Bleeding after birth
4. Give medicine to stop the bleeding.
To stop bleeding from the womb after the placenta is out
• inject 10 Units oxytocin ������������������������������������������������������in the side of the
thigh muscle
You can give this dose again in 20 minutes if bleeding does not stop.
or
• inject 0.2 mg ergometrine ������������������������������������������������in the side of the thigh muscle
or
• give 0.2 mg ergometrine pills ����������������������������������������by mouth
You can give ergometrine every 2 to 4 hours for severe bleeding, or every 6 to
12 hours for less severe bleeding, but continue to give the medicine until
bleeding has stopped and the womb is hard, usually about 48 hours.
Pills do not work as quickly as the injections.
Do not give ergometrine to a woman with high blood pressure.
or
• give 600 mcg (micrograms) misoprostol �������������by mouth OR in the rectum
The woman should dissolve tablets against her cheek or under her tongue, and
then swallow any remaining parts. If she is feeling nauseous, insert the pills into
her rectum. Wear a glove.
5. Firmly rub the womb or use 2-handed pressure (see page 237)
to stop the bleeding.
6. Go to a hospital as soon as possible. If the mother has signs of
shock, keep her head down, and her hips and
legs up (see page 239). If the mother
has lost a lot of blood, start an IV
if you can (see page 350).
If you cannot give an IV,
give rehydration drink
(see page 160) or rectal fluids
(see page 342). She is also in
great danger of getting an infection.
To prevent infection if it will take more than 1 hour to get
medical help
• give 1 g amoxicillin �����������������������������������������������������������������by mouth, 1 time only
and
• give 1 g metronidazole �������������������������������������������������������by mouth, 1 time only
You will need to give more antibiotics if the woman starts to show signs of
infection (see page 271).
231
A Book for Midwives (2010)