For further information, contact Melissa Maimann at Essential Birth Consulting.
Postpartum hemorrhage may account for rising morbidity among new mothers in affluent nations …
Adverse maternal outcomes jumped 20.9% from 1999 to 2004 with rates that rose a significant 3.8% per year among women giving birth in the most populous Australian state …
… the increase was almost entirely accounted for by women with postpartum hemorrhage …
Smaller studies in Canada and Britain have reported similar increases in postpartum hemorrhage and related maternal deaths …
Active management, such as early cord clamping and controlled cord traction … can reduce postpartum hemorrhage. Those procedures are recommended in guidelines from professional societies such as the International Confederation of Midwives and the International Federation of Gynecologists.
But practitioners may not be adhering to them, possibly explaining the increase in postpartum hemorrhage rates …
Among risk factors associated with adverse outcome in women with postpartum hemorrhage, the study noted prior Caesarean section, multiple births, a mother whose age was under 20 or over 35, extremes of parity, smoking, and induced labor and birth in a small rural hospital.
… from 1999 to 2004, annual adverse maternal outcome rates rose from 11.5 to 13.8 per 1,000 deliveries. Pregnancy and birth factors did not account for this relative increase of 3.8% per year …
… the growth primarily resulted from a 32% increase in blood transfusions (from 8.0 to 10.7 per 1,000 deliveries) …
… The majority of adverse maternal outcomes (60%) occurred among women with postpartum hemorrhage …
The overall postpartum hemorrhage rate rose significantly, from 6.2% in 1999 to 6.8% in 2004. Although most cases were not severe, adverse outcome rates increased from 10.9% to 12.5% among women with postpartum hemorrhage, (relative increase 3.1% per year, 95% CI 1.2% to 5.2%).
Interesting that they are blaming mis management of the third stage in terms of staff not employing active management of the third stage. This management is almost universal in hospitals. Birth centres and home births generally have natural third stages and their PPH rates are lower than those found in hospital delivery suites. In my experience, the cause of PPH is linked more closely to intervention in birth such as induction, epidural and caesarean.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Surely someone might look beyond the active management of third stage, to asking why? Why does a mother’s uterus bleed after the birth?
And how is it that some women attended by a skilled midwife are able to give birth unassisted, in harmony with their natural physiological processes, without fear of haemorrhage or other morbidity?
The protection and promotion of physiologically normal processes in birth, and normal birth in the continuum of healthy living, is something that the writer of this article seems unaware of.
The reason a uterus bleeds after birth is because for whatever reason there has been a failure of the normal process that is supposed to prevent it. Many things contribute to this failure – all the so called \risk factors\ – but Mother Nature herself is not 100% perfect, so it is actually biologically absolutely inevitable that on occasion, even in ideal circumstances, significant bleeding will occur and very rarely be fatal.Randomised studies have clearly shown that active management of the third stage significantly reduces this small but real risk. The debate should not be about whether or not physiological/natural management is slightly riskier, but whether or not, having been informed properly, a woman has the right to chose what she will do. And I believe, and will always support a womans right to make that choice, not just about the third stage but about place of birth and all the rest of it.