By PPH Foundation
A woman experiencing postpartum haemorrhage, PPH, cannot wait while a hospital searches for medicines, requests blood or decides how to respond. Severe bleeding can become life-threatening within minutes, making hospital preparedness one of the most important determinants of maternal survival. Experts say that saving mothers starts long before an emergency occurs, by ensuring every maternity facility has the systems, supplies and protocols needed to respond immediately (World Health Organization, 2023).
A prepared hospital is one where essential uterotonics such as oxytocin, tranexamic acid, intravenous fluids and emergency equipment are always available. It also has reliable access to blood and blood products, functional operating theatres, laboratory services, clear referral pathways and standard clinical protocols for managing obstetric emergencies. These systems reduce delays and allow life-saving treatment to begin without hesitation (Main et al., 2023).
Importantly, preparedness is not simply about having equipment on shelves. Hospitals must regularly test whether their emergency systems work. This is why many maternity facilities conduct routine obstetric emergency drills and simulation exercises. These drills recreate real-life PPH emergencies, allowing hospitals to evaluate whether medicines are accessible, blood can be mobilized quickly, emergency equipment is functional and referral systems operate as intended. They also help identify weaknesses before they contribute to preventable maternal deaths (Gallos et al., 2023).
According to Prof. Moses Obimbo, Project Lead of the End Postpartum Haemorrhage Initiative, preparedness is an ongoing process rather than a one-time achievement.
"A hospital should never wait for a postpartum haemorrhage emergency to discover that medicines are missing, blood is unavailable or essential equipment is not working. Readiness means ensuring these systems are functional every day. Regular emergency drills are equally important because they test the hospital's ability to respond under real conditions, helping facilities identify and correct gaps before lives are at risk."
He adds that routine preparedness assessments should become part of everyday maternity care.
"Every facility should periodically review emergency medicine stocks, inspect haemorrhage carts, confirm blood availability, assess referral pathways and conduct simulation exercises. These activities build confidence in hospital systems and strengthen the quality-of-care mothers receive when emergencies occur."
Global evidence supports this approach. The World Health Organization's E-MOTIVE strategy recommends early recognition of excessive blood loss followed by a rapid package of evidence-based interventions. Hospitals that combine these clinical practices with regular preparedness audits, emergency drills and continuous quality improvement are better positioned to deliver timely care and reduce severe maternal complications (Gallos et al., 2023).
Across Kenya, initiatives to strengthen emergency obstetric care continue to improve hospital preparedness through implementation of evidence-based guidelines, routine simulation training, quality improvement programmes and stronger blood systems. These investments help ensure facilities remain ready to respond whenever postpartum haemorrhage occurs.
Ultimately, preventing maternal deaths from PPH begins before the first patient arrives. Hospitals that routinely assess their readiness, maintain life-saving supplies, test their emergency systems through drills and continuously improve the quality of care are giving mothers the greatest chance of surviving childbirth.
References
Gallos, I. D., Papadopoulou, A., Man, R., et al. A cluster-randomised trial of the E-MOTIVE intervention package for postpartum haemorrhage. The New England Journal of Medicine. 2023.
Main, E. K., Goffman, D., Scavone, B. M., et al. Obstetric haemorrhage bundles and facility preparedness for postpartum haemorrhage. American Journal of Obstetrics and Gynecology. 2023.
World Health Organization. WHO recommendations for the prevention and treatment of postpartum haemorrhage. Geneva: World Health Organization; 2023.
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