If you’ve spent any time reading about maternal health recently, you’ve probably seen headlines about postpartum hemorrhage (PPH). The numbers are concerning. A recent study found that between 2016 and 2022, deliveries involving postpartum hemorrhage and/or treatment with second-line medications used to control bleeding increased from approximately 12% to nearly 20%.
As a birth injury lawyer, postpartum hemorrhage is one of the obstetric emergencies I encounter most often when reviewing medical records. Sometimes the hemorrhage was unavoidable. Sometimes there were delays in recognition or treatment. But one question comes up again and again:
Why are postpartum hemorrhage rates increasing?
The honest answer is that we don’t know for certain.
Researchers do not believe there is one single explanation. Instead, the increase is likely multifactorial, meaning several changes in obstetric care and the pregnant population are probably contributing at the same time.
One important point is that an increase in postpartum hemorrhage does not necessarily mean an increase in preventable postpartum hemorrhage. Some hemorrhages are unavoidable despite excellent medical care. Others may be preventable through timely recognition, appropriate preparation, and evidence-based management. Understanding why overall rates are increasing is a separate question from determining whether a particular hemorrhage could have been prevented.
To understand why postpartum hemorrhage rates are rising, it first helps to understand what postpartum hemorrhage is, what causes it, and how it is treated.
What Is Postpartum Hemorrhage?
Postpartum hemorrhage (PPH) is excessive bleeding after childbirth. It is traditionally defined as blood loss of 1,000 milliliters or more within the first 24 hours after delivery, or any amount of blood loss that causes signs or symptoms of low blood volume, regardless of the exact amount.
Some bleeding after birth is normal. Postpartum hemorrhage is different. Without prompt recognition and treatment, severe blood loss can lead to shock, organ injury, emergency surgery, hysterectomy, and, in rare cases, maternal death.
Fortunately, with early recognition and evidence-based treatment, most postpartum hemorrhages can be managed successfully.
What Causes Postpartum Hemorrhage?
There is no single cause of postpartum hemorrhage.
The most common cause is uterine atony, which occurs when the uterus does not contract effectively after the baby and placenta are delivered. Normally, uterine contractions compress the blood vessels where the placenta was attached. If the uterus remains relaxed, significant bleeding can occur.
Other common causes include:
- Retained placental tissue
- Tears of the cervix, vagina, or perineum
- Placental abnormalities, including placenta accreta spectrum
- Blood clotting disorders
Sometimes more than one factor contributes to the hemorrhage.
How Is Postpartum Hemorrhage Treated?
Because postpartum hemorrhage can become life-threatening very quickly, treatment focuses on rapidly identifying the cause while controlling the bleeding.
Depending on the situation, treatment may include:
- Uterine massage
- Medications (called uterotonics) that help the uterus contract
- Tranexamic acid (TXA), a medication that helps reduce bleeding
- Intravenous fluids and blood transfusions
- Removal of retained placental tissue
- Balloon tamponade to apply pressure inside the uterus
- Interventional radiology procedures
- Emergency surgery, including hysterectomy when necessary to save the mother’s life
Most hospitals also have standardized postpartum hemorrhage protocols, hemorrhage carts, and multidisciplinary response teams designed to improve recognition and speed treatment.
With that background in mind, here’s what the current research tells us about why postpartum hemorrhage rates may be increasing.
1. Today’s Obstetric Population Looks Different
Pregnancy today is different than it was several decades ago.
More people are entering pregnancy at older maternal ages and with pre-existing or chronic medical conditions such as obesity, diabetes, and hypertension. Multiple gestation pregnancies (twins or triplets) are also more common, and more patients begin pregnancy with a history of prior uterine surgery.
Many of these factors are independently associated with an increased risk of postpartum hemorrhage. While they do not explain the entire increase, they likely contribute to the overall trend.
2. Labor Management Has Changed
Labor management has also evolved over the years.
Labor inductions are more common today than they were decades ago, and synthetic oxytocin (Pitocin) is frequently used to induce or augment labor.
It’s important to emphasize that Pitocin is an evidence-based medication and is often medically necessary. In many situations, it improves outcomes for both mother and baby.
