Initiative promotes proven strategy for preventing postpartum hemorrhage

Global health experts know what it takes to address the world’s leading cause of maternal mortality: prevent postpartum hemorrhage.

Postpartum hemorrhage, or excessive bleeding after childbirth, kills an estimated 150,000 women each year. 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 and our partners, including RTI International and EngenderHealth, are helping health care providers prevent postpartum hemorrhage and increase the proportion of women who have safe deliveries—and longer lives.

A key to prevention

Fortunately, researchers have already proven the effectiveness of a feasible and inexpensive intervention that prevents postpartum hemorrhage: active management of the third stage of labor (AMTSL). Active management consists of three components that, used together, can prevent postpartum hemorrhage:

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

This intervention can eliminate at least half of postpartum hemorrhage cases—potentially saving thousands of women’s lives.

Increased awareness sets the stage

Experts around the world are recognizing the importance of making this active-management approach a routine practice. In 2003, the International Federation of Gynecology and Obstetrics and the International Confederation of Midwives issued a joint statement endorsing the approach. The World Health Organization also recommends AMTSL as a component of high-quality care and includes it in their manual, Managing Complications in Pregnancy and Childbirth.

The US Agency for International Development (USAID) is also playing a key role in expanding awareness of the approach—for example, through the Prevention of Postpartum Hemorrhage Initiative (POPPHI), which it awarded to PATH, RTI International, and EngenderHealth in 2004.

POPPHI’s mandate is to expand the use of AMTSL. Together, the three organizations are providing USAID with technical and managerial support for its special initiative to reduce postpartum hemorrhage, which is a broader effort to strengthen health care professionals’ use of AMTSL, improve services (and access to services) at facilities and in communities, and make uterotonic drugs and devices available and affordable to the countries that need them most.

Partnering for prevention

The POPPHI team works closely with a range of partners to share information and, ultimately, increase use of the prevention measures. For example, the project is working with the International Federation of Gynecology and Obstetrics and the International Confederation of Midwives to promote AMTSL among their member associations, which include both physicians and midwives. Working with other partners—particularly Rational Pharmaceutical Management Plus (RPM Plus) and Access to Clinical and Community Maternal, Neonatal, and Women’s Health Services—the project is also identifying opportunities to create synergies and maximize impact.

Through these partnerships and related activities, the POPPHI team is working to:

• Foster greater leadership to prevent postpartum hemorrhage by facilitating the meetings of key working groups, hosting technical meetings, and assisting the International Federation of Gynecology and Obstetrics and the International Confederation of Midwives in disseminating their joint statement.
• Support national professional associations in preventing postpartum hemorrhage by conducting regional workshops for association leaders in 24 countries, assisting with grant writing, and providing 16 small grants to national associations seeking to expand the use of AMTSL.
• Disseminate information to inform practices and decision-making.
• Strengthen linkages with other groups working to prevent postpartum hemorrhage.
• Provide technical assistance to USAID missions and regional bureaus.

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

Photo: PATH.