Postpartum hemorrhage is rare in physiological birth, but it remains a concern for many planning a home birth. This free three-part guide unpacks what postpartum hemorrhage actually is (hint: it’s not just about how many ounces of blood you may lose) and how to help prevent and reduce it in a truly holistic way. It goes over nutrition, herbal support, homeopathics, birth physiology, and birth environment—so, dive in!
Contents
Postpartum Hemorrhage: Three-part Series
- Part 1: Postpartum Hemorrhage: a Holistic Take on Causes & Risks
- Part 2: How to Prevent Postpartum Hemorrhage Naturally
- Part 3: Pregnancy Lifestyle for Postpartum Hemorrhage Prevention (nutrition, herbs & mental prep)
9 Ways to Prevent Postpartum Hemorrhage Naturally
In part one, I went over what postpartum hemorrhage (PPH) is from a holistic perspective and what increases the risk. In part two, we’ll turn this knowledge around and dig much deeper to understand how natural, autonomous birth is your best bet at preventing PPH.
Let’s jump straight into it: how can you naturally support your birth physiology during labor to maximally reduce your odds of experiencing PPH?
1) Birth environment
Birth environment is extremely important. Factors like privacy, low lighting, warmth, and comfort support birth physiology.
Any potential distractions and commotion should be minimal. Everything and especially everyone who enters the birth space carries a certain energy and can have an effect on labor. No strangers or unwanted guests should enter the birth space (e.g. extra midwife, uninvited family members, etc.).
You should know and carefully pick who you want present at your birth. Experienced midwives claim that knowing the mother well is among the most important factors for preventing PPH. Instead of insisting on knowing the mother’s biochemical profile (ie. blood work and vitals), this should be about establishing an open, trusting relationship (Scott, 1998).
An intimate, dark environment supports both oxytocin and melatonin production. These hormones work together to make uterine contractions efficient while also eliciting a trans-like mental state. While oxytocin is well-known as the labor and love hormone, the role of melatonin in labor isn’t as well researched. Yet, their synergy makes complete sense.
Melatonin is the sleep and relaxation/meditation hormone. It requires darkness and calm. Melatonin syncs your circadian rhythm and prepares you for nighttime. This might also be one of the reasons why most labors spontaneously start at night, which new research also confirms. Melatonin is produced by the brain, ovaries, and placenta (Reiter et al., 2014; Olcese et al., 2013).
A recent animal study on uterine cells discovered that melatonin synergizes with oxytocin to promote uterine contractions. They concluded that their synergy in humans would promote coordinated and forceful contractions needed for childbirth (Sharkey et al., 2009).
Can you guess what blocks both oxytocin and melatonin production? Stress hormones like cortisol and adrenaline!
Stress and fear should be at a minimum. Anyone in the birth space should be careful not to instill impatience and distrust. Some midwives consider that postpartum hemorrhage often occurs after a long or complicated birth (eg. shoulder dystocia) because the mother gets stressed and starts feeling scared.
Various factors can trigger stress and disturb placental birth, including interruptions (phone ringing, bright light or loud noise), routine cervical checks, stomach/fundus assessments, clamping, cutting or pulling on the umbilical cord, and any clinical observations or “busying around” in the birth space (Saxton et al., 2016).
2) Physiological birth of the baby
This factor is key!
If you’re going to focus on just one takeaway from this whole series, it should be this one. The single most important factor in preventing PPH is doing everything you can to have a physiological, undisturbed birth.
Interventions increase the risk
Labour induction, augmentation of labor, coached pushing, a “hands-on” care provider, episiotomy, instrumental delivery, and general anesthesia all increase the risk of PPH. Labor induction often sets off a cascade of interventions, but the cascade can start with any intervention or birth disturbance (Kramer et al., 2011; Belghiti et al. 2011; Phaneuf et al. 2000; Anderson & Etches, 2007; Hassan et al., 2021; Petrocnik & Marshall, 2015).
Homebirth reduces the risk
On the other hand, all circumstances that set you up for physiological birth seem to reduce the risk. One study found that just planning a homebirth reduces the risk. In the study, women planning a home birth had lower rates of hemorrhage, even if transferred to a hospital during labor, compared to women planning a hospital birth (Nove et al., 2012).
The results are open to debate, but it could be that spending time in an undisturbed setting for as long as possible, without medical interventions, is what explains the reduced risk. It could also be that women planning a home birth are more likely to decline interventions in case of a hospital transfer.
