Holistic care to prevent postpartum haemorrhage
As a traditional birth companion, what my grandmother would have called “the neighbour”, I support physiological birth in women’s homes. I never saw anything close to the awful outcomes found in hospital births, and that’s not because I supported only healthy “low-risk” mothers, but rather it’s because we didn’t engage in those things that are known to increase adverse outcomes and instead relied on holistic measures to improve wellness. And, of course, medical emergencies were handled by the medical folks in a medical facility.
Since I saw a lot less postpartum haemorrhages at homebirths (and I can read studies), a few years ago I wrote a blog post called “Beyond the Shot: Preventing Postpartum Haemorrhage ~ Wisdom from a Traditional Birth Companion” where I discussed why holistic care after a physiological birth was 2-8 fold safer when it came to postpartum haemorrhage than with active management (an intervention where the mother receives an injection of synthetic oxytocin after the birth of the baby).
Postpartum haemorrhage is considered the leading cause of maternal mortality worldwide. It’s critical to know what helps to prevent it and how to treat it promptly.
Today, we have a systematic review (a compilation of several qualifying studies to collate outcomes) “A Comparison of Physiologic Third-Stage Care, Expectant Management, and Oxytocin Prophylaxis in the Prevention of Postpartum Hemorrhage Following Physiologic Labor and Birth: A Systematic Review” (Hébert et al., 2026) that confirms yet again that active management should not be a one-size-fits-all approach as it can cause problems when used inappropriately.
Definitions used in the study:
Postpartum haemorrhage: blood loss of 1000mls or more
Physiological birth: spontaneous labour and birth with no obstetrical interventions
Minimal obstetric interventions: included women who had an epidural
Active management: the administration of synthetic oxytocin as a preventive
Expectant management: doing nothing while watching and waiting
Physiological care: tending to the mother with a calm, warm environment, skin-to-skin with the baby, promotion of early breastfeeding
Comparison groups:
After a physiological birth:
Active management vs physiological care
Active management vs expectant management
After a birth with minimal obstetric interventions:
Active management vs physiological care
Active management vs expectant management
The results were quite interesting.
Physiological care resulted in a large reduction in postpartum haemorrhage compared to synthetic oxytocin in both groups.
However, expectant management resulted in a large increase compared to synthetic oxytocin in both groups.
In other words, in a medical setting it is better to inject a mother with synthetic oxytocin than to stand around looking at her and doing nothing. However, if they want to provide her with some care, then she’s going to do much better than if she was injected. Unsurprisingly, treating a new mother with gentle kindness, cocooning her and her new baby in quiet and calmness, and perhaps tending to her thirst and hunger will promote the physiological completion of the birth with far less likelihood of excessive blood loss. And it also avoids the significant risks that come with synthetic oxytocin:
Anaphylactic reaction – an allergic reaction where the individual may stop breathing
Uterine hypertonicity, spasm, or tetanic contraction
Uterine rupture
Premature ventricular contractions – feels like heart palpitations or the heart is “skipping a beat”
Pelvic haematoma – a blood clot similar to a deep bruise
Hypertensive episodes – spiking blood pressure
Cardiac arrhythmia – fluctuations in heartbeat
Nausea and vomiting
Headache, loss of memory, confusion
Loss of coordination, fainting
Seizures
Subarachnoid haemorrhage – bleeding beneath the membrane that covers the brain. This can lead to stroke, seizures, brain damage, and death
Fatal afibrinogenemia – an absence of fibrinogen circulating in the blood which is needed for blood clotting. This leads to sudden and uncontrollable haemorrhage until death
Postpartum haemorrhage
Prolonged bleeding in the days and weeks after birth
While the WHO andmost medical and midwifery associations recommend that 100% of women receive this intervention after birth as a preventive, and indeed almost 100% of women do receive this, the incidence of postpartum haemorrhage has been steadily rising (Corbetta-Rastelli et al., 2023, Tjønneland Mentzoni1 et al., 2024).
It’s time to revisit what “care” actually means when it comes to welcoming precious new members of our humanity. Their mothers deserve better. Until then, we can do better ourselves.