Every woman deserves a safe and healthy childbirth. Yet, Postpartum Hemorrhage (PPH) or heavy bleeding after childbirth remains one of the leading causes of maternal death in India. The main challenge lies in early detection and timely treatment, and this is especially true in rural and underserved areas where timely medical care may not always available. But the good news is that PPH is both preventable and treatable.
India’s maternal mortality ratio (MMR) or mothers who die in or shortly after childbirth, has improved. From 130 per 100,000 live births between 2014-16, it dropped to 93 per 100,000 live births between 2019-21. However, it is still distant from the Sustainable Development Goal (SDG) global target of reducing MMR below 70 per 100,000 live births by 2030. To reach that goal, targeted efforts at all levels, to prevent and treat PPH are essential.
PPH occurs when a woman loses too much blood during or after giving birth (more than 500 ml of blood after vaginal delivery or 1,000 ml after a cesarean section). When trained doctors or healthcare workers are not available it may not be possible to identify PPH in time, which increases the chance of maternal mortality. However, it can both be prevented and treated in time.
For women having normal delivery (vaginal delivery), a few effective approaches during delivery may prevent PPH. One such strategy is Active Management of the Third Stage of Labor (AMTSL). It involves the use of drugs (called uterotonics) which contract the uterus, early umbilical cord clamping, and gentle aiding of the controlled rapid delivery of the placenta. They help with reducing blood loss and thus avoiding complications.
Studies show that AMTSL strategy can cut the risk of PPH by an enormous proportion. For example, active management can lower excessive bleeding (more than 1,000 ml) by nearly two-thirds. Active management also lowers the risk of anaemia (low haemoglobin) after delivery.
The most widely used drug to prevent PPH is Oxytocin, but it must be stored in a refrigerator (2–8°C) which sometimes may be a challenge and may reduce its efficacy, sometimes they may also be unavailable, however alternatives do exist. Heat Stable Carbetocin is a recently developed drug that does not need to be refrigerated and can be stored at room temperature. This is especially helpful for use in rural areas where refrigeration is generally not an option.
The other options include Methylergometrine and Misoprostol. Methylergometrine is effective but cannot be given to women with high blood pressure, so it is better not to use it if the woman has not been tested for hypertension.
In rural or remote areas, the majority of the women may deliver without the services of a skilled delivery attendant. In such cases, Misoprostol can be administered promptly by a community health worker. This simple medication can save lives by preventing PPH from becoming a life-threatening complication.
Apart from this, the use of heat-stable Carbetocin would be an actual game-changer in such regions. Since most drugs need to be stored in cold conditions, Carbetocin does not need such storage, and hence it is more easily administered in places where refrigeration and electricity may not readily be available.
We work with FIGO (International Federation of Gynecology and Obstetrics) and FOGSI (Federation of Obstetric and Gynaecological Societies of India) to assist our federation members, the Department of Health – Government of India in improving and offering our healthcare services for improved maternal health and contributing to the reduction in PPH and MMR. We also build the essential skills through trainings so as to help our members and other service providers to quickly identify and treat PPH, and also how to use standardised PPH kits.
The struggle against maternal deaths cannot be fought without collective effort. India’s diversity is its strength, but also a challenge for healthcare delivery. Urban hospitals may have high-tech solutions, but rural communities need practical, low-cost, and sustainable methods.
Local governments must tailor solutions to local needs whether that is providing solar-powered refrigerators for Oxytocin storage or training Accredited Social Health Activists (ASHAs) to administer Misoprostol in home births.
In order to curtail maternal death, we must ensure that PPH is diagnosed early and treated immediately. This calls for an all-out effort by one and all, doctors, nurses, government agencies, NGOs, other stake holders and communities.
The key is that there must not be any woman dying from a preventable condition like PPH. It can be made safer to give birth through prevention, using life-saving medications like Carbetocin and Misoprostol, and having community health workers ready to respond when needed.
Mothers are the heart of every family, and their safety during labor is something that we all need to try for. Let us make all births in India safe, and no mother should fear dying while giving birth to a baby.