By PPH Foundation

The room suddenly fills with people. Voices become urgent. Equipment appears. A healthcare worker presses firmly on the abdomen while another prepares medications. Someone mentions blood transfusion. Another calls for additional support.

For a woman experiencing postpartum haemorrhage, these moments can unfold in a blur.

The medical team is focused on saving her life. Yet amid the urgency, many women later report feeling frightened, confused, excluded from decision-making, or unsure about what happened to them during one of the most critical moments of their lives.

As global efforts to reduce maternal mortality continue to advance, experts are increasingly asking an important question: Can emergency obstetric care save lives while also protecting dignity, autonomy, and emotional wellbeing?

Evidence suggests the answer must be yes.

Research published in Reproductive Health in 2023 found that women who experienced severe maternal complications, including postpartum haemorrhage, frequently described feelings of fear, loss of control, inadequate communication, and psychological distress during emergency care. Similar findings have been reported across multiple countries, highlighting the importance of respectful maternity care even during life-threatening situations (Kassa et al., 2023).

Respectful maternity care is a rights-based approach that emphasizes dignity, informed consent, privacy, confidentiality, freedom from abuse, and meaningful participation in healthcare decisions. The World Health Organization has repeatedly stressed that every woman has the right to respectful care throughout pregnancy, childbirth, and the postnatal period, regardless of the complexity of her medical condition.

Historically, maternal health programmes have focused primarily on clinical outcomes such as survival, blood loss, and complication rates. While these indicators remain essential, experts increasingly recognize that quality care also includes a woman's experience of care.

This is particularly important during postpartum haemorrhage management.

Many lifesaving interventions can feel invasive or frightening when performed without explanation. Procedures such as uterine massage, manual removal of retained tissue, blood transfusion, surgical interventions, and uterine balloon tamponade are often introduced rapidly because every minute matters. However, when communication is absent, women may perceive these interventions as traumatic rather than therapeutic.

According to Prof Ann-Beatrice Kihara, a Co- Lead of the End PPH Initiative, respectful care must remain a priority even during emergencies.

"Emergency situations require rapid action, but rapid action should not mean abandoning communication. Even in moments of urgency, healthcare providers can explain what is happening, seek consent where possible, reassure women and their families, and preserve dignity. Clinical excellence and respectful maternity care should go hand in hand."

One area attracting growing attention is the role of human-centred design in postpartum haemorrhage technologies.

Human-centred design places the needs, experiences, cultural beliefs, and preferences of users at the centre of product development. In maternal healthcare, this means designing interventions that are not only clinically effective but also acceptable and comfortable for women and healthcare providers.

The uterine balloon tamponade is a good example.

Used when bleeding does not respond to first-line treatments, the device works by inserting a balloon into the uterus and filling it with fluid to apply pressure and control haemorrhage. Studies have demonstrated its potential to reduce severe bleeding and avoid more invasive surgical procedures (Tindell et al., BJOG, 2013).

However, researchers have increasingly explored how women perceive the intervention. Qualitative studies published in BMJ Global Health and BMC Pregnancy and Childbirth have shown that acceptance improves significantly when healthcare providers explain the purpose of the device, address concerns, involve family members where appropriate, and respect cultural preferences surrounding childbirth and reproductive health.

Human-centred approaches are also influencing the design of new maternal health technologies. Developers are working to simplify device insertion, improve comfort, reduce perceived invasiveness, enhance privacy, and ensure products are suitable for use across diverse cultural settings. Involving women, midwives, and frontline health workers during product development helps ensure that innovations respond to real-world needs rather than assumptions.

Research published in The Lancet Global Health has highlighted that women who feel informed, respected, and involved in their care are more likely to trust health systems, seek skilled care in future pregnancies, and recommend facility-based delivery to others. These outcomes are critical for improving maternal health at population level (Miller et al., 2016).

The conversation around postpartum haemorrhage is therefore evolving. Success can no longer be measured solely by whether a woman survives. It must also consider whether she was treated with dignity, whether her voice was heard, and whether her experience of care reflected the respect she deserved.

Saving a mother's life will always be the first priority during postpartum haemorrhage. But as healthcare systems become more responsive to women's needs, there is growing recognition that survival and respectful care are not separate goals. The most effective maternal health systems are those that achieve both.

Sources

1. Kassa ZY, Tsegaye B, Abeje A, Disassa G. Respectful maternity care and women's childbirth experiences following obstetric emergencies. Reproductive Health. 2023.
2. World Health Organization. WHO Recommendations on Intrapartum Care for a Positive Childbirth Experience. Geneva: WHO. 2018.
3. Tindell K, Garfinkel R, Abu-Haydar E, et al. Uterine Balloon Tamponade for the Treatment of Postpartum Haemorrhage in Resource-Poor Settings. BJOG. 2013;120(1):5-14.
4. Miller S, Abalos E, Chamillard M, et al. Beyond Too Little, Too Late and Too Much, Too Soon: A Pathway Towards Evidence-Based, Respectful Maternity Care Worldwide. The Lancet. 2016;388(10056):2176-2192.
5. Bohren MA, Vogel JP, Hunter EC, et al. The Mistreatment of Women During Childbirth in Health Facilities Globally: A Mixed-Methods Systematic Review. PLOS Medicine. 2015;12(6).
6. Image by DC Studio on Magnific</a>