Difficult Bir ths 93
If the bleeding starts after the placenta comes out:
• Ask the mother to pass urine.
• Keep the mother lying down and put the baby to her breast.
If the baby will not suckle, try rolling the mother’s nipples.
This will make the womb contract and stop bleeding.
• Firmly rub the top of her womb at the level of her navel
until the womb becomes hard. Keep
rubbing until the bleeding has stopped.
• If the womb does not become
hard after a few minutes of
rubbing, or if bleeding continues,
give medicine to stop the bleeding.
Rolling the nipples
can help the womb
contract and stop
bleeding.
Medicines to stop bleeding from the womb after the placenta is out
Medicine:
How much to give: When and how to give:
oxytocin 10. . . . . . . . . . . . . . . . . . . . . . . . . . . . Units inject. . . . . . . . . . . . . . . . . . . . . . . . . . . . in the side of the thigh muscle
You can give this dose again in 20 minutes if bleeding does not stop.
OR
ergometrine. . . . . . . . . . . . . . . . . . . . . . 0.2 mg inject. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . in the side of the thigh muscle
OR
ergometrine pills. . . . . . . . . . . . . . . . 0.2 mg give. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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 injections. Do not give ergometrine to a woman with high blood pressure.
ORmisoprostol. . . . . . . . . . . . . . . . . . . . . . . 600 mcg (micrograms). . . . . . . . . g ive by mouth, or if the woman
cannot swallow insert in rectum
If you give misoprostol by mouth, have the woman dissolve tablets against her cheek or under
her tongue and then swallow remaining parts.
If you give misoprostol in the rectum, wear a glove while inserting the pills, then throw the glove away and wash
your hands.
See page 483 for more information about medicines to stop bleeding.
If the mother continues to bleed, take her to the health
center or hospital. Send 2 family members with her to give
blood if needed. In the meantime, watch her for signs of shock.
See page 254 for signs of shock and how to treat it.
254
shock
She has been
bleeding too
long.We must
take her to
the hospital.
I’ll bring the
baby.
I’ll carry
her.
I feel
faint...
I’ll get
the
truck.
TRANSPORT!
Where Women Have No Doctor 2012