Navigating the Challenges of Postpartum Hemorrhage: A Modern Maternal Health Concern

Childbirth, while miraculous, comes with significant risks that often go undiscussed in everyday conversation. Among these risks, postpartum hemorrhage (PPH) stands out as particularly dangerous and increasingly common. Each year, approximately 14 million women worldwide experience PPH, defined as significant blood loss within 24 hours after delivery. The prevalence has increased alarmingly from 2.7% of births in 2000 to 4.3% in 2019. Recently, celebrities like Hailey Bieber have brought attention to this condition by sharing their personal experiences. As Bieber recounted her “scary” PPH experience after giving birth to her son Jack in 2024, she highlighted a terrifying reality: “I was bleeding really badly, and people die, and the thought crosses your mind.” Her candid admission reflects the genuine fear that accompanies this condition, which remains the leading cause of maternal death worldwide, claiming approximately 70,000 lives annually.

The severity of PPH stems from the unique circulatory system that develops during pregnancy. As Dr. Kameelah Phillips, a board-certified OB/GYN and founder of Calla Women’s Health, explains, “A mother’s entire blood volume can pass through the uterus in just eight to 11 minutes at term, so heavy bleeding can escalate rapidly.” This physiological reality means that what begins as normal post-birth bleeding can quickly become life-threatening without prompt intervention. While some bleeding after childbirth is expected and normal, PPH is specifically defined as blood loss exceeding 500 milliliters following a vaginal birth or 1,000 milliliters after a cesarean section. The risk factors for developing PPH include being Black, over 30, or obese, as well as having conditions like anemia, high blood pressure, prior cesarean deliveries, placental abnormalities, or experiencing unusually long labor. Early recognition is critical for successful treatment, with healthcare providers vigilantly monitoring for heavy or uncontrolled bleeding, large blood clots, or drops in blood pressure that could indicate a developing problem.

Understanding the mechanisms behind PPH requires knowledge of how the uterus functions during and after childbirth. During pregnancy, the uterus serves as the supportive home for the growing fetus. During labor, it contracts forcefully to facilitate birth, and these contractions continue afterward to expel the placenta and clamp off the blood vessels that supplied it. When these contractions aren’t strong enough, PPH can occur. Healthcare professionals use a mnemonic device—the “four Ts”—to categorize the main causes: Tone, Trauma, Tissue, and Thrombin. Uterine atony (Tone), where the uterine muscles fail to contract properly, accounts for approximately 70% of PPH cases. Trauma to the birth canal, including lacerations or uterine rupture, represents 15-20% of cases. Retained placental Tissue prevents adequate uterine contraction in about 10% of cases. Lastly, Thrombin-related issues involving blood clotting disorders account for a small percentage of cases but can be particularly challenging to manage.

Two specific complications during childbirth that can lead to PPH deserve special attention: shoulder dystocia and retained placenta. Shoulder dystocia falls under the “Trauma” category and occurs when, after the baby’s head is delivered, one or both shoulders become stuck behind the mother’s pubic bone. This complication often requires forceful maneuvers that can cause trauma to the birth canal. Though it can happen spontaneously in women with no risk factors, it’s more common with larger babies, mothers with diabetes, or those with a previous history of shoulder dystocia. Doctors watch for the rare but urgent “turtle sign”—when the delivered head retracts back against the perineum like a turtle pulling into its shell—as an indicator of this emergency. Retained placenta, the other major complication, is diagnosed when the placenta isn’t delivered within 30 minutes after the baby’s birth. The remaining placental tissue prevents the uterus from contracting effectively, potentially leading to severe bleeding and infection. Women are advised to monitor for warning signs after discharge, including heavy vaginal bleeding, foul-smelling discharge, fever, chills, or severe cramping in the lower abdomen.

The treatment approach for PPH focuses primarily on stopping the bleeding through various methods, ranging from non-invasive techniques to surgical interventions. Traditional approaches include uterine massage to stimulate contractions, medications that help the uterus contract, and balloon devices that apply pressure to the uterine walls. In severe cases, more dramatic interventions become necessary: blood transfusions to replace lost volume, surgical procedures to remove retained placental tissue, or even hysterectomy as a last resort to remove the hemorrhaging uterus. However, recent innovations have expanded the treatment options available to medical professionals. One such innovation is the JADA System, which received FDA clearance in 2020 and has since gained widespread adoption. Dr. Phillips explains that this device “works by using low-level vacuum to encourage the uterus to contract as it naturally should after birth.” Clinical studies have shown impressive results, with a median time to control bleeding of just three minutes and a success rate of approximately 94%.

For Hailey Bieber, the JADA System proved crucial in controlling her “really bad” bleeding after giving birth. Though the treatment lasted hours—a difficult time during which she recalled wanting desperately to “hold my baby” and “be with him”—it ultimately allowed her to survive a potentially fatal complication. Her experience highlights both the dangers of PPH and the hope offered by modern medical interventions. As maternal mortality rates continue to be a significant concern globally, particularly in the United States compared to other developed nations, awareness of conditions like PPH becomes increasingly important. By understanding the risk factors, recognizing early warning signs, and knowing about available treatments, expectant mothers can be better prepared to advocate for themselves during one of life’s most vulnerable moments. Medical professionals, meanwhile, continue to refine techniques and develop new technologies to address this persistent challenge to maternal health, working toward a future where no woman has to fear losing her life while giving birth.