After the Push, Looking at Postpartum Hemorrhage

One of the most physiologically demanding experiences the human body can undergo is childbirth and one of its most serious complications is postpartum hemorrhage (PPH). PPH is the world’s leading cause of maternal mortality, impacting millions each year (WHO 2023). PPH is thus an urgent area of concern in global health. Despite advances in obstetric medicine, PPH continues to threaten maternal survival, raising important questions about prevention, access to care, and healthcare equity worldwide (WHO 2023).

PPH is characterized by excess blood loss post childbirth; left untreated can result in severe complications. Traditionally, PPH is defined based on blood loss thresholds, however, it has been updated to be broader and include clinical metrics; a cumulative blood loss of 1000mL or associated hypovolemia- a critical reduction of body fluid volume or blood plasma, resulting in fast heart rate, and low blood pressure (Wormer et al. 2025; Cleveland Clinic 2022). This shift in classification acknowledges that visual blood loss estimates are often inaccurate. Clinically, PPH occurs in two ways: primary- either within the first 24 hours after delivery or secondary-up to 12 weeks postpartum

Under typical conditions, the human body naturally prevents excess bleeding via uterine contraction after placental delivery. The contractions compress the blood vessels at the placental site and act as a natural hemostatic mechanism. At the same time, the coagulation cascade forms stable clots. If this system fails, hemorrhage can rapidly occur. This failure is categorized as tone (uterine atony), trauma (lacerations or surgical injury), tissue (retained placental fragments), and thrombin (coagulation disorders). Among these, uterine atony remains the most common cause (Wormer et al. 2025).

Vitally, PPH has been found to be preventable and treatable. Management of PPH needs rapid assessment, fluid replacement, and medications like uterotonics to stimulate uterine contraction. In severe cases, surgical interventions such as B-Lynch compression sutures or uterine artery ligation are implemented to control bleeding while preserving fertility. Preventative reproductive healthcare, such as access to birth control, and safe abortion services are critical in reducing maternal risk by preventing high-risk pregnancies (Miller and Ansari 2022; WHO 2025a).

Despite known effective treatments, outcomes vary internationally. Data from 171 countries shows that the global maternal mortality rate declined by 43.9% between 1990 and 2015. However, this improvement masks a drastic inequality. According to the World Health Organization, as of 2023, 92% of maternal deaths occur in low- and lower-middle-income countries, and most were considered preventable. The lifetime risk of maternal death further illustrates this disparity: in lower-income countries, approximately 1 in 66 women will die from a maternal cause, whereas in high-income nations 1 in 7,933 died. This difference reflects unequal access to skilled healthcare providers, emergency obstetric services, and medical infrastructure (Alkema et al. 2016; WHO 2025b).

Postpartum hemorrhage (PPH) is more than just a medical complication; it highlights broader scientific and social challenges. While the biological mechanisms behind PPH are well understood, ongoing research into predictive biomarkers, improved clinical training, and affordable interventions for resource-limited settings could help close the inequalities in PPH management (Perinatal Services BC 2024; Wormer et al. 2025)

Ultimately, reducing deaths from postpartum hemorrhage needs more than innovative and novel treatments. Advancing maternal health depends on integrating scientific research with equitable healthcare access- examining prevalent health care biases and ensuring that lifesaving knowledge and interventions reach all patients — not only those in high income countries Childbirth might never be risk-free, but it can become significantly safer for mothers everywhere.