Why early recognition matters after birth
PPH can arise even when pregnancy and labour seemed uncomplicated. Antenatal risk assessment is valuable, but it cannot identify every person who will bleed heavily. Birth units need reliable readiness for every birth, not only for those labelled high risk.
Visual estimation often misses blood loss, which can delay recognition while a woman’s condition worsens. Objective measurement gives the team a clearer signal, while repeated assessment connects the amount lost with vital signs and overall condition. The 2025 WHO, FIGO, and ICM recommendations introduce a more objective approach to diagnosis and response.
The E-MOTIVE trial tested calibrated blood collection, early detection, bundled treatment, and staff training. Across more than 200,000 births in four countries, severe bleeding fell by 60%. WHO says midwives can perform the components within an organized system. Read the WHO trial summary for the findings.
This focused response complements the site’s background article on the role of midwives in maternal health.
Measure blood loss and watch vital signs
The updated WHO approach emphasizes calibrated collection drapes rather than visual estimates alone. A drape helps quantify blood loss after birth, but it does not replace observation, examination, or judgment. Staff should assess ongoing bleeding, uterine tone, pulse, blood pressure, alertness, and how the woman feels, following local practice.
What the 300 mL trigger means
The new diagnostic approach advises clinicians to act when measured blood loss reaches 300 mL or more and at least one abnormal vital sign is present. Its supporting individual-participant meta-analysis included 312,151 women across 12 datasets. The researchers found that blood loss combined with abnormal haemodynamic signs identified women at risk of severe outcomes more effectively than relying on the conventional 500 mL threshold alone. The Lancet analysis of clinical markers after birth explains the data and the trade-off between sensitivity and specificity.
The threshold is a prompt to act, not a reason to wait. If bleeding is brisk, the woman is deteriorating, or the team is concerned, follow the local emergency pathway immediately. Do not wait for a specific volume to accumulate before calling for help. The 300 mL figure is most useful when measured loss and abnormal vital signs are considered together.
Observe closely in the immediate postpartum period. Assign someone to measure blood loss, repeat observations, update the woman, and summon help, so every task has a clear owner.
Organize the first response with MOTIVE
Once PPH is recognized, the WHO guidance calls for prompt, coordinated first response. The actions are often remembered as MOTIVE. Trained staff should deliver them under the facility’s current protocol, starting tasks in parallel when staffing and circumstances allow.
- M is uterine massage.
- O is an oxytocic medicine to help the uterus contract.
- T is tranexamic acid.
- I is intravenous fluids.
- V is examination of the vagina and genital tract to look for a source of bleeding.
- E is escalation if bleeding continues or the woman’s condition requires it.
This list is a memory aid, not a treatment order. Medicine choice, timing, route, dose, fluid management, and thresholds for procedures or transfusion must follow current local guidance and each clinician’s scope. The full WHO consolidated PPH guideline covers prevention, diagnosis, treatment, and links to training materials.
Train, equip, and call for help
Preparation means clear roles, accessible supplies, working calibrated drapes, medicine checks, and known referral and blood-access routes. Brief drills let teams practise the workflow, communicate clearly, and protect privacy.
ICM’s 2026 coverage of the Lancet Series and its implementation agenda stresses that evidence must reach everyday practice. This matters where staffing, referral, or blood products are limited. Adapt workflows to local resources while keeping early recognition, escalation, and respectful care central.
Prevent delays before and during birth
Preparation begins before an emergency. Antenatal care can identify and address anaemia according to local guidance, discuss birth and referral plans, and help the team anticipate available resources. No risk checklist predicts every case, so prevention and readiness belong in routine care. The site’s article on maternal nutrition in pregnancy provides related background.
At the facility level, a readiness plan should name who leads, where supplies are stored, how additional help is called, what transport is available, and how blood products can be accessed. Review the plan after drills and real events. When a gap appears, record a practical corrective action and assign someone to follow it through.
Families also benefit from calm, clear communication. One team member can explain that bleeding is being assessed, what actions are underway, and when more help is arriving. Concise explanations preserve dignity and help the woman and her support person understand the situation without slowing urgent care.
Support recovery and learn from each case
Care continues after bleeding is controlled. Observe and follow up under local protocol. After significant blood loss, discuss indicated anaemia care, fatigue, feeding, emotional wellbeing, and symptoms that need urgent review.
Once she is stable, give the woman time to ask questions. A clear account of what happened, what care was provided, and the recovery plan can reduce confusion. Include her support person if she wishes. Midwife-led care values continuity and informed support; the site’s article on what families can expect from midwife-led care offers related context.
A confidential service review can examine how quickly blood loss was measured, when the response began, whether roles were clear, and whether referral or blood access caused delays. The aim is learning and safer systems, not blame. Share changes with the whole team and revisit them during training.
Put the guidance into local practice
The 2025 WHO guideline gives midwifery teams a clearer basis for PPH prevention, diagnosis, and first response. Its practical message is to measure objectively, consider blood loss alongside vital signs and the woman’s condition, and organize prompt action. The 2026 implementation discussion is a reminder to turn evidence into supplies, agreed roles, drills, referral plans, and follow-up.
Use this article as an educational overview, then check the current national and facility protocols that govern your practice. Clinical decisions, medicines, and escalation pathways must be set by qualified professionals for the local context. In suspected severe bleeding, activate the local emergency response immediately.
This article is for general education. It does not replace clinical training, professional judgment, or local emergency guidance.
