"You never forget the experience when a woman just slips away in your hands, and you know it is too late," said Dr Hadiza Galadanci, a professor of Obstetrics and Gynecology at Bayero University, on the experience of a woman dying as she delivers a baby.
Excessive bleeding is a common complication of childbirth that millions of women experience and survive. However, thousands of women are still dying due to haemorrhage every year, making up 27% of all maternal deaths. Nearly all these women are from sub-Saharan Africa, where a number of challenges persist, including a lack of access to prenatal care, skilled birth attendants and high-quality medicines in health facilities.
Dramatic change
However, this is primed to change. More women are surviving childbirth than ever before, in part thanks to years of research that led to a highly effective and affordable clinical protocol called the Postpartum Haemorrhage (PPH) bundle. This new way of detecting and treating postpartum haemorrhage early combines the most effective interventions into a quicker, life-saving method that is being scaled up in the places that need it the most.
“In the last year or two, we’ve seen a real difference. Even the cleaners and staff in the labour ward say the new way is a great innovation. Before, blood would flow onto the beds and floors. Now, with the drape, the blood is collected in a pouch," said Dr Galadanci.
This plastic pouch, or drape, is the first step in the new approach that takes the guesswork out of estimating blood loss. The drape itself is not new, but its consistent use is, and the difference has been immediately felt.
"You cannot accurately assess blood loss by just looking. By the time we decide to intervene, many women are already in shock – thirsty, disoriented, fading away before our eyes," said Dr Zahida Qureshi, principal investigator of the E-MOTIVE trial in Kenya and Professor of the Department of Obstetrics and Gynaecology at the University of Nairobi.
A woman holding up a plastic drape with two other people standing next to her in a medical environment. A patient dummy is lying on a hospital bed.
Simulation exercises for training at the ACEPHAP simulation lab, 2025. © Stephen Mohammed Abu
Scaffolding progress
Finding affordable and effective interventions that work to detect, treat and prevent life-threatening complications in resource-poor settings takes years of iterative research, testing and refinement. Dr Quresh explained that throughout her career she took part in multiple trials that laid the groundwork for where we are today – on the brink of altering the course of maternal mortality.
Studies like the WOMAN trial on tranexamic acid and the CHAMPION trial on oxytocic drugs, generated useful evidence that was foundational to the components of the E-MOTIVE package, or PPH bundle. Scientists and doctors at WHO, the UN’s Special Programme on Human Reproduction (HRP) and the University of Birmingham, United Kingdom of Great Britain and Northern Ireland, built off the foundation of these trials and devised the PPH bundle to address the very specific needs of women who are most at risk of dying in childbirth.
Once proven effective through a large-scale study, WHO convened a Guideline Development Group to rapidly formulate a WHO recommendation so that the solution would be taken to scale as fast as possible.
Now, doctors and midwives who are implementing and scaling up the innovative approach report drastic reductions in cases of severe bleeding and deaths. Adesida Odunayo, a midwife in Ondo State, Nigeria, said the impact of the E-MOTIVE trial has ultimately helped her save lives.
“To carry out research on your own is not easy. Without WHO, we would not know that this E-MOTIVE bundle could really reduce maternal mortality due to postpartum haemorrhage,” said Odunayo. “Somebody made the proposal and said, ‘Let’s do this together.’ That really helped us.”
What’s next
Now that the effectiveness is known, the next step is ensuring it is widely put to use.
“E-MOTIVE is more than the drape; it is a full package. We need to train people to use it effectively,” said Dr Alfred Osoti, Associate Professor at the University of Nairobi. “We need to invest in what we know works. When we have scarce resources, we cannot afford to ignore proven solutions.”
Another pressing issue is drug quality and availability. In the E-MOTIVE trial, researchers had to test brands and identify those that were effective. “Countries need systems to routinely check drug quality, not just once at registration, but on an ongoing basis,” Dr Osoti added. In the absence of such systems, facilities risk relying on poor-quality medications that fail when they are needed most.
To address maternal mortality now that resources are scarce, it is essential to put funding into solutions that we know work. This means training health workers on the complete PPH bundle, regular monitoring on drug quality and consistent monitoring and evaluation of the intervention, which helps ensure that success in one hospital can be replicated in others.
A woman still dies due to maternal causes every two minutes. With scalable solutions at hand the question is no longer what should be done, it is whether or not such solutions will make it to women everywhere.