Bleeding to death: The preventable tragedy of childbirth

PPH survivor, Mariana Takah Mutwiri, narrates her story to the Standard on October 1, 2026. [Benard Orwongo, Standard]

Bleeding after childbirth is often considered a normal part of bringing a baby into the world. But when the bleeding becomes excessive, it can turn the joy of childbirth into a fight for survival.

Without urgent treatment, a mother can die within hours.

In Kenya, an estimated 3,000 women die from postpartum haemorrhage (PPH), or excessive bleeding after childbirth, every year.

Mariana Takah-Mutwiri knows how close a mother can come to death. She survived twice, losing about one litre of blood each time.

Her first brush with death came in 2020, shortly after she delivered premature twins through a C-Section. Born at just 28 weeks, the twins weighed 980 and 790 grammes.

They needed specialised care in the neonatal intensive care unit, while Mutwiri hoped for a chance to see them.

But about three hours after delivery, she began bleeding excessively, coupled with dizziness, unusual cold and grew weaker.

“When I delivered my twins, I became very dizzy. Since I was in the theatre, I felt very cold and realised that I was losing blood,” she recalls.

“I really wanted to have a glance at my babies, but I was too weak. As I struggled to see them, I was bleeding, and doctors quickly rushed me back to theatre to stop the bleeding.”

Doctors managed to stop the bleeding and save her life. But the twins later died of sepsis (infection).

Having nearly lost her own life, she was afraid of another pregnancy.

In 2021, she suffered a miscarriage. When she conceived again the following year, the anxiety returned.

At six weeks, she began bleeding. This time, she sought medical attention and her doctor developed a plan to help her carry the pregnancy to term.

At 14 weeks, she was placed on bed rest and underwent a McDonald cerclage, a procedure in which a stitch is placed around the cervix to help keep it closed and reduce the risk of premature birth.

At 36 weeks, her waters broke while the stitch was still in place. Mutwiri safely delivered her baby, but while recovering, she realised she was lying in a pool of blood.

“Dizziness, cold and weakness that had marked my first encounter with PPH returned. I realised I was bleeding excessively,” she recalls.

Doctors used abdominal packing and medication to control the bleeding.

She also sought professional counselling and psychotherapy to cope with the loss of her twins and the trauma of nearly dying twice.

Today, Mutwiri is an End PPH ambassador, using runs and social media campaigns to educate women about excessive bleeding after childbirth and the need for timely treatment.

“I had a near miss because many women go through PPH and never live to tell their stories. I have gone through it twice, and I am here, able to tell my story and speak for many more who have never had an opportunity to speak about it,” she says.

Globally, PPH kills 43,000 to 70,000 mothers annually, according to WHO.

Prof Moses Obimbo, project lead of the End PPH Initiative, says the danger is compounded by the belief that bleeding after childbirth is normal.

“There are some myths in the community that because a pregnant woman does not bleed for nine months, after birth, it is normal for her to bleed,” he says.

The challenge. Notes Prof Obimbo,  is recognising when the bleeding becomes dangerous and ensuring treatment begins without delay.

Last year, the World Health Organization (WHO), the International Federation of Gynecology and Obstetrics and the International Confederation of Midwives issued updated recommendations to support earlier detection and treatment of PPH.

Under the guidance, first response treatment of PPH should begin when blood loss reaches 300 millilitres and is accompanied by an abnormal vital sign, or when it reaches 500 millilitres, whichever occurs first within 24 hours after birth.

The approach emphasises measuring blood loss accurately and monitoring a woman's condition rather than relying on visual estimates alone.

Obimbo says PPH can occur when the uterus fails to contract adequately after delivery.

Bleeding can also result from tears in the cervix or vagina, pieces of the placenta remaining in the uterus, or blood-clotting disorders.

Nevertheless, the danger is greater for women who enter childbirth with anaemia, as they have less capacity to withstand blood loss.

