By PPH Foundation

Postpartum haemorrhage remains the leading cause of maternal mortality worldwide, and women diagnosed with uterine fibroids are often concerned about whether they are destined to experience severe bleeding during childbirth. While fibroids can increase the risk of complications that contribute to PPH, they do not automatically cause postpartum haemorrhage. Most women with fibroids have healthy pregnancies and successful deliveries, particularly when they receive early antenatal care, individualized birth planning and skilled obstetric care (World Health Organization, 2023).

Fibroids are non-cancerous growths that develop from the muscular wall of the uterus and affect millions of women during their reproductive years. Although many women live with fibroids without symptoms, others experience heavy menstrual bleeding, pelvic pain or fertility challenges. During pregnancy, fibroids may remain stable, grow or occasionally shrink, depending on hormonal changes. Their effect on pregnancy largely depends on their size, number and location.

Despite growing awareness, misconceptions surrounding fibroids continue to create unnecessary fear among expectant mothers. Understanding the facts can help women make informed decisions about their pregnancy and childbirth.

Myth 1: Every woman with fibroids will experience heavy bleeding during childbirth.

This is false.

Although women with fibroids have a higher risk of postpartum haemorrhage than women without fibroids, the majority do not develop severe bleeding after delivery. Research published in BMC Pregnancy and Childbirth in 2024 found that fibroids increase the likelihood of postpartum haemorrhage, particularly when they are large or located within the muscular wall of the uterus. However, PPH occurs only in a proportion of women with fibroids and can often be prevented through appropriate obstetric care (Wang et al., 2024).

Myth 2: Women with fibroids cannot deliver normally.

This is also false.

Many women with fibroids have uncomplicated vaginal births. Whether a vaginal delivery is possible depends on factors such as the size and location of the fibroids, the baby's position and the overall progress of labour. Fibroids that obstruct the birth canal or contribute to abnormal fetal positioning may require delivery by caesarean section, but this is determined individually rather than automatically.

Current evidence indicates that while caesarean delivery is more common among women with fibroids, vaginal birth remains a safe and appropriate option for many women following careful clinical assessment.

Myth 3: Fibroids should always be removed before pregnancy.

Not necessarily.

Most fibroids do not require surgery before pregnancy. Decisions regarding myomectomy should be individualized based on symptoms, fertility concerns, previous pregnancy outcomes and the size and location of the fibroids. Surgery itself carries risks, including uterine scarring, which may influence future pregnancies.

Healthcare providers carefully weigh the benefits and risks before recommending surgical removal. For many women, conservative management with close antenatal monitoring is sufficient to achieve a healthy pregnancy and safe delivery.

Myth 4: If you have fibroids, postpartum haemorrhage is inevitable.

Absolutely not.

While fibroids are recognised as one of several risk factors for postpartum haemorrhage, they do not determine a woman's outcome. Numerous factors influence the likelihood of PPH, including uterine contractions after delivery, placental separation, prolonged labour, operative delivery and the availability of timely emergency obstetric care.

Modern maternity care focuses on identifying women at increased risk early in pregnancy so that preventive measures can be implemented before labour begins. This includes individualized birth plans, delivery in appropriately equipped health facilities, availability of uterotonic medicines, access to blood and blood products where necessary, and close monitoring during the immediate postpartum period.

According to Dr. Eunice Atsali, Vice President of the Midwives Association of Kenya and Co-Lead of the End Postpartum Haemorrhage Initiative, education and individualized care are the most effective ways of addressing fears surrounding fibroids during pregnancy.

"One of the biggest misconceptions is that fibroids automatically mean a difficult pregnancy or postpartum haemorrhage. That is simply not true. Every woman should be assessed individually because fibroids vary greatly in size, number and location. With regular antenatal care, skilled birth attendance and proper planning, most women with fibroids deliver safely and recover well."

She adds that antenatal care provides an opportunity to identify potential risks before they become emergencies.

"Routine antenatal visits allow healthcare providers to monitor fibroid growth, assess fetal position and prepare for labour based on each woman's unique circumstances. This proactive approach enables healthcare teams to prevent complications whenever possible and respond quickly if they occur."

The World Health Organization recommends that all women receive evidence-based interventions for the prevention of postpartum haemorrhage, including routine administration of uterotonic medicines immediately after birth and prompt recognition and treatment of excessive bleeding (World Health Organization, 2023). For women with fibroids, adherence to these recommendations, combined with individualized maternity care, further strengthens maternal safety.

Fibroids should never be viewed as a reason to lose hope or fear pregnancy. Instead, they highlight the importance of early diagnosis, informed decision-making and continuous antenatal monitoring. By separating myths from scientific evidence, women can approach pregnancy with confidence, knowing that with the right care and preparation, postpartum haemorrhage is often preventable and healthy motherhood remains well within reach.

References

Stewart, E. A., Cookson, C. L., Gandolfo, R. A., & Schulze-Rath, R. Epidemiology of uterine fibroids: A systematic review. BJOG: An International Journal of Obstetrics and Gynaecology. 2017.

Wang, Y., et al. The influence of uterine fibroids on adverse outcomes in pregnant women: A systematic review and meta-analysis. BMC Pregnancy and Childbirth. 2024.

World Health Organization. WHO recommendations for the prevention and treatment of postpartum haemorrhage. Geneva: World Health Organization; 2023.

Image by jcomp on Magnific</a>