“Can It Happen Again?” Pregnancy and Birth After a Postpartum Haemorrhage
In this article
This article is for women thinking about, or already in, another pregnancy after a postpartum haemorrhage (PPH). It covers the chance of it happening again, what NSW guidelines say your care team should do differently, the questions to ask, how to build a birth plan that feels safe, how to manage the fear, and what the law expects about information and consent second time round.
Quick answer · updated November 2026
A previous PPH raises the chance of another, with some studies estimating up to 15%. Most women go on to have safe births. NSW guidelines say your history should shape a written plan: anaemia checks, the right hospital, a placenta scan after a caesarean, and medication after the birth to reduce bleeding. You can ask for all of it.
Planning a pregnancy after a PPH
- 1Before pregnancyRecords, debrief, iron, emotional readiness.
- 2Early pregnancyTell your team, risk assessment, blood tests.
- 3Mid to late pregnancy28-week bloods, placenta scan, written plan.
- 4The birthRight hospital, IV, medication, measured blood loss.
- 5AfterwardsWatching for bleeding, support for the fear.
At any stage: heavy bleeding in pregnancy or after birth is an emergency. Call 000 or go to your nearest emergency department. If fear is overwhelming you, PANDA (1300 726 306) can help.
I did the test in the bathroom at work, on my lunch break. Two lines. And I sat on the closed toilet lid and couldn’t breathe.
We had wanted this. We had talked about it for a year. I was the one who said I was ready. But in that moment I wasn’t thinking about a baby. I was thinking about the floor of the birth suite. About my husband’s face. About being cold all the way through and hearing someone say “two litres” like a weather report.
I rang my sister instead of my husband. She said, “That’s wonderful.” I said, “What if it happens again?” And she didn’t have an answer, because nobody had ever given me one.
When I went to my first appointment, the midwife had my new file open and asked, “Any complications last time?” I said, “I had a haemorrhage.” She wrote “PPH” and moved on to my blood type. I went home and cried in the car, because it felt like the most important thing in my life fit in three letters.
A composite story, drawn from the experiences of many families I have worked with, combined and changed so that no one can be identified. It does not describe any individual client.
If you are thinking about another baby after a haemorrhage, or you are already pregnant, the fear can be overwhelming. Some women decide not to have more children. Some do, and spend the pregnancy bracing for the birth. Some find, to their surprise, that a well-planned second birth heals something.
All of those are valid. This article is about making sure that whatever you choose, you choose it with real information, and that your care team does what it should with your history. It is part of a series that starts with “I thought I was going to die”: postpartum haemorrhage, what happened and what you can do.
Why I can write this
I have been a medical negligence lawyer since 2013 and have worked on many hundreds of claims, many involving birth. In some of the hardest cases I see, a woman’s history was known and not acted on. My doctorate studied patterns of failure in medical negligence. I am not medically qualified, and nothing here replaces advice from your own obstetrician or midwife. The clinical information comes from the NSW Health PPH guideline (GL2025_013), RANZCOG’s PPH statement and other sources linked below.
Start with your question
- “What are the chances it will happen again?” The risk
- “What should be different this time?” What your plan should include
- “Should I have a caesarean?” Choosing how to give birth
- “What if I had a caesarean last time?” The placenta scan
- “How do I cope with the fear?” Managing the fear
- “What should I take to my first appointment?” Records to bring
- “What if they ignored my history?” How the law looks at it
The chance of it happening again
Having one postpartum haemorrhage does raise the chance of another. Mater’s patient information says studies estimate a risk of up to 15% for recurrence in a later pregnancy. Put the other way round, most women who have had a PPH do not have another.
Your own risk depends on why you bled the first time and on your circumstances now. NSW Health’s guideline lists previous primary or secondary PPH as a risk factor, alongside others such as anaemia, a body mass index over 35, being 35 or older, having had many babies, a previous caesarean, and bleeding earlier in pregnancy. Some causes, like a tear, may not repeat. Others, like a placenta that grows too deeply, can become more likely after a caesarean.
RANZCOG makes an important point the other way: most PPHs happen in women with no identifiable risk factor. That is why it recommends that all women give birth in a unit with rapid access to blood and blood products, and that every birth setting has a clear plan for escalation.
If you don’t know why you bled, finding out is the first step. “Nobody ever told me why” explains the four main causes and where to look in your notes.
Definition
Recurrence risk: the chance that a condition you had before will happen again in a later pregnancy.
In plain terms: a higher chance, not a certainty. It is a reason for a careful plan, not a reason to assume the worst.
Before you get pregnant
If you have time to plan, a few things can help:
- Get your records. Your new team needs more than “PPH”. They need to know how much you lost, what caused it, what was done and whether there were complications. My guide to getting and reading your birth records explains how.
