New health guidelines aim to end deaths from bleeding after childbirth

The WHO, FIGO and ICM have released new global guidelines to detect and treat postpartum haemorrhage faster, offering hope to save thousands of mothers each year

Postpartum haemorrhage (PPH), or severe bleeding after childbirth, remains one of the leading causes of maternal death, claiming nearly 45,000 lives each year, most of them in low- and middle-income countries. But most of these deaths are preventable.

 

Now, a new set of guidelines issued by the World Health Organization (WHO), the International Federation of Gynecology and Obstetrics (FIGO), and the International Confederation of Midwives (ICM) offers a stronger framework to detect bleeding sooner, respond faster, and save more lives. 

 

“These guidelines are designed to maximize impact where the burden is highest and resources are most limited – helping ensure more women survive childbirth and can return home safely to their families,” said Dr Jeremy Farrar, assistant director-general for Health Promotion and Disease Prevention and Care at WHO.

 

 

What is postpartum haemorrhage?

Postpartum haemorrhage is defined as excessive bleeding after childbirth. It is one of the leading causes of maternal mortality globally. Even when not fatal, severe bleeding can lead to serious complications like organ damage, the need for hysterectomy, psychological trauma, and long-term morbidity.

 

“Postpartum haemorrhage is the most dangerous childbirth complication since it can escalate with such alarming speed. While it is not always predictable, deaths are preventable with the right care,” shared Dr Farrar.

New guidelines of health bodies

The new guidelines draw on the evidence from a major study titled – ‘Prognostic accuracy of clinical markers of postpartum bleeding in predicting maternal mortality or severe morbidity: a WHO individual participant data meta-analysis’, published in The Lancet.

This study is the most detailed analysis of postpartum haemorrhage so far, using data from over 300,000 women across 23 countries and diverse healthcare settings.

 

Here are the most important changes:

1. Lowering the diagnostic threshold

Previously, PPH was typically defined as blood loss of 500 ml or more after birth. The new guidance recommends diagnosing PPH even at 300 ml of blood loss, to prompt earlier action. To help measure this more accurately, clinicians are advised to use calibrated blood collection drapes 9simple devices that collect and accurately quantify lost blood) immediately after birth.

2. Introduction of the MOTIVE approach

When PPH is detected, the guideline promotes the use of a standardised set of interventions that should be deployed simultaneously. The acronym proposed is MOTIVE:

Massage of the uterus

Oxytocic drugs

Tranexamic acid

Intravenous fluids

Vaginal and genital tract examination

Escalation of care (if bleeding continues) 

3. Good antenatal and postnatal care

Emphasising the link between maternal nutrition and safe childbirth, the guidelines call for stronger antenatal and postnatal care to address anaemia – a condition still prevalent in low- and lower-middle-income countries. Anaemia not only raises the risk of postpartum haemorrhage but also worsens recovery outcomes.

WHO recommends daily oral iron and folate for all pregnant women, and intravenous iron infusions where rapid correction is needed, particularly after severe bleeding or when oral supplements fail.

4. Discouraging harmful practices

The guidelines caution against unsafe procedures such as routine episiotomies, which can increase the risk of trauma and bleeding. Instead, they promote safer, evidence-based preventive measures like perineal massage during late pregnancy to help reduce the chances of severe bleeding after birth.

5. Strengthening third-stage care

During the third stage of labour, the guideline recommends administering a quality-assured uterotonic (medication that stimulates the contraction of the uterus) to ensure effective uterine contractions. Oxytocin remains the preferred option, while heat-stable carbetocin can be used as an alternative. If injectable drugs or reliable cold chains are unavailable, misoprostol is advised as a last-resort alternative.

 

To support these changes, the guidelines come with a set of training and support materials developed with partners like the United Nations Population Fund (UNFPA). These include easy-to-use modules for frontline health workers, national guides to help countries adopt the new practices, and simulation-based exercises to improve emergency response during childbirth.

   

Postpartum haemorrhage - excessive bleeding after childbirth - affects millions of women annually and causes nearly 45,000 deaths.  Better prevention, early diagnosis and rapid treatment are critical for saving lives.  New WHO guidelines https://t.co/4PvzXn5hAP pic.twitter.com/FD0f3A2vdP

— World Health Organization (WHO) (@WHO) October 6, 2025

Key barriers

While the new guidance is ambitious and evidence-based, its success depends on how well it’s implemented on the ground. Major barriers include:

• Weak national policy and leadership: Most countries lack clear PPH targets, systematic data collection, and alignment between global and national guidelines. Stronger national leadership and policy action are needed to prioritise PPH within maternal health agendas.
• Poor procurement and supply chains: Ensuring a steady supply of quality, affordable commodities across all health facilities remains a major challenge.
• Inadequate staffing and training: Many countries face shortages of trained, motivated healthcare workers. PPH prevention and management are often overlooked during training, while midwives and nurses face regulatory and social barriers that limit their ability to deliver lifesaving care, especially in remote areas.
• Inequities in access to care: Rural, poor, and marginalised women continue to face barriers such as distance, cost, and lack of coverage under public insurance schemes. Addressing these inequities is essential to achieving universal maternal health.
• Gender and social barriers: Cultural norms, limited education, and poor legal protection for women’s rights restrict their choices around pregnancy and childbirth. Lack of maternity support, and pressure for rapid repeat pregnancies further heighten risks around maternal health and recovery.

 

“These guidelines are a game-changer. But to end preventable deaths from PPH, we need more than evidence and protocols. We call on governments, health systems, donors, and partners to step up, adopt these recommendations, adopt them quickly, and invest in midwives and maternal care so that postpartum haemorrhage becomes a tragedy of the past," said Professor Jacqueline Dunkley-Bent OBE, ICM’s Chief Midwife.

A leap forward in prevention

The 2025 WHO–FIGO–ICM consolidated guidelines mark a major step forward in the global fight against postpartum haemorrhage. By lowering diagnostic thresholds, promoting a bundled approach to treatment, and strengthening health systems, they provide a clear roadmap to prevent thousands of avoidable maternal deaths.

 

Starting this year, 5 October will be observed annually as World PPH Day – a day to reflect on progress, renew commitment, and remind the world that postpartum haemorrhage is not only a medical emergency but also a matter of human rights and social justice. Each year will highlight a priority theme linked to broader global health goals, including the Sustainable Development Goals and Universal Health Coverage, keeping maternal survival at the centre of the global health agenda.

   

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This report is for informational purposes only and is not a substitute for professional medical advice.