“The Pain Wouldn’t Stop Between Contractions”: When a Placental Abruption Is Missed

Birth trauma guides · 15 min read · Published 10 November 2026 · Reviewed 10 November 2026 · Next review May 2027

By Dr Rosemary Listing, PhD (Law) · Medical negligence lawyer since 2014 · Of Counsel, Peter Evans & Associates

If you had a placental abruption and you’re wondering whether it was recognised quickly enough, I want you to know that your questions are reasonable. You knew something was wrong. Wanting to understand why help came when it did is not blaming yourself, and it is not ungrateful to the people who helped you in the end.

This guide covers what an abruption is, the warning signs, why it can be missed, what should happen, what your records should show, and how the law looks at it.

Start with your question

• What is a placental abruption?
• What are the signs of placental abruption?
• Can you have an abruption without bleeding?
• How is placental abruption diagnosed?
• How does an abruption affect the baby?
• What causes placental abruption?
• Could a missed abruption be negligence?

What a placental abruption is

Pregnancy, Birth and Baby describes placental abruption as the placenta partly or completely separating from the wall of the uterus, usually suddenly. It happens in fewer than 1 in 100 pregnancies, most often late in pregnancy. It is a medical emergency, because the baby relies on the placenta for oxygen and nutrients.¹

The warning signs

Symptoms can include vaginal bleeding, tummy pain, contractions, lower back pain, reduced baby movements and dizziness. The pain is usually constant rather than coming in waves, and it may be severe, mild, or absent.¹ A Queensland ambulance guideline describes constant pain, intense sustained contractions and a uterus that feels rigid to touch.²

When there’s little or no bleeding

The amount of bleeding doesn’t reliably show how serious an abruption is, because some bleeding may be hidden behind the placenta.¹ The ambulance guideline warns about blood loss that isn’t visible, and notes that only some abruptions are likely to cause visible bleeding.² This is one of the main reasons abruptions are missed: a little spotting can be mistaken for a “show” in early labour.

Expected, worth a call, or emergency

The phone call

Many abruptions begin at home, and the first contact is often a phone call to the birth suite. Pregnancy, Birth and Baby advises contacting a midwife or doctor straight away for any bleeding or sudden tummy pain in pregnancy, and calling 000 if it is severe.¹ Advice to stay home should take account of pain that is constant, reduced movements, or any bleeding. What was said on that call is usually written in a phone log or triage note.

Questions to ask when you call or arrive

• Could this be an abruption?
• Can my baby’s heart rate be checked now?
• Can a doctor see me?
• What should make me come in, or call 000?

How it’s diagnosed

There is no single test. Abruption is suspected from symptoms and examination. An ultrasound can rule out other causes such as placenta praevia, a CTG checks the baby’s wellbeing, and blood tests check for blood loss and prepare for transfusion.¹ Our guide to placenta previa explains the other common cause of bleeding.

Treatment

Treatment depends on how unwell the mother and baby are, how far along the pregnancy is, and how much bleeding there is. A small abruption with mild symptoms may be managed with close monitoring in hospital. A large or complete separation usually means an emergency caesarean.¹

Effects on baby and mother

For the baby, complications can include brain injury from lack of oxygen, slower growth, premature birth and stillbirth. For the mother, severe blood loss can cause shock or kidney failure and may require a transfusion.¹ The ambulance guideline also lists disseminated intravascular coagulation, a serious clotting problem.² Our guides to whether HIE could have been prevented and postpartum haemorrhage cover related harm.

Risk factors

Often there is no identifiable cause. Known risk factors include high blood pressure or pre-eclampsia, infection in the uterus, a previous abruption, waters breaking before 37 weeks, a previous caesarean, twins, smoking or vaping, some drugs, older age, and injury such as a fall or car accident.¹ If you had risk factors, your care team should have been especially alert to symptoms.

Afterwards

After a birth involving an abruption, many parents want to understand what happened. You can ask for a debrief with the obstetric team, and you can request your records. Our guide to getting and reading your birth records explains how. For support, see finding support after birth trauma.

What to look for in the records

Your records are often where the story becomes clear. You have a right to access your own health information. In NSW the Health Records and Information Privacy Act 2002 covers both public and private providers, and the Information and Privacy Commission explains how to ask.³ Our step-by-step guide to getting your medical records in Australia walks you through it.

How the law looks at it

A placental abruption is not caused by negligence, and many happen suddenly despite excellent care. The legal questions are about the response: whether the signs were recognised promptly, whether monitoring and birth happened quickly enough, and whether a delay probably caused harm that could have been avoided.

A claim usually turns on three questions: whether the care fell below what peers would widely accept as competent practice (section 5O of the Civil Liability Act 2002 (NSW))⁴, whether that shortfall probably caused harm you wouldn't otherwise have had (Tabet v Gett)⁵, and, where it matters, whether you were told the material risks first (Rogers v Whitaker)⁶⁷. Our guide to how a medical negligence claim works explains each one in plain terms.

In an abruption case, the questions might be: when you called or arrived, was constant pain, bleeding or reduced movement taken seriously? Were you told to come in? Was CTG monitoring started promptly, and were abnormal traces acted on? Was the decision to deliver made in time? Were risk factors taken into account?

In plain terms, the question is whether earlier assessment and birth would probably have avoided or reduced the harm to your baby or to you.

In an emergency, consent may be brief. The focus is usually on whether you were properly assessed and advised, rather than on consent forms.

Who can claim, and when

The birthing parent can claim for their own harm. A claim can also be made for the baby, usually by a parent on the baby’s behalf. If a baby died, the family may have a claim. In NSW, time usually runs from when you knew, or ought to have known, enough to claim, not from the treatment itself, and courts can sometimes extend it, so an old injury may still count. See time limits in NSW or other states, and ask early.

More: complaint or claim? · how a claim is paid for · what a claim can cover

In my practice

In abruption files, I often find that the most important record is the shortest: a two-line phone log. It records spotting and tightenings, and advice to stay home, but not the constant pain the mother described or whether anyone asked about movements. The CTG on arrival then tells the rest of the story. Reading those two documents side by side often shows exactly where time was lost.

Both things can be true

The team who delivered your baby may have acted quickly and saved a life, and the earlier advice may still have fallen short. You can be grateful for the emergency care and still want to know about the hour before it.

The bigger picture

Placental abruption is uncommon, but it is one of the reasons maternity services emphasise taking reduced movements and bleeding seriously. Our guide to reduced foetal movements explains why. Complaints about care in NSW can go to the Health Care Complaints Commission,⁸ and you can check a practitioner on the Ahpra public register.⁹ Our guide on complaining after a traumatic birth may help.

Support

You don't have to work through this alone. These services can help:

• Lifeline, 24-hour crisis support: 13 11 14 (listed on healthdirect's helplines page)¹⁰
• Beyond Blue, anxiety and depression support: 1300 22 4636
• Medicare Mental Health, help finding mental health support: 1800 595 212
• healthdirect, 24-hour nurse advice: 1800 022 222
• Health Care Complaints Commission (NSW): 1800 043 159

A mother who said the pain wasn’t coming and going now holds the note that shows she said it. You deserve that clarity too.

With care,
Rosemary

Frequently asked questions