- Ask for a debrief if you haven’t had one. NSW Health says the information from a PPH should inform recommendations for future pregnancies. See how to ask for a birth debrief.
- Check your iron. Low iron stores before pregnancy make anaemia during it more likely. Your GP can check your haemoglobin and ferritin. Recovery after a PPH covers anaemia.
- Look after your mind. If you have flashbacks or panic about the birth, getting help before pregnancy can make a real difference. See PTSD after a PPH.
- Consider timing. Talk to your GP or obstetrician about how long to wait, especially if you had a caesarean or surgery.
Early pregnancy: telling your new team
NSW Health’s guideline says risk factors for PPH must be assessed throughout pregnancy, labour and the early postnatal period, and that “a clear plan” is to be developed with you. That plan should list your risk factors and how each will be reduced.
At your first appointment, say more than “I had a PPH”. If you can, say how much blood you lost, whether you needed a transfusion, surgery or intensive care, and what caused it. Ask that it be recorded as a risk factor and flagged on your file. If it helps, write it down and hand it over.
The guideline also expects women at higher risk to be cared for at a hospital with the right capability. If you are booked into a small unit, ask whether it is the right place for you, or whether you should be referred.
Mid to late pregnancy
Anaemia checks
NSW Health says haemoglobin should be offered at the first visit and at 28 weeks, and that for women at higher risk of anaemia, blood tests should include ferritin (iron stores). Repeat testing at 36 weeks is recommended where there are symptoms or risk factors. Anaemia should be treated with iron, and an iron infusion may be considered if tablets don’t work. Going into labour with good iron levels means your body copes better if you do bleed.
The placenta scan after a caesarean
If you had a caesarean, the guideline says your placental site must be confirmed by ultrasound. A previous caesarean raises the risk of the placenta lying low (praevia) or growing into the scar (placenta accreta spectrum), both of which can cause severe bleeding. RANZCOG says all women should have the location of their placenta found by ultrasound.
If there are signs the placenta is abnormally attached, the guideline expects a documented plan from a team of specialists, before labour, including where you should give birth. Pregnancy, Birth and Baby and my article on placenta praevia explain more.
Definition
Placenta accreta spectrum: a condition where the placenta grows too deeply into the wall of the uterus, sometimes into the scar from a previous caesarean, and doesn’t come away after birth.
In plain terms: it can cause very heavy bleeding, but when it is found on a scan beforehand, the birth can be planned with blood and specialists ready.
What your written plan should cover
Where
A hospital with the right level of care, rapid access to blood and an obstetrician and anaesthetist available. Know your plan if labour starts fast.
Before the birth
Iron levels checked and treated. Placenta location confirmed if you had a caesarean. A blood sample ready for cross-matching, where your team recommends it.
During labour
Whether a drip (cannula) should go in early. Who is told about your history when you arrive. How blood loss will be measured, not just estimated.
The third stage
Medication to help the uterus contract after the birth, such as oxytocin. What happens if bleeding starts, and who will be called.
Based on NSW Health GL2025_013, sections 3.1 to 3.4, and RANZCOG C-Obs 43. Your plan should be tailored to your history by your care team.
The birth
After the baby is born comes the third stage: the delivery of the placenta. NSW Health advises a preventive medication (a “uterotonic”) when risk factors are present, with oxytocin as the drug of choice: usually an injection into your thigh after a vaginal birth. RANZCOG recommends this “active management” for all women, saying it reduces PPH and the need for transfusion. If you would prefer a physiological third stage, the guideline says you must be given information about the risks in light of your history, and agree in advance when to switch to active management.
The guideline also says a drip (cannula) in labour should be considered for women with risk factors. Some women find it reassuring to know a drip is already in. Others find it brings back memories. You can talk about this beforehand.
Ask how blood loss will be measured. RANZCOG notes that judging blood loss by eye is unreliable. Weighing pads and drapes is more accurate. Knowing the number, whatever it is, can be grounding for many women.
Make sure your team knows
- How much blood you lost last time, and the cause if known
- Whether you needed a transfusion, surgery, a balloon or intensive care
- Your iron and haemoglobin results in this pregnancy
- Whether you had a caesarean, and what the placenta scan showed
- Your wishes for the third stage, and what you agreed if bleeding starts
- That you may feel frightened, and what helps you
Tip: keep a one-page summary in your hospital bag and give a copy to your partner. If staff change shifts, hand it over again.
Choosing how to give birth
Some women ask for a planned caesarean, believing it will be safer. Others want to avoid one. The answer depends on your history and is a decision for you, made with your obstetrician. A caesarean has its own risks of bleeding, and future caesareans raise the risk of placental problems. A vaginal birth may be very reasonable if your previous bleed came from a cause that is unlikely to repeat.
