Healthy women can lose a lot more than half a litre of blood in third stage
and immediately thereafter and still lactate perfectly well.  They seem to
recover more quickly in the immediate post partum period if their fluid
needs are taken care of, whether p.o. or IV.  (Profoundly anemic women are
by virtue of their anemia, more vulnerable to injury from blood loss.  It is
probably prudent to assume that most women need their blood, and to practice
in ways that allow them to keep as much as they need of it.)

If, however, the sight of lots of blood leads to irrational responses by the
birth attendants such as separating mother and baby for purposes of
'observation' or even worse, 'rest', then the BF will suffer the usual ill
effects of separation.

If the woman has been gravely shocked, and this is not something that should
be occurring at all often in developed countries, she may suffer
aftereffects of hypoxia to the brain, including the pituitary.  I have
never, ever seen a case of this in my 13 years of midwifery practice in
Norway.  I HAVE seen lots of mothers go through the stages of early
lactogenesis very rapidly because their PPH left them incapable of doing
much besides lying in bed with their babies for the first three days or so.

And while we are talking about myths and folklore (which I wasn't, til now),
we have a corollary to the supposed vulnerability to sore nipples by
redheads, which states that they are more prone to PPH.  This is so widely
known that if a woman is red-haired, it will be mentioned in report on the
labor ward and the midwife will be expected to be especially on guard about
PPH.  I have not observed it to be true  myself and I don't know where it
comes from.

Rachel Myr
Kristiansand, Norway

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