What would it take to stop women from bleeding to death after childbirth?
What would it take to stop women from bleeding to death after childbirth?
What would it take to stop - Dr. Olufemi Oladapo still recalls the moment he couldn’t save a young mother in Nigeria years ago. “I was running around hospitals trying to get blood. By the time I got back, she was gone,” he said, reflecting on the tragic event that left him questioning how such a preventable loss could occur. That mother, who had waited six years to conceive, died from postpartum hemorrhage — a condition that claims over 43,000 lives annually worldwide. Despite being the most common cause of maternal mortality, this preventable crisis remains underaddressed in many regions.
A Global Call for Action
Today, Dr. Oladapo, now a WHO expert in reproductive health, co-authored a groundbreaking three-part series in the Lancet that outlines the magnitude of the problem and offers solutions. The research, spanning Nigeria, Kenya, Tanzania, and South Africa, involved more than 200,000 women and revealed critical gaps in how postpartum hemorrhage is managed. “This is a comprehensive compilation of all the evidence,” said Dr. Harshad Sanghvi, former Jhpiego Chief Medical Officer, praising the work as “a tremendous effort” and “a significant call to action.” Jhpiego, a nonprofit dedicated to improving women’s and children’s health, has long championed innovative approaches to maternal care.
Postpartum hemorrhage, or PPH, is not just a medical issue — it’s a matter of survival. The condition affects 27 million women globally each year, with some experiencing normal blood loss after childbirth. However, when bleeding becomes excessive, it can escalate into a life-threatening emergency. “It can become a medical emergency very quickly,” explained Adam Devall, a maternal health professor at the University of Oxford. “A woman who had an otherwise uncomplicated labor can deteriorate within minutes if the bleeding isn’t recognized and treated promptly.”
Recognizing the Signs
Women themselves often sense the severity of PPH. “Typically, the women say, ‘I feel like I’m dying,’” noted Ioannis Gallos of the WHO’s Maternal and Perinatal Health Unit. “They actually sense it when they are bleeding too much.” This awareness is crucial, yet it’s not always enough to prevent fatal outcomes. “If no one acts on it, within 10 to 20 minutes, a woman can die,” Gallos added, emphasizing the urgency of timely intervention.
Early detection is key, and the study highlights a simple yet effective tool: a plastic drape designed to measure blood loss. “The blood collects into this specially designed drape, which has calibrated lines on it,” Devall explained. “These lines allow midwives and doctors to easily see the amount of blood loss after the birth.” By using this method, healthcare providers can more accurately assess the situation, ensuring that hemorrhages are not missed half the time.
Interventions and Training
The research team outlines multiple interventions, including uterine massage, medication, and IV fluids. But these strategies only work if they’re applied early and consistently. To achieve this, the authors advocate for a “pit-crew-like” simulation-based training program for the entire care team. “The goal is to get medical professionals and health workers to adopt these recommendations,” said Oladapo, who now leads efforts to implement the findings on a global scale.
Professor Doreen Kainyu Kaura of the University of the Western Cape in South Africa, who wasn’t part of the research, echoed this sentiment. “This approach will ensure that lifesaving interventions reach women at the right place and time,” she said, supporting the idea that structured training can bridge the gap between knowledge and action. The study also underscores the economic benefits of these interventions, showing that the cost of preventing PPH is far lower than the cost of managing its consequences.
Survival Rates Across the Globe
One of the most striking findings is the disparity in survival rates between high-income and low-resource countries. While the rate of postpartum hemorrhage is similar globally, the outcomes vary dramatically. “What’s different is what is given when these conditions are identified,” Oladapo pointed out. In well-resourced nations like the United States, mortality rates from PPH can be more than 200 times lower than in countries such as Afghanistan, Vietnam, or Nigeria — places where he once witnessed the devastating toll of the condition.
Oxytocin, a medication that can effectively stop bleeding, is a cornerstone of treatment. However, its use is complicated by the need for refrigeration, a challenge in under-resourced settings. The study emphasizes the importance of having accessible tools and protocols to ensure that every woman receives the care she needs, regardless of location.
Devall highlighted the transformative impact of the study’s methods. “We saw a massive decrease in severe bleeding,” he said, describing the results as “unmistakable.” The findings suggest that with early detection, clear criteria for treatment, and coordinated interventions, the risk of PPH can be drastically reduced. “Women should not be dying from PPH in this day and age, given what we know,” Oladapo reiterated. “If we use what we have now, we will reduce more than 95% of the deaths.”
The research underscores a critical message: the tools to prevent maternal death from PPH are already available. What’s needed is a shift in how they’re implemented. “This is a race against time,” Devall remarked, stressing that the clock starts the moment a woman begins to bleed excessively. By prioritizing early action, improving training, and ensuring resources are accessible, the global health community can take significant steps toward ending this preventable tragedy.
As the series emphasizes, the solutions are clear, but their adoption requires commitment. From simple drape systems to team-based training, these measures can save lives. With a unified effort, the dream of a world where no woman bleeds to death after childbirth may become a reality.