Woman and infant.

This short video shows how providing oxytocin via the Uniject® injection system can help prevent postpartum hemmorhage. Photo: PATH.

Promoting effective strategies for preventing postpartum hemorrhage

Editor’s note: Because childbirth should be the start—not the end—of life, PATH addresses the leading cause of maternal death from all angles. The Prevention of Postpartum Hemorrhage Initiative (POPPPHI) raised awareness of a lifesaving strategy, while other PATH efforts are improving tools to prevent and control excessive bleeding.

Global health experts know what it takes to address the world’s leading cause of maternal mortality: prevent postpartum hemorrhage, or excessive bleeding after childbirth.

In developing countries, where most births occur in homes or local clinics, the interventions needed to treat postpartum hemorrhage—emergency referrals, obstetric care, blood transfusion, and surgery—are often out of reach. Treatment simply is not available for the majority of women.

PATH helps health care providers in low-income countries prevent postpartum hemorrhage and increase the proportion of women who have safe deliveries—and longer lives.

One key to prevention

One inexpensive intervention—active management of the third stage of labor (AMTSL)—could eliminate at least half of postpartum hemorrhage cases, potentially saving thousands of women’s lives.

Active management consists of three components that, used together, can prevent postpartum hemorrhage:

  • Administering uterotonic drugs (such as oxytocin).
  • Assisting with the delivery of the placenta, known as “controlled cord traction.”
  • Massaging the uterus after the placenta has been delivered.

Experts around the world have recognized active management as a routine practice for low-income countries. The Prevention of Postpartum Hemorrhage Initiative played a key role in expanding awareness of the approach.

Partnering for prevention

Awarded to PATH, RTI International, and EngenderHealth in 2004 by the US Agency for International Development (USAID), POPPHI’s mandate was to expand the use of AMTSL. The POPPHI team provided USAID with technical and managerial support for its special initiative to reduce postpartum hemorrhage and worked closely with a range of partners to share information and increase use of the prevention measures.

For example, the project worked with the International Federation of Gynecology and Obstetrics and the International Confederation of Midwives to endorse AMTSL and promote it among their member associations, which include physicians and midwives. The project also identified opportunities to create synergies and maximize impact with partners including Rational Pharmaceutical Management Plus (RPM Plus) and Access to Clinical and Community Maternal, Neonatal, and Women’s Health Services.

Through these partnerships and related activities, the POPPHI team:

  • Fostered greater leadership to prevent postpartum hemorrhage.
  • Supported national professional associations through regional workshops and small grants.
  • Disseminated information to inform practices and decision-making.
  • Strengthened linkages with other groups working to prevent postpartum hemorrhage.
  • Provided technical assistance to USAID missions and regional bureaus.

By accelerating the routine use of AMTSL around the world, the POPPHI project worked to decrease the number of women who experience postpartum hemorrhage. All efforts were focused on one essential goal: saving mother’s lives.