Postpartum Hemorrhage After Childbirth: When Should Providers Respond?
You expected the hours after delivery to be about meeting your baby and beginning your recovery. Instead, the bleeding did not slow down. Nurses repeatedly checked your vital signs. More people entered the room. Medications were given, blood was drawn, or you were suddenly told that you needed a transfusion or another procedure.
Afterward, you may have been told that postpartum hemorrhage is a known complication of childbirth. That can be true. But it does not answer another important question: Was the bleeding recognized and treated appropriately?
Heavy bleeding after childbirth can signal postpartum hemorrhage, an obstetric emergency that requires prompt recognition and treatment.
Postpartum hemorrhage, or PPH, can occur after a vaginal delivery or cesarean section, and serious blood loss can lead to shock, organ injury, emergency surgery, blood transfusion, and other complications.
Not every postpartum hemorrhage is malpractice. The legal issue is whether the doctors, nurses, or hospital responded as reasonably competent providers would have under the circumstances and whether a departure from appropriate care caused or worsened the mother's injury.
What Can Cause Postpartum Hemorrhage?
One of the most common causes of postpartum hemorrhage is uterine atony. After the placenta separates, the uterus normally contracts, helping compress the blood vessels at the placental site. When the uterus does not contract effectively, significant bleeding can continue.
Other causes can include retained placental tissue, trauma or lacerations, placental problems, uterine rupture or inversion, and problems with blood clotting.
Providers also consider circumstances that can increase hemorrhage risk, such as prolonged labor, carrying more than one baby, an overly distended uterus, placental abnormalities, prior uterine surgery, and a history of postpartum hemorrhage.
Risk factors do not predict every hemorrhage. A patient without an obvious risk factor can still develop severe bleeding. That is why monitoring blood loss and the mother's condition after delivery matters.
What Should Happen When Heavy Bleeding Develops?
The response depends on the cause, severity of the bleeding, vital signs, laboratory findings, and how the patient responds to treatment.
Current obstetric hemorrhage guidance emphasizes assessing hemorrhage risk, measuring cumulative blood loss, having a stage-based emergency response plan, ensuring rapid access to hemorrhage medications and blood products, and escalating care when bleeding continues.
Depending on the cause and severity of the bleeding, treatment can involve uterine massage, medications to help the uterus contract or control bleeding, intravenous fluids, evaluation for retained placental tissue or trauma, blood products, procedures to control bleeding, or surgery.
The important question in a potential malpractice case is not whether every possible intervention was used. It is whether the medical team recognized what was happening and responded appropriately as the mother's condition changed.
Where Can Postpartum Hemorrhage Care Break Down?
A postpartum hemorrhage malpractice investigation often focuses on the timeline.
Medical records may show when excessive bleeding began, how blood loss was measured, what the mother's blood pressure and heart rate showed, when a physician was notified, which treatments were ordered, whether the patient responded, and when additional help or a higher level of intervention was requested.
Potential concerns can include:
- failing to recognize significant or continuing blood loss
- failing to measure or communicate cumulative blood loss appropriately
- delaying evaluation of the cause of the bleeding
- failing to respond appropriately to worsening vital signs or other evidence of instability
- unreasonable delays in administering indicated medications, blood products, or procedures
- delays in escalating to surgical or other advanced treatment when bleeding continues
- communication failures among nurses, obstetricians, anesthesiologists, the blood bank, and other members of the response team
None of these circumstances automatically proves negligence. The question is whether the care fell below the accepted standard under the circumstances and whether that departure caused additional harm.
What Injuries Can Follow a Severe Postpartum Hemorrhage?
Severe blood loss can cause consequences far beyond the delivery room.
A mother may require blood transfusions, intensive care, additional surgery, or an emergency hysterectomy when bleeding cannot otherwise be controlled. Serious hemorrhage can also result in shock, kidney or other organ injury, severe anemia, and, in rare cases, pituitary damage that can lead to Sheehan syndrome.
Postpartum hemorrhage can also be fatal.
For a family trying to understand what happened, however, the severity of the injury is only part of the legal analysis. A poor outcome does not establish malpractice by itself. The medical evidence must connect the harm to a departure from the applicable standard of care.
How Is a Postpartum Hemorrhage Malpractice Claim Evaluated in New Jersey?
A New Jersey medical malpractice claim generally requires evidence of the applicable standard of care, a departure from that standard, a causal connection between the departure and the injury, and resulting damages.
That means a meaningful review of a postpartum hemorrhage case usually requires more than the discharge summary. Relevant evidence can include labor and delivery records, nursing notes, blood loss documentation, vital signs, medication records, laboratory results, blood-bank records, operative reports, and the timing of consultations or procedures.
New Jersey also generally requires an Affidavit of Merit in a medical-malpractice action. The statute generally requires an appropriately qualified licensed professional to state that there is a reasonable probability that the care at issue fell outside acceptable professional standards. The affidavit is generally due within 60 days after a defendant files an answer, subject to a possible extension for good cause, and the person providing it must meet specific qualification requirements.
Filing deadlines also apply. Because the applicable deadline can depend on when the claim accrued, the identity of potential defendants, and other facts, families should not try to calculate the deadline from general information online.
What Should You Do if You Think Your Hemorrhage Was Mishandled?
Your medical care comes first. If you are currently experiencing heavy postpartum bleeding, dizziness, weakness, shortness of breath, fainting, or another concerning symptom after childbirth, seek immediate medical attention.
Once your immediate medical needs are addressed, keep your hospital discharge paperwork and follow-up records. Write down what you remember about when the bleeding started, what you reported, what treatment you received, and when your condition changed. Preserve patient-portal messages and other communications with your providers.
You do not need to determine yourself whether malpractice occurred. The purpose of a legal and medical review is to reconstruct the timeline and determine whether the evidence supports that conclusion.
How Andres, Berger & Tran Can Help
Andres, Berger & Tran is based in Haddonfield and handles medical malpractice and obstetrical malpractice matters throughout New Jersey. The firm also represents medical-malpractice clients in Philadelphia and other parts of southeastern Pennsylvania.
When a mother suffers serious harm from postpartum hemorrhage, the firm's role is to determine what happened, when providers recognized the emergency, how the team responded, and whether the medical evidence supports a claim.
That can include obtaining the complete medical record, reconstructing the sequence of bleeding and treatment, identifying the providers responsible for key decisions, and consulting appropriately qualified medical professionals about the standard of care and causation.
Get Answers About Heavy Bleeding After Childbirth
Postpartum hemorrhage can occur even when appropriate medical care is provided. But when serious bleeding is not recognized or treated appropriately, a family has a legitimate reason to ask whether the outcome could have been different.
When did the bleeding become significant? How was it measured? What did the mother's vital signs show? What treatments were provided and when? If her condition continued to worsen, was care escalated appropriately?
Those are the questions that help distinguish a complication that occurred despite appropriate care from a potentially actionable medical-malpractice claim.
If you suffered serious harm from postpartum hemorrhage after giving birth in New Jersey, contact Andres, Berger & Tran to schedule a free consultation.
Disclaimer: Results may vary depending on your particular facts and legal circumstances. The articles on this blog are for informational purposes only and are no substitute for legal advice or an attorney-client relationship. If you are seeking legal advice, please contact an attorney directly.