By PPH Foundation

When postpartum haemorrhage (PPH) occurs, the ability of healthcare workers to act quickly and together can make the difference between survival and death. Managing severe bleeding after childbirth may require several interventions at the same time, including uterine massage, administration of medicines, intravenous fluids, examination to identify the source of bleeding and preparation for further emergency care. The World Health Organization's 2025 consolidated guidelines recommend a coordinated first-response treatment bundle, highlighting the importance of teamwork rather than carrying out lifesaving interventions one after another.

A PPH emergency can develop rapidly, placing considerable demands on the healthcare worker attending the mother. While one provider assesses blood loss and uterine contraction, another may need to prepare and administer prescribed medicines, establish intravenous access, monitor vital signs or call for additional support. Dividing responsibilities allows essential tasks to proceed concurrently and reduces the risk of delays while one healthcare worker attempts to manage every aspect of the emergency.

Dr Kireki Omanwa, President of the Kenya Obstetrical and Gynaecological Society (KOGS) and co-lead of the EndPPH Initiative, highlights the importance of coordinated action when a mother develops PPH.

 “Managing postpartum haemorrhage requires a coordinated response. While one healthcare worker attends to the immediate needs of the mother, another can support assessment, treatment and monitoring. This teamwork helps ensure that critical interventions are not delayed when every minute matters.”

The evidence supporting coordinated care is demonstrated by the E-MOTIVE trial, published in The New England Journal of Medicine in 2023. The study involved 210,132 women who gave birth vaginally in 80 secondary-level hospitals across Kenya, Nigeria, South Africa and Tanzania. Researchers assessed an intervention combining early detection of PPH using calibrated blood-collection drapes with a treatment bundle comprising uterine massage, medicines to contract the uterus, tranexamic acid, intravenous fluids, examination and escalation of care.

The primary outcome, a composite of severe PPH, laparotomy for bleeding or maternal death from bleeding, occurred in 1.6% of women in hospitals implementing the intervention, compared with 4.3% in hospitals providing usual care. The trial demonstrated the benefits of early detection and consistent implementation of coordinated treatment. It did not, however, compare outcomes based specifically on whether one or two healthcare workers attended an emergency.

The WHO's 2025 guidelines similarly recommend a standardized and timely approach to PPH treatment. The recommended first-response bundle brings together several interventions that should be initiated promptly, rather than administered in a delayed sequence. Effective implementation requires clear communication, staff who understand their roles and the ability to mobilise additional help when the mother's condition requires it.

Having two healthcare workers available does not mean that every PPH emergency can be managed by only two people. The number of staff required depends on the severity of bleeding, the mother's condition and the interventions needed. Severe cases may require a larger multidisciplinary team, including obstetricians, midwives, anaesthesia providers, laboratory staff and personnel responsible for blood transfusion or surgery. Facilities must also have systems for rapid escalation and referral when the required services are unavailable.

Staffing shortages can make coordinated care difficult, particularly in busy maternity units where several women may need attention simultaneously. The WHO's evidence review identifies inadequate staffing, heavy workloads and communication challenges as barriers to effective PPH management. Simulation-based training, clear emergency protocols and regular team practice can help healthcare workers recognise their responsibilities and respond efficiently.

Ultimately, preventing PPH-related deaths requires more than the availability of medicines and equipment. It also requires a prepared team capable of recognising danger, communicating effectively and delivering lifesaving interventions without unnecessary delay. Strengthening teamwork and ensuring adequate staffing are therefore important components of efforts to improve maternal outcomes.

References

1. 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
2. Gallos, I. D., Devall, A. J., Martin, J., et al. (2023). Randomized trial of early detection and treatment of postpartum hemorrhage. The New England Journal of Medicine, 389(1), 11–21. https://doi.org/10.1056/NEJMoa2303966
3. World Health Organization. (2023). WHO recommendations on the assessment of postpartum blood loss and use of a treatment bundle for postpartum haemorrhage. Geneva: World Health Organization. https://www.who.int/publications-detail-redirect/9789240085398
4. World Health Organization. (2025). Consolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage: Recommendations and supporting evidence. Geneva: World Health Organization. https://www.ncbi.nlm.nih.gov/books/NBK619233/
5. Image by stefamerpik on Magnific</a>