Insight

The First 60 Minutes: Building a Reliable Response to Bleeding After Birth

Postpartum haemorrhage (PPH) remains one of the most serious complications of childbirth. It is a leading cause of preventable maternal mortality worldwide, and a major contributor to severe maternal morbidity in the UK.

Recent trials, including the E‑MOTIVE study led by teams at the University of Birmingham and the University of Oxford, have reinforced that the window for making a difference is narrow. Earlier, more accurate diagnosis of PPH at the bedside, followed by prompt, bundled treatment, is associated with reductions in severe PPH and life‑saving interventions. 

International guidance from WHO, FIGO and ICM now recommends routine, objective measurement of postpartum blood loss for all women following birth, with calibrated drapes highlighted as a practical method to support earlier detection and treatment.. For more information on the recommendations and their implications for practice, read our article Improving the Diagnosis of PPH.

Why the first 60 minutes matter

In the immediate period after birth, blood loss may appear modest at the bedside. The presence of expected postpartum bleeding can make it difficult to distinguish early PPH from normal blood loss. By the time a haemorrhage is obvious to the naked eye, the opportunity for simple, ward‑based interventions may already be closing.

Findings from E-MOTIVE and other related work have helped to clarify the link between timely diagnosis and outcomes. This evidence underpins a growing policy and clinical push (reflected in RCOG and NHS guidance) towards structured PPH pathways that emphasise early recognition, clear thresholds and team working.

The question for maternity services is not just how to treat PPH once diagnosed, but how to make the first 60 minutes after birth as reliable as possible.

Where recognition and response break down

Despite widespread awareness of the risks, visual estimates of blood loss remain a common point of weakness. Blood soaking into sheets and clothing, or pooling under a woman or birthing person, is hard to quantify accurately, particularly when staff are multitasking. 

Meanwhile, variation between sites adds another layer of complexity. Clinicians bring different training and levels of experience to assessing blood loss, which can influence when they act. Moreover, documentation of blood loss and escalation decisions may not always be aligned across wards, theatres, and recovery areas. 

These are systemic challenges. They arise where systems and processes rely too heavily on judgement and memory, and not enough on objective measurement, shared mental models and practice. Addressing them requires changes not only to tools, but to pathways and team behaviours.

Building a reliable first‑60‑minutes response

A more reliable response to bleeding after birth starts with changing how blood loss is measured. Calibrated PPH drapes offer a practical way to implement the recommendation for routine, objective quantification. Rather than estimating volume, blood is collected into a graduated pouch or funnel with clear volume markers. Placed on the bed or comfortably attached to the woman or birthing person, teams can monitor cumulative loss in real time.

Current international guidance recommends objective measurement of postpartum blood loss to support timely recognition and treatment of PPH. This allows midwives and doctors to see at a glance, whether blood loss is approaching or exceeding locally-agreed thresholds for concern.

Measurement alone, however, is not sufficient. A reliable response also depends on clear roles and escalation pathways. In a standardised PPH pathway, roles and responsibilities are clear, with regards to who’s watching for blood, who’s responsible for uterotonics, who is documenting and who is leading communication and escalation. Locally agreed thresholds, such as specific blood loss volumes, rate of loss or clinical signs, help teams decide when to move from observation to active intervention.

The third component of a reliable response is rehearsal. While policies are essential, they do not, on their own, guarantee consistent performance in high-pressure situations. Regular multidisciplinary drills and simulations, using the actual equipment found on the unit, help teams internalise the steps of their PPH pathway and build fluency in the first minutes of a haemorrhage.

Embedding standardisation across wards, shifts and sites

For many services, the challenge is not knowing what good looks like, but delivering it consistently. Embedding standardisation means making quantitative blood loss measurement the default rather than the exception, ensuring that PPH equipment is stocked and positioned consistently, and aligning documentation so that recognition times, escalation points and interventions can be audited across sites.

Standardising product choices can support this work. Consistency in equipment availability and familiarity can also support implementation, helping teams rehearse PPH pathways using the same equipment they will encounter in clinical practice. New staff and rotating trainees can build confidence more quickly when tools and pathways are familiar wherever they work.

Making every minute count

PPH cannot always be predicted, making a reliable and timely response essential. By combining objective blood-loss measurement with clear escalation pathways, defined team roles and regular rehearsal, maternity teams can strengthen the way PPH is recognised and managed in the critical period after birth.

Maternity by Kimal works with services across the UK to support this shift. To learn more about how Maternity by Kimal’s products can support early accurate detection and management of PPH, visit our website or contact the team for more information.