If you’re preparing for childbirth, understanding the risks and how to prevent complications is crucial for your safety. In October 2025, the World Health Organization (WHO), along with the International Federation of Gynecology and Obstetrics (FIGO) and the International Confederation of Midwives (ICM), released groundbreaking new guidelines that could save tens of thousands of lives each year. These guidelines focus on postpartum hemorrhage (PPH) — one of the most dangerous complications that can occur after giving birth.
Postpartum hemorrhage is excessive bleeding after childbirth, and it remains one of the leading causes of maternal death worldwide, claiming approximately 45,000 lives annually. Even when it’s not fatal, PPH can lead to serious long-term health problems including organ damage, emergency hysterectomies, and lasting psychological trauma. The good news? Most of these deaths are preventable with proper care and early intervention.
Understanding Postpartum Hemorrhage: The Basics
Postpartum hemorrhage occurs when a woman loses more blood than normal after delivery. Traditionally, doctors defined PPH as losing 500 milliliters (about 2 cups) or more of blood after vaginal delivery, or 1,000 milliliters after a cesarean section. However, the new WHO guidelines introduce more nuanced diagnostic criteria that help healthcare providers catch this complication earlier.
What makes PPH particularly dangerous is how quickly it can escalate. A woman can go from stable to critical in a matter of minutes, which is why the 2025 guidelines emphasize the importance of close monitoring immediately after birth — the period when most maternal deaths occur.
What Causes Excessive Bleeding After Birth?
Several factors can lead to postpartum hemorrhage. The most common cause is uterine atony, which happens when the uterus doesn’t contract properly after delivery. Other causes include retained placental tissue, tears in the cervix or vagina, blood clotting disorders, or placental complications like placenta accreta.
Many cases of PPH occur in women with no identifiable risk factors, which is why universal preventive measures and vigilant monitoring are so important for every birth.
What’s New in the 2025 WHO Guidelines
The newly released guidelines represent the most comprehensive approach to preventing and treating postpartum hemorrhage to date. With 51 evidence-based recommendations drawn from the largest study on the topic — involving over 300,000 women across 23 countries — these guidelines are set to transform maternal care worldwide.
Earlier Detection Through New Diagnostic Criteria
One of the most significant changes is the introduction of earlier warning signs. Healthcare providers are now advised to take action when blood loss reaches 300 milliliters and any abnormal vital signs are observed, rather than waiting until 500 milliliters of blood is lost. This shift toward earlier intervention could be lifesaving, as it allows medical teams to respond before the situation becomes critical.
Calibrated Drapes for Accurate Blood Loss Measurement
The guidelines strongly recommend using calibrated drapes — simple devices that collect and accurately measure blood lost during and after delivery. This seemingly simple tool addresses a major challenge in PPH management: healthcare providers often underestimate blood loss through visual assessment alone. With precise measurements, medical teams can make faster, more informed decisions about when to intervene.
Prevention Strategies Every Expectant Mother Should Know
The 2025 guidelines place significant emphasis on prevention, recognizing that stopping PPH before it starts is far better than treating it after it occurs. Here’s what you should know about the preventive measures recommended for your delivery.
Active Management of the Third Stage of Labor
The third stage of labor — the period between your baby’s birth and the delivery of the placenta — is when most postpartum hemorrhages begin. The guidelines recommend what’s called “active management,” which includes administering medication to help your uterus contract properly.
The preferred medication is oxytocin, or alternatively, heat-stable carbetocin. These drugs help the uterus contract and compress blood vessels, significantly reducing bleeding. If these aren’t available and proper refrigeration is unreliable, misoprostol may be used as a last resort. This is standard practice in most hospitals, but it’s worth discussing with your healthcare provider as part of your birth plan preparation.
Perineal Massage in Late Pregnancy
The guidelines also promote preventive techniques you can start before labor begins. Perineal massage during late pregnancy can reduce the likelihood of severe tears during delivery, which in turn reduces the risk of excessive bleeding. This is something you can discuss with your healthcare provider in your third trimester.
Avoiding Unnecessary Interventions
Interestingly, the guidelines discourage certain practices that were once routine. Routine episiotomies (surgical cuts to enlarge the vaginal opening) are no longer recommended unless medically necessary, as they can actually increase bleeding risk without providing clear benefits for most deliveries.
