Deadlier than crashes: How bleeding crisis is haunting delivery rooms

Every time a mother gives birth in Kenya, she is rolling a dice with death. It’s a gamble that could end in joy or in tragedy. At the heart of this grim reality is postpartum haemorrhage (PPH), a condition that silently kills more women in Kenya than road traffic accidents.

Medical professionals are raising the alarm, warning that while the public fixates on dramatic crashes and visible trauma, the deadliest threat to pregnant women is one that bleeds them dry sometimes in minutes.

“Postpartum haemorrhage contributes to over 34 per cent of maternal deaths in Kenya,” says Dr Mugeni Richard, an obstetrician-gynaecologist and Head of Department at Moi Teaching and Referral Hospital in Eldoret.

“The problem with PPH is that it often ambushes the healthcare provider. It comes suddenly, and without proper preparation, it can easily take a mother’s life.”

According to the World Health Organisation (WHO), over 287,000 women died globally in 2020 due to pregnancy and childbirth complications. PPH remains the leading direct cause of maternal mortality worldwide, responsible for approximately 25 per cent of all maternal deaths.

In sub-Saharan Africa, where access to emergency obstetric care is limited, the impact is even more pronounced.

Kenya’s maternal mortality ratio (MMR) currently stands at 355 deaths per 100,000 live births, according to the Kenya Demographic and Health Survey (KDHS) 2022. This is far higher than the global average of 223 per 100,000 live births, as estimated by the WHO.

In Kenya, postpartum hemorrhage is the single biggest contributor to these deaths.

Placenta abnormality

One of the key drivers of PPH, according to Dr Mugeni, is placental abnormality. Conditions such as placenta previa where the placenta implants in the lower segment of the uterus instead of the upper part increase the risk of excessive bleeding during or after delivery.

“Placenta previa may seem rare, but it affects between three to five women in every 1,000 pregnancies,” he explains. “Risk factors include previous caesarean sections, surgical removal of fibroids, smoking, and multiple pregnancies like twins or triplets. Women who have experienced placenta previa before are also more likely to have it again.”

In more severe cases, the placenta may not just lie low it may also invade deep into the uterine wall, a condition known as placenta accreta spectrum. This creates dangerously large blood vessels that can rupture during delivery.

“If this happens, the bleeding is so profuse that sometimes the only way to save the mother is to remove the uterus entirely,” Dr Mugeni says.

Normally, after childbirth, the placenta should detach and be expelled within 30 minutes. But sometimes it gets stuck, or a portion called a lobe remains inside the uterus. This retained tissue can lead to torrential bleeding, demanding immediate surgical intervention.

And even caesarean sections — seen by many as a “safe” alternative to vaginal birth — come with significant risks. “These aren’t routine surgeries. A caesarean in the presence of placental abnormalities is a complex procedure that should only be performed by highly skilled professionals,” Dr Mugeni cautions.

A 2023 WHO study on Global Causes of Maternal Deaths found that two-thirds of maternal deaths could be prevented with access to proper emergency obstetric care, skilled health personnel, and timely interventions such as access to blood transfusions and uterotonic drugs.

In Kenya, however, these life-saving interventions are often unavailable, especially in rural or low-resource settings.

While PPH can strike without warning, proper preparation can save lives. Dr Mugeni emphasises that women must be properly assessed during antenatal visits, and those at risk of abnormal placentation must be closely monitored.

“When the placenta is found to be low-lying, delivery should only be conducted in well-equipped centres with blood banks and experienced surgical teams,” he says.

Where advanced specialists are available, doctors can perform uterine artery embolisation to control bleeding or use surgical techniques to tie off major blood vessels. In some cases, they may even leave the placenta in place and use medication to manage the bleeding.

One major hurdle in managing PPH is the availability of blood. “You can’t stop PPH without blood,” says Dr Mugeni. “We need robust national blood donation campaigns. Blood should always be available, especially in maternal wards.”

And prevention starts early. Women are routinely given iron supplements during pregnancy to boost their hemoglobin levels, giving them a better chance of surviving blood loss.

However, Dr Mugeni raises concern over a growing trend — underqualified professionals conducting caesarean deliveries.

And as caesarean deliveries become more normalised, even requested by mothers for convenience, Dr Mugeni urges caution. “Every CS increases the risk of placental complications in the future. If it’s not medically necessary, it should not be done.”

The WHO also advises that cesarean section rates should not exceed 10–15 per cent of all births.