By PPH Foundation
When labour continues for longer than expected, the risks to both mother and baby can increase, including the risk of postpartum haemorrhage (PPH), or excessive bleeding after childbirth. Prolonged labour can affect the uterus’s ability to contract effectively after delivery, increasing the likelihood of uterine atony, one of the leading causes of PPH.
A 2024 meta-analysis published in Ginekologia Polska examined the relationship between the duration of labour and postpartum haemorrhage, adding to evidence that the length of labour is an important factor to consider when assessing maternal risk. The World Health Organization’s consolidated guidelines, published in 2025, also identify prolonged labour as a risk factor for PPH and emphasise the importance of monitoring labour progress and responding promptly when complications arise.
During labour, the uterus contracts to help the cervix open and move the baby through the birth canal. After delivery, these contractions must continue to compress the blood vessels at the site where the placenta was attached. When the uterus does not contract firmly enough, these vessels can continue to bleed, resulting in postpartum haemorrhage.
Prolonged labour may contribute to this problem by affecting the uterus’s ability to contract effectively. It can also be associated with other complications, including infection and an increased likelihood of assisted or caesarean birth, which may introduce additional risks of bleeding. However, prolonged labour does not automatically lead to PPH, and haemorrhage can occur even when labour has progressed normally.
For Dr. Eunice Atsali, a midwife and Co-Lead of the End Postpartum Haemorrhage Initiative, recognising changes during labour and ensuring timely care are important parts of protecting mothers from preventable complications.
“Midwives play a critical role in recognising prolonged labour, monitoring the mother and baby, and ensuring that timely interventions are provided when complications arise. Close monitoring must continue after birth because early recognition of excessive bleeding and a prompt response can save a mother’s life.”
The prevention of PPH begins before bleeding occurs. Health workers need to monitor the progress of labour, assess maternal and fetal wellbeing, identify when labour is prolonged and determine when further assessment or intervention is necessary. After birth, careful observation remains essential because excessive bleeding can develop rapidly.
The WHO’s 2025 guidelines recommend objective assessment of blood loss and prompt treatment when PPH is identified. They also emphasise assessing uterine tone after delivery to identify uterine atony early. Timely action, appropriate medicines, intravenous fluids and escalation of care when needed form part of an effective response to haemorrhage.
For health facilities, preventing deaths from PPH requires skilled midwives, clear referral pathways, essential medicines, reliable blood supplies and teams prepared to respond to obstetric emergencies. These measures are particularly important where access to emergency obstetric care is limited.
As efforts to end preventable maternal deaths continue, understanding the connection between prolonged labour and PPH reinforces the need for quality care throughout childbirth. Careful monitoring, timely clinical decisions and continued observation after delivery can help health workers identify complications early and respond before bleeding becomes life-threatening.
References
- Cai, Y., Li, K., & Shi, Q. (2024). Meta-analysis of the effect of duration of labour on postpartum haemorrhage. Ginekologia Polska, 95(5), 391–397. https://doi.org/10.5603/gpl.90444
- World Health Organization. (2025). Consolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage. Geneva: World Health Organization. https://www.who.int/publications/i/item/9789240115637
- National Institute for Health and Care Excellence. (2023, updated guidance). Intrapartum care. Recommendations include reassessment of PPH risk factors during labour, including prolonged first or second stages. https://www.nice.org.uk/guidance/ng235/chapter/Recommendations
- Image by DC Studio on Magnific</a>