“I was running around hospitals trying to get blood. By the time I got back she was gone.”
Dr. Olufemi Oladapo still feels the weight of a heartbreaking memory from early in his career in Nigeria. A woman, so excited to become a mother after waiting six long years, tragically died from postpartum hemorrhage—something that ultimately claims around 43,000 lives every year.
To tackle this pressing issue, Dr. Oladapo, who now works with the World Health Organization on human reproduction, has co-authored a comprehensive three-part series in The Lancet, which details the crisis and potential solutions.
This condition affects about 27 million women globally each year. While some bleeding post-childbirth is standard, excessive bleeding—known as postpartum hemorrhage—can quickly turn fatal.
“It can become a medical emergency very quickly,” says Adam Devall, a maternal health professor at the University of Oxford. A woman who has had a straightforward labor could be in serious trouble in just a matter of minutes if the bleeding isn’t addressed.
Many women are acutely aware of the severity of the situation.
“Typically, the women say, ‘I feel like I’m dying.’ They actually sense it when they are bleeding too much,” remarks Ioannis Gallos from the WHO’s Maternal and Perinatal Health Unit. “Without intervention, a woman can easily die within 10 to 20 minutes.”
Consequently, postpartum hemorrhage is often described as “a race against time.”
Dr. Harshad Sanghvi, formerly of Jhpiego, praised the series as a thorough collection of evidence and a crucial “call to action.” Jhpiego, you’ll recall, is dedicated to the health of women and children.
Starting with a special drape
The authors emphasize that accurately measuring blood loss is vital—eye-balling it is simply inadequate and often leads to oversights. Devall suggests that using a specially designed plastic drape placed under the woman can make all the difference.
“The blood collects in this drape, marked with calibrated lines,” explains Devall. “This makes it easy for midwives and doctors to see the extent of blood loss post-birth.”
Various interventions are available, including uterine massage, medications, and IV fluids.
The researchers conducted an extensive trial involving over 200,000 women across Nigeria, Kenya, Tanzania, and South Africa. They implemented early detection methods using the drape, set clear treatment criteria, and executed simultaneous interventions, yielding remarkable results.
Devall spoke of the trial’s outcome: “We witnessed a major reduction in severe bleeding.”
A survival gap
The findings also highlight a stark contrast in survival rates between wealthy nations and those with limited resources.
“The incidence of postpartum hemorrhage doesn’t differ much between high-income and low-income countries,” says Oladapo. “The disparity lies in the quality of care provided when these conditions arise.”
The report reveals that mortality rates from postpartum hemorrhage can exceed 200 times higher in under-resourced nations like Afghanistan or Nigeria than in well-equipped countries like the United States.
Oxytocin is effective for managing bleeding, but it requires refrigeration, which is often not feasible where resources are scarce.
The report advocates for training that mimics a pit-crew approach for the entire care team.
The research team’s aim now is to persuade healthcare professionals to embrace their recommendations.
Doreen Kainyu Kaura, a midwifery professor at the University of the Western Cape in South Africa, who was not part of the study, finds the conclusions resonate with her experiences in the delivery room.
“This would be a fantastic way to ensure that these life-saving interventions reach women when they need them the most,” she says.
“Women shouldn’t have to die from postpartum hemorrhage in this day and age,” Oladapo asserts. “If we properly utilize what we already have, we could prevent more than 95% of these deaths.”
Economically, addressing postpartum hemorrhage could save more than it costs to prevent it. “Invest just 5% of the expenses linked to postpartum hemorrhage in its prevention,” Oladapo concludes, “and you’ll not only save lives but also expenses.”
Dr. Sanghvi expresses hope: “This decade could be the one we successfully eliminate postpartum hemorrhage as the leading cause of maternal death. I genuinely believe it’s achievable.”