What matters is that you are given real information about the options and the risks for you, and that your choice is respected. NSW Health’s guideline says informed decision-making applies, and that discussions and choices must be documented. If you had a caesarean last time, pregnancy after a traumatic C-section may also help.
Managing the fear
Fear in a pregnancy after a haemorrhage is not irrational. It is your mind remembering something that really happened. For some women the fear is mild and manageable. For others it is intense and affects sleep, work and the relationship with the pregnancy itself.
Things that help:
- Information. A clear plan and a team that knows your story can lower fear more than reassurance alone.
- Continuity. Ask whether the same midwife or obstetrician can see you throughout. Many hospitals have continuity of care or specialist clinics for women after a traumatic birth.
- Psychological support. A psychologist experienced in birth trauma can help. The Gidget Foundation offers free sessions for expectant parents. PANDA’s childbirth trauma page notes that previous birth trauma is a risk factor for trauma in a later birth.
- Your partner. Your partner may be just as frightened. Include them in the plan. This article is for them.
- A visit. Some women find it helps to visit the birth suite before labour, or to plan a different room.
Records to bring to your new team
A summary sheet is useful, but your new team may want detail. If you can, request these from the hospital where you had your PPH.
| Record | Why your new team needs it |
|---|---|
| Discharge summary | A short overview of what happened and any recommendations for next time. |
| Blood loss and transfusion records | How severe the bleed was, and whether you have antibodies from transfusion that affect future blood matching. |
| Operation notes | Any surgery, sutures, balloon or embolisation, and the state of the uterus. |
| Placenta and pathology reports | Whether the placenta was complete or abnormally attached. |
| Anaesthetic records | Any problems with anaesthetic that will help plan this birth. |
| Debrief or incident notes | What the hospital said caused the PPH and what it recommended. |
After the birth
Most heavy bleeding happens in the first hours, but it can happen later. A secondary PPH can occur from 24 hours to six weeks or more after birth. Know the signs: soaking a pad in an hour or less, large clots, feeling faint, a racing heart, fever or smelly discharge. “I passed a clot the size of a golf ball” explains what to watch for.
Ask for your blood loss to be recorded and told to you. Ask for a check of your haemoglobin before you go home if you bled. And give yourself permission to feel whatever comes: relief, grief for the first birth, or both.
Our second baby was born on a Tuesday afternoon. I had a drip in. I had a folder with a one-page summary on top that my obstetrician and I wrote together, and I gave a copy to every new midwife who came on shift. My husband did too, which made them laugh, and then they read it.
After the birth, the midwife gave me the injection in my thigh and said, “That’s your oxytocin. I’m going to weigh everything.” Twenty minutes later she said, “Three hundred and fifty mils. You’re doing beautifully.” I asked her to say it again.
My husband held the baby skin to skin on his chest while they checked me, and this time he wasn’t in a corner. He was right next to me, and he was crying, but the good kind.
Afterwards, I asked the obstetrician what had been different. She said: “Your iron was good, we knew your history, and we were ready.” I thought about the three letters on my first file. And I asked for a copy of the plan, for my records, because I want my daughter to have it one day.
A composite story, drawn from the experiences of many families I have worked with, combined and changed so that no one can be identified. It does not describe any individual client.
How the law looks at it
Most pregnancies after a PPH go well, and this section is not meant to frighten you. But women do ask what the law expects of their care team second time round.
Information and consent
Under Rogers v Whitaker [1992] HCA 58, doctors must warn of material risks: risks a reasonable person in your position would want to know, or that the doctor knows or should know you would want to know. After a PPH, your risk of another, and the options for reducing it, are likely to matter to you. NSW Health’s consent manual sets out what NSW clinicians must do.
Acting on a known history
Under section 5O of the Civil Liability Act 2002 (NSW), the question is whether care was widely accepted in Australia by peers as competent professional practice. Where a guideline requires something, such as a placenta scan after a caesarean or treating anaemia, experts will ask whether it was done and, if not, why. A history that was recorded but not acted on is the kind of issue that comes up in claims.
Causation
Even if something was missed, the law asks whether it made a difference. In Tabet v Gett [2010] HCA 12 the High Court confirmed that losing only a chance of a better outcome is not enough. Experts look at whether proper care would probably have prevented or reduced the harm.
The first birth and time limits
If you have questions about your first PPH, don’t wait until after your next baby is born to ask them. In NSW, claims generally must start within three years of when they became discoverable, with a twelve-year outer limit. A second pregnancy can take up much of that time. See “Is it too late?” and medical negligence time limits in NSW.
If a haemorrhage affected your ability to have more children, or made a future pregnancy riskier, that can be part of what is considered when an injury is assessed. If you had a hysterectomy, “They had to take my uterus” is written for you.