Spontaneous pushing & a hands-off approach reduce the risk
This part goes right back to physiological birth–it’s not just about medical interventions but also about how “hands-on” your Ob or midwife might be.
In one study, the duration of the second stage of labor was shorter (5-10 min) in a spontaneous pushing (54.0%) group compared to the direct pushing group (2.0%). Only 4% of women who pushed spontaneously experienced mild postpartum hemorrhage—the remaining 96% didn’t experience hemorrhage at all. In comparison, in the directed pushing group, 20% had mild hemorrhage and a shocking 44% suffered moderate hemorrhage (Hassan et al., 2021).
According to a systematic literature review, the “hands-off” technique resulted in lower rates of postpartum hemorrhage, and it also caused less perineal trauma and reduced rates of episiotomy. (Petrocnik & Marshall, 2015).
Unfortunately, coached pushing and “hands-on” techniques that involve touching the perineal tissues are still a routine among many care providers, so choose wisely.
3) Physiological birth of the placenta
This factor is a continuation of the previous one. The physiological birth of the baby allows for a physiological birth of the placenta. The same environment and hormonal matrix contribute to both and they exist on a natural birth continuum.
First of all, no rush.
According to many experienced midwives and freebirthers, rushing the delivery of the placenta may increase the risk of hemorrhage. No studies have yet been carried out to systematically examine this. However, it makes a lot of sense from a biopsychological perspective.
Some midwives have even claimed that most postpartum hemorrhages are caused by hurrying to “deliver” the placenta. This is a very common scenario in hospitals, where physiological placental birth is rare (Scott, 1998).
Theoretically, when the placenta is rushed, hemorrhage could be a result of intervillous spaces—small blood vessels between the hair-like threads that remain after the placenta detaches—not having a chance to contract and reduce blood flow.
No rush means no prescribed timeframes.
Many hospitals have policies in place that don’t tolerate waiting over half an hour, which does not account for physiology. It’s also a source of stress and anxiety, which can inhibit the placental stage.
Stories of home births and free births help us understand that the range of physiologically normal time frames for placental birth is vast. The average is around an hour of the baby’s birth, but it may take several hours (Reed et al., 2019).
Additionally, manipulating the uterus to speed up the birth of the placenta can cause lobes to remain on the uterine wall, causing uneven contractions and requiring further interventions. Therefore, in many cases, “hands-on” care providers who routinely intervene and over-manage the placental stage can cause PPH.
So, as with the birth of the baby, a hands-off approach is the best way to go for placental birth too.
Getting up and letting gravity assist often helps bring along the placenta. The worst position is lying on the back semi-seated. In this position, the baby and uterus compress the vein carrying blood from the uterus to the heart (vena cava), increasing the chance of hemorrhage due to blocked blood flow from the uterus.
According to Michel Odent, a mother needs to feel uninhibited and nobody else should put thoughts in her head as to how and when she should birth the placenta. This helps women tune in with their intuition and instinctively find the best position that optimizes blood flow to and from the uterus, thus reducing blood loss.
“Just as during the delivery itself, in this post-delivery stage it is out of the question to recommend one good position in particular.” (Michel Odent, Birth & Breastfeeding)
Emptying the bladder may help too.
If you’ve been laboring for a while, you may forget to pee. Your bladder can become full and press on the uterus, preventing the placenta from coming out. Remember to urinate during labor and right after to support the birth of the placenta.
4) Overcoming fears
Birth depends on optimal oxytocin release and activity in the body. Fear, especially as labor progresses and deepens, can disrupt oxytocin action and may increase the risk of postpartum hemorrhage due to uterine atony (Saxton et al., 2016).
Aside from orchestrating uterine contractions, oxytocin triggers a wave of calm loving thoughts that translate to nurturing behavior.
Stress hormones like adrenaline counter the effects of oxytocin. Adrenaline is released by the “fight-or-flight” sympathetic nervous system when you’re in fear or under stress. It binds to and competes with the same receptors as oxytocin. Worst case scenario, stress hormones can completely block oxytocin.
The “fight-or-flight” response also reduces uterine contractions, which explains why birth often stalls when something stressful is happening (leaving home for the hospital, unknown people, commotion, etc.). In fact, this has been known for decades, and drugs that are used to delay preterm labor, like Terbutaline, mimic this response (Saxton et al., 2016).