The scientist, also the chair of the department of human anatomy highlights that preventing maternal deaths requires attention to women's health long before pregnancy, including addressing heavy menstrual bleeding that may contribute to anaemia.

Obimbo explains that PPH can develop within the first 24 hours after childbirth, while secondary PPH can occur days or even weeks later.

This is what happened to 36-year-old Beatrice Nyongesa, from Kasembeli village in Endebes, Trans Nzoia County, whose bleeding began days after delivery. By the time she reached specialist care, she was dead.

Her husband, Protus Wafula Nyongesa, is still struggling to understand how his wife died from bleeding days after giving birth.

Beatrice went into labour on August 29, during a prolonged nurses' strike that had disrupted services in public hospitals.

Following paralysis in public hospital, with no alternative, her husband took her to a traditional birth attendant, where she safely delivered their baby.

Beatrice experienced bleeding that the birth attendant attempted to stop with herbs and conventional medicine.

Though she was released back home, the bleeding was on and off.

On September 2, four days after delivery, Beatrice complained of spotting while at home with her husband and their newborn. Gradually, the bleeding became heavier.

The family rushed her to a private clinic in Kitale, but her condition continued to deteriorate. The following day,  On the clinic referred her to Dr Geoffrey Kasembeli, a consultant obstetrician and gynaecologist in Trans Nzoia County.

However, by the time she arrived, she was dead.

“She died of PPH. PPH could not be treated by a birth attendant. Sadly, the mother died while seeking care,” says Dr Kasembeli.

Obimbo says many deaths from PPH can be prevented if recognised early and women receive appropriate treatment without delay.

WHO recommends a coordinated first response that includes uterine massage, medicines to help the uterus contract, tranexamic acid to reduce bleeding, intravenous fluids, examination to identify the source of bleeding and escalation of care when necessary.

But according to the scientist, these interventions depend on health facilities having trained staff, essential medicines, equipment and reliable referral systems.

“When a mother dies because of PPH, it usually implies that the health system has failed,” Obimbo says, pointing to possible shortages of resources and delays in providing care.

Blood availability. Obimbo estimates that two in every 10 women who die from PPH do so because blood is unavailable at the facilities where they seek treatment.

Additionally, facilities need medicines that help the uterus contract, tranexamic acid, blood for transfusion and non-pneumatic anti-shock garments that can help stabilise women experiencing severe blood loss while they are referred for further treatment.

In 2023, WHO introduced a roadmap to accelerate action against PPH by 2030. Obimbo says the End PPH Initiative was formed with partners in 2024 to strengthen advocacy, community engagement, research and health-system capacity.

At least 13 counties have been identified as hotspots for PPH related maternal deaths, including Garissa, Wajir, Tana River, Homa Bay, Siaya and West Pokot.

However, Obimbo emphasises that preparedness must extend to all 47 counties.

At Pumwani Maternity Hospital, the leading facility in deliveries nationally, health workers prompt recognition and treatment of PPH as critical to saving mothers lives.

The hospital records about 15,000 deliveries annually, with between 30 and 40 mothers delivering vaginally each day with 10 through CS.

At least three in every 10 women who deliver at the hospital develop PPH, according to Dr Kevin Muriithi, a medical officer.

“Most of the women who develop PPH are those who come to hospital after labouring for so long. They labour at home for about two to three days,” explains the doctor.

“Mothers diagnosed with PPH are immediately started on treatment, with blood transfusions provided when necessary.”

The hospital transfuses at least five mothers every day, a move that underline the need for a reliable blood supply to manage obstetric emergencies.

Dennis Oduor, the blood transfusion coordinator in Nairobi County says between 25 and 50 percent of collected blood goes towards maternity and newborn care.

Despite the high demand, blood collection remains seasonal, with supplies often dipping during school holidays when many donation drives rely on students.

For example, in 2025, Nairobi collected about 33,000 pints against annual target of 43,971, according to Oduor.

To strengthen supplies, Pumwani established a blood satellite in May 2024, that has since collected more than 10,000 units