By PPH Foundation
For many families, childbirth marks the end of danger. But for thousands of women, the most critical period begins after the baby is born. The hours and days following delivery remain a high-risk window where complications such as Postpartum haemorrhage can rapidly turn fatal if not detected and managed in time.
Postpartum haemorrhage, defined as excessive bleeding after childbirth, can occur within the first 24 hours or even weeks after delivery. It is often sudden, unpredictable, and fast-moving. Medical evidence shows that the leading causes of PPH include uterine atony, trauma, retained placenta, and clotting disorders, collectively known as the “Four Ts.”
Yet beyond the clinical causes, what continues to place mothers at risk is what happens after they leave the delivery room. Weak postnatal monitoring, delayed recognition of danger signs, and gaps in follow-up care significantly increase the likelihood of severe complications. Studies in low- and middle-income countries show that factors such as cesarean delivery, infection risk, and delayed response to complications contribute to maternal deaths and hospital readmissions in the postpartum period.
Dr Kireki Omanwa, a gynaecologist and a Co-Lead of the End PPH Initiative, explains that the danger lies in the false sense of safety after delivery.
“Most people think once the baby is out, the risk is over, but that is not true. The postpartum period is one of the most vulnerable times for a mother, especially because bleeding can escalate very quickly if not identified early,” he says.
He adds that timely monitoring of uterine contraction, bleeding levels, and vital signs is critical in the first hours after birth. However, in many settings, overstretched health systems and early discharge mean that mothers may not receive adequate observation.
The risk does not end at the facility level. Once mothers return home, the burden of recognizing complications often shifts to families. Without proper knowledge of warning signs such as excessive bleeding, dizziness, or passing large clots, delays in seeking care become inevitable.
Evidence shows that postpartum haemorrhage can occur even in women without prior risk factors, and in some cases, complications such as prolonged labour significantly increase the likelihood of severe bleeding. This unpredictability makes continuous vigilance essential.
This is where family and partner support becomes critical. When households are informed and prepared, they are more likely to act quickly, reducing delays that can mean the difference between life and death. Male involvement, in particular, plays a crucial role in decision-making, access to transport, and mobilizing emergency care.
Strengthening postnatal care, improving monitoring systems, and ensuring families understand the risks beyond delivery are key steps toward reducing maternal deaths. Because the truth remains clear, surviving childbirth does not mean the danger has passed. For many women, it is only the beginning of a critical window where timely care determines survival.
Sources
World Health Organization. Trends in Maternal Mortality 2000 to 2023, Estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA Population Division. Geneva, World Health Organization, 2023.
Miller, C.M., et al. Risk Factors for Postpartum Hemorrhage Following Vaginal Delivery, Journal of Perinatology, 2017, Volume 37, Issue 6.
Evensen, A., Anderson, J.M., Fontaine, P. Postpartum Hemorrhage, Prevention and Treatment, American Family Physician, 2017, Volume 95, Issue 7.
Maina, E.W., et al. Assessing the Quality of Care for Postpartum Hemorrhage in Low- and Middle-Income Countries, BMC Pregnancy and Childbirth, 2023, Volume 23.
World Health Organization. WHO Recommendations for the Prevention and Treatment of Postpartum Haemorrhage. Geneva, World Health Organization, 2012.
Yargawa, J., Leonardi-Bee, J. Male Involvement and Maternal Health Outcomes, Systematic Review and Meta-Analysis, BMC Pregnancy and Childbirth, 2015, Volume 15.
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