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News / Understanding Obstetric Hemorrhage: Insights From a Women’s Health Nurse Practitioner 

Understanding Obstetric Hemorrhage: Insights From a Women’s Health Nurse Practitioner 

Published Aug 12, 2024

Jennifer Hawn, DNP, R.N., WHNP-BC, RDMS OB/GYN, C-EFM
Women and Infants Advanced Practice Nurse Clinical Specialist
Missouri Baptist Medical Center | BJC HealthCare 

The Urgency of Addressing Obstetric Hemorrhage 

Delayed recognition and response to maternal hemorrhage that may lead to mortality is largely due to inefficient risk assessment and preparation and antiquated practice with visual estimation of blood loss. Lack of preparation and proper estimation of blood loss with quantitative measurement practices delays recognition of acuity and therefore, delays the opportunity to provide appropriate lifesaving treatment. Beyond the potential for mortality is also the experience of morbidity associated with postpartum hemorrhage, which is often overlooked by the health care team. Mothers who experience an obstetric hemorrhage also may have lasting medical or mental health effects due to the trauma associated with the experience, creating a cascade of challenges in the immediate postpartum period and beyond. The concept and importance of patient support and advocacy for mothers and families who experience a postpartum hemorrhage remains vastly underrecognized by the health care team. 

What Patients Should Know 

Patients should engage in proactive discussions with their obstetric providers about hemorrhage risks. This dialogue should start during prenatal visits and continue through labor, delivery and the postpartum period. Frequent risk assessment guides the health care team in appropriate actions to prepare for the potential for postpartum hemorrhage and alerts the team to those at greatest risk.  

It’s crucial for patients to understand normal and abnormal bleeding patterns, especially since delayed postpartum hemorrhage can occur after discharge. Knowing when to seek help is vital for ensuring safety. 

What Providers Need to Know 

For health care providers, understanding the nuances of obstetric hemorrhage is essential. Quantitative blood loss measurement, although not perfect, is a more reliable method for estimating bleeding than visual estimates. It is supported in the literature and by key stakeholders, such as the American College of Obstetricians and Gynecologists (ACOG), as the most accurate way to estimate blood loss. Institutions must adopt standardized protocols that guide health care teams in responding to excessive blood loss effectively.  

Treatment protocols also should be standardized in the health care setting. Treatment should be based on standardized stage-based protocols that outline clear actionable steps for the health care team with protocols in place for events that require the acquisition of large amounts of blood. Stage-based protocols help define the acuity of the hemorrhage and can guide the team with appropriate escalating interventions and actions. The use of evidence-based tools, like the AWHONN hemorrhage risk-prediction tool, can help identify women at higher risk for hemorrhage, ensuring they receive appropriate care. The AWHONN hemorrhage risk-prediction tool is endorsed by ACOG and has been shown to identify women at moderate or highest risk for hemorrhage-related morbidity and has a high negative predictive value for those who fall into the low-risk category (Colalillo et al., 2021). 

Providers must advocate for patients with significant risk factors for obstetric hemorrhage to deliver at birthing facilities that have necessary staff and adequate volumes of blood products available for treatment if needed. Additionally, providers should prepare for patients who cannot receive blood products as these patients may require more preparation for potential problems and additional communication between the patient and provider. 

Overcoming Barriers to Effective Treatment 

Several barriers exist in effectively managing obstetric hemorrhage, including the lack of preparation, appropriate equipment, standardized protocols, along with culture tendencies to continue the visual estimation of blood loss. These challenges can often be mitigated through enhanced training, the adoption of evidence-based practices and fostering a culture of preparedness within health care settings.  

While some obstetric hemorrhage occurrences are unpredictable, patients at increased risk for obstetric hemorrhage can be recognized with appropriate screening tools, reducing the potential for situations where the appropriate treatments and health care teams needed are unavailable. 

By improving risk assessment and management strategies, we can better equip ourselves to handle obstetric hemorrhage and ultimately save lives. As health care professionals, it’s our responsibility to raise awareness and advocate for changes that prioritize the safety and well-being of mothers and their families. 

About the Author

Jennifer Hawn is a Women’s Health Nurse Practitioner (WHNP) with two decades of experience in maternal and child health. Her journey has led her through various nursing roles and, most recently, into a leadership position focused on quality improvement at a large community hospital in St. Louis. Now, she oversees initiatives related to labor and delivery, mother/baby care, NICU, and pediatrics. Jennifer is a member of Missouri’s Maternal-Child Learning and Action Network and the MO PQC’s Optimizing Postpartum Care Task Force. She also is an appointed member of the Missouri Pregnancy Mortality Review Board and formerly served on the board of the National Association of Nurse Practitioners in Women’s Health. 

References 
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Topics

birthing people

maternal care

obstetric hemorrhage

pregnancy