In my practice
In second-pregnancy cases, I rarely see one big failure. I see a chain of small ones: a previous PPH written as three letters and never expanded; a ferritin result that was low and not followed up; a 28-week blood test that didn’t happen; a placenta scan not ordered after a caesarean; a new shift that didn’t know the history; blood loss estimated by eye again. Each is small. Together they can recreate the conditions for the first emergency. When those links are all in place, as they were in the second story above, the difference is striking.
Holding two truths
You can want another baby and be terrified of giving birth. You can trust your new team and still need them to prove it. You can feel the second birth healed something, and still grieve the first one.
The bigger picture
Postpartum haemorrhage remains one of the leading causes of serious harm to mothers in Australia. Safer Care Victoria’s PPH improvement work focuses on measuring blood loss, recognising risk early and escalating promptly. The World Health Organization’s 2023 roadmap on PPH puts prevention, including treating anaemia, at the centre. NSW Health’s 2025 guideline asks for written, risk-based plans made with the woman. These changes matter most for women with a history like yours.
Support
- PANDA National Helpline: 1300 726 306. For expecting and new parents.
- Gidget Foundation Australia: 1300 851 758. Free psychological sessions in pregnancy and after.
- Pregnancy, Birth and Baby: 1800 882 436. Free advice from maternal child health nurses.
- Birth Trauma Australia: peer support for women and partners.
- MensLine Australia: 1300 78 99 78. For partners, 24/7.
- Lifeline: 13 11 14, 24 hours. In an emergency, call 000.
More options are in finding support after birth trauma in Australia.
The woman in the bathroom at work kept the plan. It is in a folder with the first discharge summary, the one with three letters on it. She says she reads them together sometimes. One is what happened. The other is what she made happen next.
With care, Rosemary
Frequently asked questions
Will I have another postpartum haemorrhage?
Not necessarily. A previous PPH raises the risk, with studies estimating up to 15%, but most women do not have another. Your own risk depends on the cause.
What can be done to prevent another PPH?
Treating anaemia, birthing in the right hospital, a placenta scan after a caesarean, a drip in labour where advised, and medication after the birth to help the uterus contract.
Should I have a caesarean after a PPH?
Not automatically. Caesareans carry their own bleeding risks. Discuss the options and risks for your history with your obstetrician.
Can I have a physiological third stage after a previous PPH?
It’s your choice, but NSW guidelines say you should be told about the risks given your history and agree when to switch to active management.
What should I tell my new midwife or obstetrician?
How much blood you lost, the cause, any transfusion or surgery, and whether you had a caesarean. Bring your records if you can.
How do I cope with fear of birth after a haemorrhage?
A clear plan, continuity of care and psychological support all help. PANDA and the Gidget Foundation support expectant parents for free.
Questions about your last birth before the next one?
When you’re ready, and not before, I can help you understand what happened the first time. A free case review means I listen, read your records, and tell you honestly what I see, with no obligation.
The series: After a postpartum haemorrhage
- “I Thought I Was Going to Die”: Postpartum Haemorrhage (PPH), What Happened and What You Can Do
- “Is It Too Late?” PPH: Time Limits and What a Claim Can Cover
- “Nobody Ever Told Me Why”: Why Did I Bleed So Much?
- “Their Arm Was Inside Me and No One Explained”: What Happens During a PPH
- “I Lost Over Two Litres”: Recovery, Anaemia and Milk Supply After a PPH
- “I Passed a Clot the Size of a Golf Ball”: Secondary PPH and Retained Placenta
- “I Kept Telling Them Something Was Wrong”: When PPH Care Falls Short
- “He Was Left Holding Our Baby in the Corner”: When Your Family Saw the Haemorrhage
- “I Still Wake Up Back in That Room”: PTSD After a PPH
- “Can It Happen Again?” Pregnancy and Birth After a PPH (you are here)
- “They Had to Take My Uterus”: Emergency Hysterectomy After Birth
This series is part of my work on birth trauma and obstetric negligence.
References
- NSW Health. Postpartum Haemorrhage, Guideline GL2025_013, sections 3.1–3.4, 7.2 and Appendix 1. August 2025.
- RANZCOG. Management of Postpartum Haemorrhage (C-Obs 43).
- Mater. Postpartum haemorrhage: patient information.
- Pregnancy, Birth and Baby. Placenta accreta.
- PANDA. Childbirth trauma and recovery.
- Safer Care Victoria. Postpartum haemorrhage.
- World Health Organization. A roadmap to combat postpartum haemorrhage between 2023 and 2030.
- NSW Health. Consent to Medical and Healthcare Treatment Manual.
- Civil Liability Act 2002 (NSW), s 5O.
- Tabet v Gett [2010] HCA 12.
- Rogers v Whitaker [1992] HCA 58; (1992) 175 CLR 479.
A composite story, drawn from the experiences of many families I have worked with, combined and changed so that no one can be identified. It does not describe any individual client.
