Postpartum Hemorrhage Is a Deadly Problem

Maternal mortality in the U.S.

Maternal mortality rates more than doubled in the decade between 2009 and 2019 in the U.S. They kept going up all the way until 2022, when the rates finally declined.

Maternal mortality rates increased by nearly 40% during the pandemic. And, in 2021, the Centers for Disease Control and Prevention (CDC) reported a rate of 32.9 deaths per 100,000 live births. In 2022, the rates went down slightly to 22.3 out of 100,000 births, but that was still higher than all the years prior.

The U.S. has the highest rates of maternal mortality among all developed nations. “Compared to all high-income countries, the mortality rate in the U.S. was double the average,” said Jamille Nagtalon-Ramos, EdD, MSN, WHNP-BC, FAANP, a nurse practitioner and assistant professor of nursing at Rutgers University.

What’s alarming is that many pregnancy-related deaths — including PPH — can be prevented.

Maternal mortality in people of color

The increase during the pandemic was across all racial and ethnic groups, but people of color have higher rates of maternal mortality compared to white people.

Research shows Black women and American Indian and Alaska Native women are more likely to die from pregnancy-related causes compared to white women. In 2022, the maternal mortality rate for Black women was 49.5 deaths per 100,000 live births, which was significantly higher than the rates for all other groups.

Nagtalon-Ramos said disparities such as a lack of access to care and insurance coverage are some of the reasons for higher maternal mortality rates for people of color.

Postpartum hemorrhage is the leading cause of maternal mortality

Millions of women experience PPH. More than 1 out of 10 maternal deaths in the U.S. are caused by severe postpartum bleeding, which usually happens right away but can happen up to 12 weeks after the pregnancy ends.

The loss of blood can cause a drop in blood pressure, and when your organs don’t get enough blood flow, your body can go into shock and die.

Some common causes of PPH are:

• Uterine atony — when uterine muscles don’t tighten properly after childbirth
• Deep cuts or tears in the birth canal
• Placental disorders — conditions that affect the placenta
• Coagulopathy — a blood clotting disorder

A delay in treatment can result in poor outcomes, so the sooner PPH is discovered, the better.

Postpartum hemorrhage treatment options

The first step in stopping PPH is finding the cause of the bleeding so you can stop it. That may require examining the uterus, pelvic tissues, vagina and vulva for bleeding — sometimes through surgery that opens the abdomen (called a laparotomy).

The following methods can be used to stop the bleeding:

• Removing any placenta that’s in the uterus
• Tying off or sealing bleeding blood vessels
• Uterine massage or medication
• Intrauterine devices like a catheter, balloon or vacuum system
• Hysterectomy (removal of the uterus)

Nagtalon-Ramos said healthcare providers (HCPs) underestimating the amount of blood loss during childbirth is a common reason for treatment delays. “Inaccurate estimation of blood loss by healthcare providers during birth and the immediate postpartum period is the main reason for the delayed response to treatment and management,” Nagtalon-Ramos said.

Postpartum hemorrhage risk factors

About 6 in 10 cases of PPH happen in women with known risk factors. And some types of PPH are preventable, like bleeding that results from uterine atony or a blood clotting disorder. So, attending regular prenatal visits, knowing your risk factors and good communication between HCP and patient can help lower the risk for PPH.

In addition to having had a previous PPH, risk factors for PPH include:

• A history of five or more previous deliveries
• A history of carrying multiple babies at the same time
• High blood pressure or preeclampsia
• Blood clotting conditions or other blood-related disorders
• Intrahepatic cholestasis of pregnancy (ICP)
• Living with obesity
• Having an induced labor

Signs of PPH

Vaginal bleeding that isn’t decreasing over time or heavy bleeding that soaks a pad every hour and doesn’t slow down in the postpartum period is a sign of PPH.

Other warning signs of PPH can include:

• Racing heartbeat
• Clammy skin
• Dizziness
• Confusion
• Feeling faint or confused
• Nausea or vomiting
• Pale skin

If you think you’re bleeding too much after giving birth — don’t wait for the typical follow-up appointment four to six weeks after delivery. Contact your HCP or call 911 right away.

The reality of maternal mortality is frankly unacceptable. And your prognosis if you have a PPH is largely dependent on your HCP and support team. But knowing the risk factors and the signs of PPH can help save your life.