What This Means for Your Birth Experience
These new guidelines will likely influence how your healthcare team manages your delivery and immediate postpartum care. Here’s what you can expect and how to advocate for yourself.
Enhanced Monitoring After Delivery
You’ll likely notice that nurses and midwives check on you more frequently in the hours immediately after birth. They’ll be monitoring your vital signs closely — checking your blood pressure, heart rate, and overall condition — and using calibrated drapes or other methods to accurately measure any bleeding.
This increased vigilance isn’t cause for alarm; it’s actually a sign that your healthcare facility is implementing best practices to keep you safe. The American College of Obstetricians and Gynecologists supports these enhanced monitoring protocols as essential for maternal safety.
Questions to Ask Your Healthcare Provider
Being informed and prepared helps you feel more confident about your birth experience. Consider asking your obstetrician or midwife these questions during your prenatal visits:
- What protocols does your facility follow for preventing postpartum hemorrhage?
- Do you use calibrated drapes or other tools to measure blood loss accurately?
- What medications will be used during the third stage of labor, and why?
- How quickly can your team respond if excessive bleeding occurs?
- What blood products are available on-site in case of emergency?
Training and Implementation Resources
The WHO guidelines come with comprehensive training modules for healthcare workers, simulation-based emergency response training, and national-level implementation guides. This means that hospitals and birthing centers around the world are receiving the tools they need to implement these lifesaving practices effectively.
Risk Factors and Warning Signs to Watch For
While PPH can happen to anyone, certain factors may increase your risk. Being aware of these can help you and your healthcare team take extra precautions.
High-Risk Factors
You may be at higher risk for postpartum hemorrhage if you have a history of PPH in previous pregnancies, are carrying multiples, have placental abnormalities, have a bleeding disorder, or are experiencing prolonged labor. Other risk factors include having a large baby, obesity, and certain medical conditions like preeclampsia.
However, it’s crucial to understand that many women who experience PPH have none of these risk factors. This is precisely why the new guidelines emphasize universal prevention and monitoring for all births, not just high-risk pregnancies.
Immediate Warning Signs
After delivery, be aware of these warning signs that warrant immediate medical attention: heavy bleeding that soaks through a pad in an hour or less, passing large blood clots (bigger than a golf ball), feeling dizzy or lightheaded, having a rapid heartbeat, or feeling weak and cold. Your healthcare team will be monitoring for these signs, but it’s important that you report any concerning symptoms immediately.
The Global Impact and Future of Maternal Safety
These new guidelines were launched at the 2025 FIGO World Congress in Cape Town, South Africa, as part of the Global Roadmap to Combat Postpartum Hemorrhage between 2023 and 2030. The initiative aims to dramatically reduce maternal deaths worldwide through evidence-based interventions and improved access to quality care.
Professor Jacqueline Dunkley-Bent, Chief Midwife of the International Confederation of Midwives, emphasized that while these guidelines are game-changing, success requires more than just protocols. It demands investment in midwives, maternal care infrastructure, and ensuring that quality healthcare is accessible to all women, regardless of their economic status or geographic location.
Taking Action: Your Role in a Safer Birth
Knowledge is power when it comes to your health and safety during childbirth. Now that you understand the importance of postpartum hemorrhage prevention and the new standards of care, you can be an active participant in your birth experience.
Discuss these guidelines with your healthcare provider at your next prenatal appointment. Ask about your facility’s protocols and how they align with the WHO recommendations. Consider including specific requests about PPH prevention and monitoring in your birth plan. And most importantly, trust your instincts — if something doesn’t feel right after delivery, speak up immediately.
The release of these comprehensive guidelines represents a major step forward in maternal safety. By understanding what postpartum hemorrhage is, how it’s prevented, and what the latest standards of care entail, you’re better equipped to have informed conversations with your healthcare team and ensure the safest possible birth experience for you and your baby.
Remember, the vast majority of births proceed without complications, and with proper care and monitoring, even when PPH occurs, it can be managed effectively. These new guidelines are designed to make childbirth safer for every woman, everywhere — and that includes you.