When stress hormones dominate, the uterus may lose its tone and not contract efficiently enough to stop postpartum bleeding.
Fear and stress can come from the environment or from within. It’s important to work on facing and overcoming excessive fear during pregnancy. If you’re a birth worker, be very mindful of the energy you bring into the birthing space. Heal yourself first to avoid bringing your own trauma or fears into someone else’s birth.
5) Nursing and skin-to-skin time with baby
One study looked at the consequences of removing babies from their mothers after birth and discovered that women who didn’t breastfeed or have skin-to-skin contact were almost twice as likely to experience postpartum hemorrhage (PPH) (Saxton et al. 2015).
Any skin-to-skin contact and breastfeeding within 30 min of birth were associated with an almost 50% reduction in PPH rates.
The authors concluded: “…this study suggests that skin to skin contact and breastfeeding immediately after birth may be effective in reducing PPH rates for women at any level of risk of PPH.” (Saxton et al. 2015)
The combination of skin-to-skin contact and breastfeeding within 30 min of birth has been termed “Pronurturance” in the literature (Saxton et al., 2016).
A holistic mind-body approach
Immediate skin-to-skin contact with your baby at birth facilitates the activation of your “fascination attentional network.” This network is how the body/mind works when the mind has fascinated focussed attention, experienced when we create and love. I see it as the mind-body manifestation of awe. When the fascination network is active, we lose sense of time and “get lost” in our object or fascination to experience calmness and pleasure.
For the fascination network to be active and for the mother to focus on her baby, distractions need to be at a minimum. Warmth and skin-to-skin contact will help and promote oxytocin release after the baby has been born. The mother needs to feel safe and comfortable to allow her being to go into parasympathetic “rest, digest, and relax” mode (Saxton et al., 2016).
It’s only in this hormonal matrix that innate nurturing behaviors can fully emerge. This holistic mind-body approach has been termed “Pronurturance Plus” (Saxton et al., 2016).
The physiology of the placental stage and mother-baby
Mother-baby is intentionally spelled as one word because the mother and baby are—in a biological and physiological (and even probably energetic) sense—inseparable in the early postpartum.
With that in mind, let’s follow the physiology of the placental stage to understand why keeping mother-baby instinctively close and cuddled is crucial…
After the birth of the baby, the uterine contraction pattern changes, and there’s a short break. Instinctive mother-baby interactions help keep oxytocin flowing and the uterus contracting. These interactions involve smell, touch, taste, sound—all senses.
While the cord is left intact, the placenta “drains.” It transfers its blood full of iron and stem cells to the baby as the baby transitions to breathing. In turn, the placenta becomes emptier, lighter, and less bulky.
Left undisturbed, the baby will “crawl” on the mother’s abdomen, the baby’s feet stimulating her uterus to contract. That’s nature’s “fundal massage.” The baby may latch to breastfeed, but this is not essential for oxytocin release in the first moments.
Meanwhile, blood in the intervillous spaces—where the placenta was attached to the uterus and connected to the mother’s bloodstream—flows back into the uterine lining. Uterine muscle fibers retract, constricting the blood vessels supplying the placenta, This prevents blood from draining back from the placenta into the mother’s circulation.
As a result, placental veins rupture, and the villi shed off the uterine wall. A clot forms behind the placenta. At that point, the placenta is unable to remain attached and peels away – usually starting from the middle.
Oxytocin waves build up from skin-to-skin contact, breastfeeding, and feeling safe and at peace with her baby. This leads to a final urge to birth the placenta, which usually slides out easily once it has detached. Right after it comes the blood clot and some normal bleeding. Most women having a homebirth then place the placenta in a bowl and wait for the cord to be completely white before cutting it (or burning it if doing a cord burning ceremony, or leaving it as is if doing a lotus birth).
When the mother and baby are separated, all these complex physiological cues that turn on the fascination network and boost oxytocin flow are lacking. Separation can disrupt the instinctive behavior, hormones, and nerve signals that are meant to prevent excessive bleeding.
Takeaway
To sum it up, undisturbed interactions between mother and baby help reduce the chance of postpartum hemorrhage by supporting placental birth, breastfeeding, and bonding.
6) Food and fluids
During long labors (and sometimes short ones too), your body asks for nourishment. You need energy. Don’t forget to drink fluids. While you can get an electrolyte powder and dissolve it in water, many foods and herbs are naturally high in electrolytes and minerals.
