in settings where pharmaceutical options might not be readily accessible.

Pharmaceutical Interventions

Pharmaceutical interventions are often the first line of defense in managing PPH due to their efficacy and rapid action. The most commonly used medications include Pitocin, Methergine, Misoprostol, Hemabate, and Tranexamic Acid (TXA).

  • Pitocin (Oxytocin): Oxytocin, commonly known by the brand name Pitocin, is a synthetic hormone that mimics the natural hormone oxytocin. It is administered intravenously or intramuscularly to induce strong uterine contractions and reduce bleeding. Oxytocin is typically the first choice in hospital settings due to its effectiveness and quick action.
  • Methergine (Methylergonovine): Methergine is an ergot alkaloid that causes sustained uterine contractions. It is usually given intramuscularly or orally if oxytocin alone is not sufficient. Methergine should be used with caution in individuals with hypertension or preeclampsia due to its potential to increase blood pressure.
  • Misoprostol: Misoprostol is a prostaglandin analogue that can be administered orally, sublingually, rectally, or vaginally. It is particularly useful in low-resource settings because it does not require refrigeration and can be administered without injections. Misoprostol is effective in inducing uterine contractions and controlling bleeding.
  • Hemabate (Carboprost Tromethamine): Hemabate is a synthetic prostaglandin analogue used to treat severe PPH. It is administered intramuscularly and works by inducing strong uterine contractions. Hemabate is effective but may cause side effects such as diarrhea, fever, and bronchospasm, so it should be used cautiously, especially in individuals with asthma.
  • Tranexamic Acid (TXA): Tranexamic Acid is an antifibrinolytic agent that helps reduce bleeding by preventing the breakdown of blood clots. It can be administered intravenously and is particularly useful in cases of severe hemorrhage. TXA has been shown to be effective in reducing mortality due to PPH and is recommended by the World Health Organization as part of the management protocol for PPH.

Herbal Remedies

In addition to pharmaceutical options, several herbal remedies are traditionally used to manage PPH. These remedies can be effective, particularly in settings where immediate medical intervention is not available.

  • Hemhalt Relief Tincture: This tincture is a blend of herbs known for their ability to help control bleeding and promote uterine contractions. The herbs in Hemhalt Relief include Shepherd’s Purse, Yarrow, Lady’s Mantle, and Motherwort. It can be a valuable addition to the toolkit for managing PPH.
  • Shepherd’s Purse: Shepherd’s Purse (Capsella bursa-pastoris) is an herb known for its astringent properties and ability to promote uterine contractions. It can be taken as a tincture or tea to help reduce bleeding.
  • Yarrow: Yarrow (Achillea millefolium) is another herb traditionally used to control bleeding. It can be used as a tea, tincture, or applied topically in a compress.
  • Cayenne Pepper: Cayenne pepper (Capsicum annuum) is known for its stimulating effects on the circulatory system. It can be taken internally in small doses to help control bleeding and promote clotting.

What I Carry for Managing Postpartum Hemorrhage

As a midwife, I ensure that I am well-prepared to manage postpartum hemorrhage by carrying a range of pharmaceutical and herbal remedies. These include:

  • Pharmaceuticals:
    • Pitocin (Oxytocin)
    • Methergine (Methylergonovine)
    • Misoprostol
  • Herbal Remedies:
    • Hemhalt Relief Tincture (contains Shepherd’s Purse, Yarrow, Lady’s Mantle, and Motherwort)
    • Shepherd’s Purse

These tools allow me to provide comprehensive and effective care for birthing individuals experiencing PPH.

By staying prepared and knowledgeable about both modern and traditional methods for managing postpartum hemorrhage, midwives and healthcare providers can ensure the best possible care for their clients. This preparedness can make a significant difference in outcomes, providing peace of mind and safety for birthing individuals and their families.

Disclaimer

The information provided in this article is for informational purposes only and is not intended as medical advice. While every effort has been made to ensure the accuracy of the content, it should not replace professional medical guidance. Always consult with a qualified healthcare provider before making any decisions regarding medical care or treatment. The practices discussed, including the use of placenta, pharmaceutical interventions, and herbal remedies for postpartum hemorrhage, should be supervised by a knowledgeable and licensed healthcare professional. The authors and publishers of this article are not responsible for any adverse effects or consequences resulting from the use of any suggestions, preparations, or procedures discussed herein.

References

  1. Gaskin, I. M. (2003). Ina May’s Guide to Childbirth. Bantam Books.
  2. Frye, A. (2004). Holistic Midwifery: A Comprehensive Textbook for Midwives in Homebirth Practice, Volume II: Care of the Mother and Baby from the Onset of Labor Through the First Hours After Birth. Labrys Press.
  3. American College of Obstetricians and Gynecologists. (2017). Postpartum Hemorrhage. ACOG Practice Bulletin No. 183.
  4. World Health Organization. (2012). WHO Recommendations for the Prevention and Treatment of Postpartum Haemorrhage.
  5. National Institutes of Health. (2020). Methylergonovine. MedlinePlus.
  6. Blum, J., Alfirevic, Z., Walraven, G., Weeks, A., & Winikoff, B. (2007). Treatment of postpartum hemorrhage with misoprostol. International Journal of Gynecology & Obstetrics, 99, S202-S205.
  7. Romm, A. (2010). Botanical Medicine for Women’s Health. Churchill Livingstone.
  8. Gladstar, R. (2012). Herbal Healing for Women. Simon & Schuster.
  9. Bienstock, J. L., Eke, A. C., Hueppchen, N. A., & Fox, H. E. (2017). Hacker & Moore’s Essentials of Obstetrics and Gynecology. Elsevier.
  10. Shakur, H., Roberts, I., Fawole, B., et al. (2017). Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial. The Lancet, 389(10084), 2105-2116.

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