Postpartum hemorrhage is defined as blood loss greater than 500 mL after delivery.

Postpartum hemorrhage: a term that sounds clinical, but it’s about real moments and real care. For doulas and the families we stand with, knowing what this means in plain language can change how quickly help arrives and how supported a mom feels in a moment that’s scary and intense. Let me walk you through a clear, human-centered understanding of postpartum hemorrhage and why that 500 mL number matters.

What is postpartum hemorrhage, really?

Postpartum hemorrhage (PPH) is a situation where a mother loses a lot of blood after giving birth. In many clinical guides, the threshold used is more than 500 milliliters of blood lost after delivery. That number isn’t just a statistic—it’s a signal that the body is having trouble clamping down and keeping blood where it should be. It’s important to recognize that there are two timing patterns people talk about:

• Primary PPH: bleeding that occurs within the first 24 hours after birth.

• Secondary PPH: bleeding that starts after 24 hours but within six weeks postpartum.

The distinction helps medical teams decide how aggressively to respond and what kinds of treatments might be needed. For doulas, understanding this timing helps you stay attuned to a family’s experience in the hospital or birth center and to the signs that something isn’t right.

Why the 500 mL mark matters (without turning this into math class)

The 500 mL threshold isn’t a vague target. It’s a standard used by clinicians to flag when blood loss is exceeding what’s expected after birth. It’s not about judging a mom—it's about recognizing a potential problem early so care can happen quickly. Quick response can reduce the risk of serious complications, including shock or organ stress.

Of course, measuring blood loss isn’t always precise in the moment. There are pads, drapes, and how the delivering team counts clots. The number might feel abstract, but the principle is practical: more bleeding than usual signals a need for heightened attention and possible treatment.

Where this fits into the birth window

Postpartum care isn’t just a single moment; it’s a window. Within the first hours after birth, the body is adjusting to new rhythms—breathing, circulation, and the way the uterus contracts. If blood loss crosses that 500 mL line, the medical team may act to stop the bleeding, restore volume, and prevent complications. For families, this can mean changes in what’s happening in the room, the presence of extra team members, or a shift to more monitoring. Your calm, steady presence as a doula helps families understand what’s happening without feeling overwhelmed.

What causes PPH? The big picture plus the everyday realities

The leading cause isn’t one single villain; it’s a mix of factors that can show up in different ways. Here are a few ideas you’ll hear about in the hospital or birth center, with a practical lens for doulas:

• Uterine atony: the uterus isn’t contracting well after birth, so the bleeding continues. This is the most common cause.

• Retained placenta: small bits of the placenta stay behind and keep bleeding.

• Lacerations or tears: the birth canal can bleed if there are tears that aren’t closing on their own.

• Coagulation issues: sometimes blood doesn’t clot as it should, which makes bleeding harder to control.

Then there are situational factors—long labor, a very rapid delivery, many previous births, high blood pressure, or heavy fluid shifts—things that can ebb and flow and tip the balance toward more bleeding. For doulas, knowing that a mix of factors can contribute helps you support the family with empathy while the team gathers the right information and care.

Doulas at the bedside: how to respond with care and competence

As a doula, your role isn’t to diagnose or treat—that’s the medical team’s job. Your value lies in presence, communication, and practical support. Here are some concrete ways to respond when bleeding is in the picture:

• Stay calm and present. A composed partner or doula helps the person giving birth feel safer, which can ease anxiety and support better cooperation with medical staff.

• Communicate clearly with the medical team. If the mother feels faint, or if there’s a new symptom, relay that information promptly and succinctly (without piling on the stress for the patient).

• Help the family understand what’s happening, in plain language. You can translate medical terms into everyday words so they can participate in decisions with confidence.

• Support comfort and dignity. Keep the environment calm, offer reassurance, and help with practical needs—hydration, gentle positioning, and privacy.

• Document what’s happening for the family. Simple notes about timing, the appearance of blood, and who is present can be invaluable for memory after the moment passes.

Emotional cues without overplaying them

Birth is a roller coaster of emotions. When PPH enters the scene, fear, concern, and worry are natural. You don’t need to oversell feelings, but a few well-placed phrases can make a difference: “You’re doing great; we’re in good hands,” or “Let’s take it one step at a time.” Subtle reassurance helps families stay engaged with their care team while honoring the intensity of the moment.

What families might notice or wonder about

A lot of questions can swirl around a PPH moment. Here are some common things families might be curious about, kept simple and honest:

• Is this going to be OK? In most cases, yes, with quick action. The medical team is trained for this scenario, and the goal is to stabilize and protect health.

• Will the baby be safe? Yes. The baby’s well-being is a top priority, and teams coordinate to monitor both mom and baby.

• Will we go home soon? The timeline varies. Some moms recover quickly, others need a bit more observation. Your role is to be a steady voice through whatever comes next.

A quick starter glossary for clarity

To keep things accessible, here are a few terms you’ll hear in conversations about PPH:

• PPH (postpartum hemorrhage): significant bleeding after birth, often defined by the 500 mL threshold.

• Primary PPH: bleeding within the first 24 hours after birth.

• Secondary PPH: bleeding that occurs after 24 hours but within six weeks postpartum.

• Uterine atony: a uterus that isn’t contracting enough to clamp down on blood vessels.

• Retained placenta: pieces of placenta left inside the uterus after birth.

Bringing it back to everyday life after birth

Postpartum isn’t over once the baby arrives. For families, there’s a healing arc—physical recovery, adjustments to feeding, sleep patterns, and new routines. If a moment of heavy bleeding happens, the lessons aren’t just clinical; they include how to ask for help, how to support one another, and how to recognize when to seek help again if something doesn’t feel right. Your steady presence can anchor a family through the uncertainties.

A few practical takeaways you can carry forward

• Know the numbers, but hold them lightly. The 500 mL figure is a guideline that signals the need for attention—not a verdict on a person’s worth or strength.

• Listen for timing cues. Primary vs. secondary PPH changes how care unfolds and what support looks like.

• See the whole person. Bleeding is a medical event, but the experience around it is personal—fears, hopes, and questions all matter.

• Teamwork matters. Doulas don’t replace clinicians; we amplify safety by helping families stay informed, calm, and connected to care.

Closing thought: preparedness meets compassion

Postpartum hemorrhage isn’t a feel-good topic, and that’s exactly why it deserves clarity. When doulas carry a clear, compassionate understanding of what PPH is—and what it isn’t—we’re better at supporting families through the tough moments and the quiet moments that follow. It’s about being present, being practical, and keeping the focus on the health and dignity of both mother and baby.

If you’re building a foundation for this kind of care, think of it like this: the more you know about the why behind the numbers, the more you can be a steady, trustworthy guide in the birthing room. And that steadiness—often more than any technique—can be the difference that helps families feel seen, safe, and supported, no matter what the hours after birth bring.