An essential core skill of a midwife or any health professional attending women in labour is estimating blood loss at birth. Postpartum haemorrhage (PPH) is as one of the leading causes of death of women giving birth, particularly in low-income countries. While traditionally a PPH is defined as a blood loss greater than 500mls or any amount of blood loss that causes a new mother’s condition to deteriorate. The World Health Organisation (WHO) suggests that a blood loss below 1000mls may be physiological in a well, healthy woman. The rationale behind this is that most women will remain well with this amount of blood loss.

Recognising Postpartum Haemorrhage

Following birth, to keep women safe, midwives and doctors,  must recognise and treat PPH appropriately. Many studies, however, show an inaccuracy in visual estimation of blood loss at birth. This inaccuracy may lead to a woman bleeding excessively, and a PPH missed. A missed PPH can result in a woman becoming unwell or even worse losing her life.

Numerous strategies have evolved to help midwives and doctors to improve their evaluation of blood loss; however, none are relevant to a woman giving birth in water. The only way blood loss in water can be estimated is via a visual estimation.

When we did a quick scan of the evidence, the literature shows that most training scenarios use simulated blood. As a result, the end product doesn’t necessarily simulate the real thing. Consequently, the result can lead to an over or underestimation of blood loss.

Visual tool for Estimating Blood Loss at Birth

At PBB, we wanted to develop a quick visual tool to help health professionals more accurately recognise blood loss in a birth pool. More specifically, using a Birth Pool in a Box (regular size). Using real expired blood obtained from the Blood Bank, we measured four different amounts and poured them into an inflated birth pool in a box filled with warm water (approximately 37 degrees celsius). Subsequently, we videoed and photographed the quantities of blood in the pool. Then we created this training tool for you to view.

We wanted to create a free resource to help improve midwives and doctors accuracy in estimating blood loss in a birth pool. PBB welcomes feedback and comments to help improve this free tool. Also, we have created a visual PDF document that you can download and share in your workplace.

Download our Estimating blood loss at birth visual estimator

Estimating blood loss at birth

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Published 3rd July 2020

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