While postpartum hemorrhage can affect any woman, certain conditions and circumstances greatly increase the likelihood of severe bleeding after childbirth. Recognizing these risk factors helps health workers and families prepare early and take preventive action before complications arise.
Prof Moses Obimbo Madadi, the PPH Foundation Project Lead, notes that several maternal and medical conditions contribute to the risk. “Women who experience prolonged or obstructed labour, multiple pregnancies, or give birth to large babies face a higher chance of excessive bleeding,” he says. “The uterus can become overstretched and exhausted, reducing its ability to contract effectively after delivery.”
According to the 2023 World Health Organization guidelines on postpartum hemorrhage, additional risk factors include retained placenta, high blood pressure during pregnancy, infections, and previous history of PPH. Mothers who undergo cesarean sections or instrumental deliveries such as forceps or vacuum extraction are also more vulnerable due to possible trauma to the uterus or birth canal.
However, WHO cautions that risk scoring alone should never replace vigilance. Even mothers with no identifiable risk factors may develop PPH suddenly. For that reason, the new guidelines recommend universal preparedness; ensuring that every birth is attended by skilled personnel and that all facilities are ready to act once blood loss reaches about 300 millilitres or if the mother shows abnormal vital signs.
Dr Frederick Kireki Omanwa, Consultant Obstetrician and Gynaecologist and President of the Kenya Obstetrical and Gynaecological Society, explains that underlying health issues can further complicate delivery. “Anemia, bleeding disorders, and poor nutrition reduce a woman’s capacity to withstand blood loss,” he says. “This is why screening during antenatal visits is critical — it helps identify mothers who may need special attention during childbirth.”
Environmental and systemic factors also play a major role. Women who deliver without skilled birth attendants or in facilities lacking essential medicines and blood supplies are at greater risk. In some rural areas, delays in reaching health centres or cultural practices that discourage hospital delivery increase the danger.
Dr Eunice Atsali, a midwife and maternal health specialist with the PPH Foundation, adds that awareness at the community level is essential. “Families should know that risk factors do not mean a woman should fear childbirth,” she says. “They mean that both the family and the health team should be ready, with a plan for safe delivery and rapid response if bleeding starts.”
WHO now encourages facilities to adopt an integrated approach to PPH prevention, combining active management of the third stage of labour with routine use of uterotonic drugs, accurate measurement of blood loss, and readiness to apply a treatment bundle if haemorrhage occurs. These measures, when consistently applied, can significantly reduce maternal deaths.
Experts agree that identifying high-risk mothers before labour begins is one of the most effective ways to reduce maternal deaths. Routine antenatal assessments, skilled attendance at birth, and readiness for emergencies are crucial safeguards.
Postpartum hemorrhage may strike unexpectedly, but with awareness, early action, and preparedness, its most devastating outcomes can be prevented. The next story in this series will focus on prevention, the proven measures that can keep mothers safe from this leading cause of maternal death.
Sources
• World Health Organization, Recommendations on the Prevention and Treatment of Postpartum Hemorrhage, 2023
• World Health Organization, Updated PPH Care Bundle and Early Action Threshold, 2024
• Kenya Ministry of Health, Maternal and Newborn Health Guidelines, 2022
• Kenya Obstetrical and Gynaecological Society, Clinical Guidance Updates, 2023
• PPH Foundation Expert Interviews, 2024