Some great and refreshing options include:
- Coconut water (high in electrolytes)
- Lemonade with honey (energy and vitamin C)
- Nettle infusions (to boost energy and minerals)
- Other herbal infusions of your choice
- Fresh fruits
- Natural energy bars
- Smoothies, and
- Dates
You can even have a full meal if you feel up for it! Just be sure to fill up your cupboards ahead of time.
One interesting study showed that women who were given dates to eat during labor experienced less postpartum bleeding over women who received a Pitocin injection (Odent, 2013).
7) Herbs
General philosophy
Herbal tinctures and teas are traditionally sometimes used to prevent or reduce heavy postpartum bleeding. The exact herb choice and formulation depends on many factors, such as what plants you feel called to, what your herbalist is familiar with using, and which plants are locally available and part of your herbal folklore.
I encourage wildcrafting and the use of plants that naturally grow in your area. For example, if you live in Europe, you don’t need to buy herbs imported from China. If you live in North America, you don’t need to buy herbs that grow only in Africa… and so on.
I am also personally against routine use “to reduce risks.”
Taking anything from a risk-based perspective psychologically introduces the risk. I also think following all the steps previously outlined above is key. Herbs can’t replace undisturbed birth and mother-baby interaction. However, I do think that herbs can be great allies for supporting the physiology of labor and postpartum. They can help women ease into labor contractions, relax, re-energize, and optimize blood flow.
PPH herbs and their actions
Most herbs used for postpartum hemorrhage typically act as oxytocics (toning the uterus and stimulating contractions by supporting the production and response to oxytocin), hemostatics (constricting and reducing bleeding), and nervines (relaxing and soothing).
Usually, these actions are intermingled. One herb may have one of them dominant but will usually display a combination of the others, aside from its own unique actions.
Herbs that are traditionally used for postpartum hemorrhage include (Akins, 1994):
- Motherwort, herb (Leonurus cardiaca) – nervine oxytocic and my personal favorite, especially acts on an emotional level
- Angelica, root (Angelica archangelica) – oxytocic and adaptogen, usually taken before birthing the placenta (commonly for retained placenta)
- Witch hazel, leaf or bark (Hamamelis) – hemostatic, typically used before delivering the placenta
- Shepherd’s purse, seed, leaf, or flower (Capsella bursa-pastoris) – used only after birthing the placenta if bleeding seems heavy, not as a preventive
- Lady’s mantle, herb (Alchemilla vulgaris) – hemostatic, but with some uterine and relaxing action
- Yarrow, flower (Achillea millefolium) – hemostatic
- Agrimony, herb (Agrimonia eupatoria) – mostly hemostatic
- Hibiscus, flower and leaves (Hibiscus sabdariffa/Hibiscus rosa-sinensis) – hemostatic and hormone-balancing (Caution: reported to worsen heavy bleeding in some cases)
- Blue cohosh, root (Caulophyllum thalictroides) – oxytocic
- Bayberry, bark or root extract (Myrica cerifera) – mostly hemostatic
- Cotton root, bark (Gossypium herbaceum) – mostly oxytocic
- Pomegranate, seed extract (Punica granatum) – oxytocic and hemostatic
- Ground ivy, herb (Glechoma hederacea)– oxytocic, anecdotally may support in bringing a stubborn placenta down and encouraging the clamping down of the uterus
Dosage
The dosing recommendations vary, the effects are individual, and there is no hard-fixed rule. Have in mind that tinctures may also come in differing strengths.
The typical dosing regimen tends to start with one standard 1ml dropperfull (~20 drops) of a tincture. Larger droppers may also be 1.5 ml or ~30 drops.
Some herbalists suggest 10 drops of a predominantly oxytocic tincture and 20 drops of a hemostatic tincture, given sublingually and repeated as necessary.
For motherwort tincture, 10 drops is the typical starting dose.
Making a strong herbal infusion is also an option, although many of these herbs are bitter. I personally still like infusions and think having a strong motherwort honey infusion on hand can be helpful. I suggest using 1 big tablespoon of the dried herb per cup.
For heavy bleeding after the placenta has been birthed, dosing shepherd’s purse at 12-40 drops reportedly stops hemorrhage within 5-30 seconds (Akins, 1994)
For witch hazel, the typical tincture dosage mentioned when the placenta has not yet been birthed is 20 drops under the tongue (Akins, 1994).
