Bleeding during labor
Signs for the midwife to check in stage 1
Some blood from the mother’s vagina is
normal. The mucus plug can be very
red and bloody looking. But blood clots,
bright red blood, or losing more than
200 milliliters (1 cup) of blood during
labor are warning signs.
Bleeding without pain (placenta previa)
If a mother is bleeding and has no pain between contractions,
she may have placenta previa, which
means the placenta is covering the cervix
(see page 112). There are usually signs of
placenta previa in late pregnancy, but
A placenta that covers
the cervix, like this,
will bleed fresh red
blood when the
sometimes the first sign is bright red
cervix opens.
bleeding (enough to soak a pad) while
the mother is in labor.
Get medical help immediately.
A woman with placenta previa can bleed to death very fast once the cervix is
open, so it is not safe to wait and see if the bleeding gets worse. Treat for shock on
the way to a medical center (see page 239).
WARNING! Never do a vaginal exam if there is
unusual bleeding. You could poke a hole in the placenta
with your finger and make the bleeding much worse.
Pain in the womb
If the mother feels pain between contractions and the womb stays hard, or she
feels unusual pain during contractions, it could mean that:
• the placenta is detached from the wall of the womb.
• the womb is torn.
• the womb is infected.
183
A Book for Midwives (2010)