Postpartum hemorrhage (PPH), or bleeding in the period immediately following birth, is the leading direct cause of maternal death in sub-Saharan Africa and South Asia, and is a major cause of long-term disability. Active Management of the Third Stage of Labor (AMTSL) provides a protocol for managing the time immediately following birth when women are most likely to experience uncontrolled bleeding. Simple actions—including administration of a medication to contract the uterus, controlled delivery of the placenta and careful monitoring of the tone of the uterus and the amount of bleeding—can save lives. Despite the fact that the World Health Organization (WHO) has recommended AMTSL as an evidence-based intervention for preventing PPH for many years, countries have been slow to scale it up and develop systems to measure how frequently, and with what quality, AMTSL is being provided.
Jhpiego has worked in more than 30 countries to operationalize WHO recommendations regarding AMTSL, including collaborating with Ministries of Health to revise policies and service delivery guidelines. We also work with professional associations and facilities to ensure that all health care providers responsible for assisting with childbirth have the skills they need to perform AMTSL to standard. We partner with midwifery, nursing and medical schools to ensure that their students graduate with these same basic abilities to prevent and manage bleeding after birth. Jhpiego recognizes that a provider cannot make a difference without access to the lifesaving medication, equipment and supplies that they need to do their jobs. We also work with governments and hospitals to ensure that workers are optimally supported in their jobs. And beginning in 2008 under the Maternal and Child Health Integrated Program (MCHIP), funded by the U.S. Agency for International Development and led by Jhpiego, pre-service education for skilled birth attendants, including prevention of PPH, was improved in 12 countries: Democratic Republic of Congo, India, Liberia, Malawi, Mozambique, Ethiopia, Ghana, Guinea, Nigeria, Rwanda, Zimbabwe and Bangladesh.
To assist country programs, donors and governments to develop comprehensive and innovative programs to address PPH, Jhpiego and partners under MCHIP have developed a PPH toolkit, the Postpartum Hemorrhage: Prevention and Management toolkit. This program guidance toolkit outlines keysteps, identifies available documents and highlights lessons learned from current projects. As such, it serves as a valuable resource of current evidence, materials and experiences from around the world. It reflects contributions from many donors, agencies, associations, academic institutions and organizations that have identified PPH as a priority and have contributed in different ways to address it, including use of AMTSL and beyond.
Moving forward, Jhpiego and its implementing partners are taking into account the latest evidence regarding the effectiveness of AMTSL. We will interpret and operationalize the latest PPH recommendations and guidelines from WHO and the International Federation of Gynecology and Obstetrics for additional countries—with the ultimate aim of reducing maternal death and disability worldwide.