Hemostatic herbs are also traditionally used to decrease the lochia in the first weeks postpartum.
8) Homeopathic remedies
Homeopathic remedies commonly used for postpartum hemorrhage include:
- Caulophyllum (blue cohosh) – weakness and uterine exhaustion, long labor, too weak to birth placenta
- Arnica – bright red clots, traumatic birth, long or rapid birth, aversion to being touched
- Aconite – high anxiety, fear of death, gushing red blood, rapid pulse
- Belladonna – heat and redness, hot red blood with clots, facial flushing, fever
- Carbo veg – passivity and slowness, slow dark bleeding, uterine atony, paleness, cold extremities
- Cimicifuga (blue cohosh) – erratic emotions, no contractions and passive, dark, coagulated blood
- Pulsatilla (pasque flower) – changeability and alteration, retained placenta or clots, hemorrhage alternates with pains, need for validation
- Bellis perennis (daisy) – stasis, soreness, weakness, atrophy, birth trauma and swelling
This list is not extensive and homeopathic remedies should always be taken to match each person’s symptoms and unique bioenergetic state. Usually, 30C or 200C potencies are used immediately after birth. Some practitioners recommend continuing with Arnica 30C every 2-3 hours over the next 24 hours.
One study randomized, double-blind, placebo-controlled study of 40 women found that Arnica montana C6 or C30 and Bellis perennis C6 or C30 reduced mild postpartum bleeding as measured by hemoglobin levels (Hb) at 48 and 72 h postpartum. Arnica was given in the first 48 hours, after which patients continued taking Bellis until the cessation of lochia (Oberbaum et al. 2005).
9) Eating the Placenta/Cord
Anecdotally, eating the placenta is said to reduce postpartum bleeding. No studies have tested this theory. Theoretically, this might make sense since the placenta is full of oxytocin and other hormones that help promote uterine contractions and reduce bleeding. Other mammals eat their placentas after giving birth, so humans seem to be an exception.
Small pieces of the placenta are usually cut, rinsed, and placed between the cheek and gums or under the tongue. This helps absorb hormones directly into the bloodstream. Some women have even reported chewing on the cord if heavier bleeding starts before the placenta has been birthed.
10) Rest and lying in
Lastly, don’t forget to eat and drink fluids after the baby is born! And, perhaps most importantly, rest and stay in bed with your baby as much as you can. Avoid getting up and walking around unless you feel completely sure and up for it. Rest, nourishment, and lying in support postpartum healing and reduce bleeding.
When to seek help
If you feel like you are unwell or like something is wrong, seek medical help. You know yourself best and you can best assess how you feel and when you might need medical assistance.
Summary
- The best way to naturally help avoid postpartum hemorrhage is to have an undisturbed physiological birth of the baby and placenta. Ensure a safe, supportive, and intimate birth environment. Bring distractions to a minimum. Get baby skin-to-skin and nursing after birth if possible.
- Make sure you’ve previously faced your fears and that nobody is bringing fear or impatience into your birth space.
- Stay nourished and hydrated. Have healthy snacks and drinks on hand.
- Some commonly used herbs for postpartum hemorrhage include motherwort, yarrow, angelica (before birthing the placenta), and shepherd’s purse (after birthing the placenta if the bleeding seems heavy).
- Homeopathic remedies for postpartum hemorrhage include Caulophyllum, Arnica, and Pulsatilla.
- Anecdotally, chewing on the placenta or cord may also stop heavy bleeding.
- Rest and stay nourished. May your postpartum goal be to stay cuddled with your baby and lay in for as long as you can to support healing and reduce excessive bleeding.
Did you experience postpartum hemorrhage? What was birthing your baby and placenta like for you? What’s your experience with PPH as a midwife, birthkeeper, herbalist, or doula? Let me know in the comments and share this post if you found it useful. <3
Read Next:
The founder of Herbal Doula.
Home-birthing mama, independent scientist, natural pharmacist, doula, birthkeeper, and holistic health and birthrights advocate. Endlessly passionate about creating and sharing empowering health information and birth support. Ana has written 150+ and edited 800+ articles, some of which reached over 1 million people
[…] >>>>> If you’re interested in blood-building herbs that help prevent anemia, be sure to read this article about ways to prevent postpartum hemorrhage naturally. […]
[…] >>>>> If you’re interested in blood-building herbs that help prevent anemia, be sure to read this article about ways to prevent postpartum hemorrhage naturally. […]