At the same time, prolonged exposure to oxytocin is a recognized risk factor for uterine atony, the failure of the uterine muscles to contract effectively after birth, which is the most common cause of postpartum hemorrhage. Researchers have proposed that prolonged exposure during labor may lead to temporary oxytocin receptor desensitization, making the uterus less responsive after birth when strong contractions are needed to compress blood vessels and stop bleeding.
However, while this mechanism is biologically plausible, it has not been shown to fully explain the national increase in postpartum hemorrhage on its own.
3. More Patients Have Prior Cesarean Deliveries
Another important contributor may be the increasing number of patients entering pregnancy after a previous Cesarean delivery.
A prior C-section increases the risk of Placenta Accreta Spectrum (PAS) in future pregnancies, particularly when placenta previa is also present.
Placenta accreta occurs when the placenta grows too deeply into the uterine wall and cannot separate normally after delivery. Because the placenta cannot detach properly, these pregnancies carry a substantially higher risk of severe postpartum hemorrhage, massive blood transfusions, or emergency hysterectomy.
As repeat Cesarean rates have increased over time, so has the documented incidence of placenta accreta spectrum.
4. We Are Better at Recognizing Postpartum Hemorrhage
Not every increase in the numbers necessarily reflects an increase in actual disease.
Historically, blood loss during childbirth was estimated visually. Research has consistently shown that visual estimation often underestimates actual blood loss, particularly during larger hemorrhages.
Today, many hospitals have adopted Quantitative Blood Loss (QBL), which uses measured blood collection and weighed surgical materials rather than visual estimation alone. Hospitals have also implemented standardized postpartum hemorrhage bundles, multidisciplinary response teams, and earlier treatment pathways.
As a result, clinicians are likely identifying and documenting postpartum hemorrhage more consistently than they did in previous decades. In other words, part of the statistical increase may reflect improved recognition and documentation rather than a true increase in severe bleeding events.
The Bottom Line
The rise in postpartum hemorrhage is unlikely to be explained by any single factor. Instead, current evidence suggests it is probably the result of multiple overlapping changes, including:
- A changing obstetric population with more complex medical histories
- Evolving labor management practices, including increased use of labor induction and oxytocin
- More pregnancies following a prior Cesarean delivery
- Better recognition, measurement, and documentation of blood loss
Researchers continue to study how much each of these factors contributes.
Understanding these trends is important, not because every postpartum hemorrhage is preventable, but because early recognition, preparation, and timely treatment remain some of the most effective tools we have to reduce serious maternal complications and save lives.
References
- Rood KM, et al. Treatment Patterns and Costs Among Hospital Births With Postpartum Hemorrhage and/or Second-Line Uterotonics or Tranexamic Acid in the United States. Pregnancy. 2025.
- American College of Obstetricians and Gynecologists. Practice Bulletin No. 183: Postpartum Hemorrhage.Obstetrics & Gynecology. 2017.
- American College of Obstetricians and Gynecologists. Committee Opinion No. 794: Quantitative Blood Loss in Obstetric Hemorrhage. Reaffirmed 2023.
- American College of Obstetricians and Gynecologists. Obstetric Care Consensus No. 7: Placenta Accreta Spectrum. Obstetrics & Gynecology. 2018.
- Callaghan WM, Kuklina EV, Berg CJ. Trends in Postpartum Hemorrhage: United States, 1994–2006. American Journal of Obstetrics & Gynecology. 2010.
- Menard MK, Main EK, Currigan SM. Executive Summary of the reVITALize Initiative: Standardizing Obstetric Data Definitions. Obstetrics & Gynecology. 2014.
- Phaneuf S, et al. The Desensitization of Oxytocin Receptors in Human Myometrium Is Accompanied by Down-Regulation of Oxytocin Receptor Messenger RNA. Molecular Endocrinology. 2000.
Disclaimer: This article is provided for educational purposes only and does not constitute medical or legal advice. Every pregnancy, birth, and postpartum recovery is unique. If you have concerns about your health, seek care from a qualified healthcare professional. If you have questions about a potential legal claim, consult an attorney regarding the specific facts of your situation.