How can Maternal Mortality from Postpartum Haemorrhage in the Developing World be most effectively reduced

Decreasing the rates of maternal mortality has been set as one of the priorities of the United National Millennium Development Goals (MDGs). For MDG5, goals relating to the decrease of maternal mortality by three quarters from 1990 to 2015 have been set, and since 1990, rates of maternal deaths have been decreased by 47%. Women in developing countries also have a higher rate of pregnancy as compared to women in developed countries. As such, their risk of pregnancy-related death is higher. Maternal deaths are attributed to different factors including severe bleeding (postpartum haemorrhage), infections, high blood pressure at pregnancy, and unsafe abortion. This study will focus on postpartum haemorrhage. The WHO (2013) declares that severe postpartum bleeding can kill a delivering mother within two hours from delivery if interventions are not implemented immediately and the bleeding is not stopped. Moderate postpartum haemorrhage is defined as blood loss more than or equivalent to 500 millilitres in the first 24 hours following delivery of the child. Severe postpartum haemorrhage is considered as blood loss of 1000 millilitres or more (WHO, 2008). Postpartum haemorrhage according to the World Health Organization (WHO) can be attributed to the uterus’s failure to contract adequately (atony). … It is sometimes caused by prolonged labour (Fischer, 2012). During postpartum haemorrhage, the placenta connecting to the foetus and the maternal uterine wall is separated with the contraction and retraction of the uterine walls (Fischer, 2012). Every minute, about 500 to 800 millilitres of blood flows at the site of the placenta attachment. As the mother’s uterus contracts during childbirth, the blood vessels then close. Bleeding then stops (WHO, 2008). Where the maternal uterus does not contract, the blood vessels stay open and bleeding will likely persist. Death can follow within minutes where no immediate care is provided (WHO, 2008). As discussed by the US Agency for International Development (USAID) (2009), postpartum haemorrhage is the most significant cause of maternal deaths worldwide. In fact, it is being credited for about 132,000 yearly maternal deaths. For developing countries where majority of the births are carried out in homes and local health units, the management for childbirths including postpartum haemorrhage is largely inadequate. The various interventions used to manage postpartum haemorrhage, including emergency referrals, blood transfusion, obstetric care, and surgery are not accessible or available to these women (USAID, 2009). As a result, these gaps in the delivery of maternal care are persistently posing a significant danger to the lives of pregnant and delivering mothers and their infants. This paper shall discuss how midwives working in rural regions of developing countries can reduce maternal mortality from postpartum haemorrhage. A critical appraisal of studies shall be carried out, covering primarily the causes of postpartum haemorrhage in developing countries, the roles of midwives in managing postpartum bleeding, and the