After the Unexpected: Ontario Midwifery Clients’ Experiences of Postpartum Hemorrhage


Jenna Robertson, MA, RM, Sophia Kehler, BA, Anna Meuser, MPH, Tasha MacDonald, MHSc, RM, Jenny Gilbert, MA, and Suzannah Bennett, MHSc



Background: The incidence of postpartum hemorrhage (PPH) varies worldwide. While there is abundant research to guide midwifery practice regarding the acute clinical management of PPH, there is less known about the psychological needs of clients and families following significant blood loss during birth, and no relevant research conducted in a Canadian setting.

Methods: Analysis of qualitative data was conducted based on data from two focus groups and two online surveys with participants who had received midwifery care during at least one pregnancy and had experienced at least one PPH.

Objective: The goal of this research was to describe the experiences of midwifery clients in Ontario who had suffered a PPH and to compare those findings to what is documented in existing literature.

Findings: This study found a range of physical and emotional responses to the experience of PPH, ranging from no effect to short- or longer-term psychological trauma, which is consistent with a small but growing body of international studies. While the risk of delayed lactogenesis increases with PPH, most participants in this study reported no breastfeeding concerns. This study is unique in reporting on creative strategies families developed to cope with PPH.

Conclusion: Overall, midwifery clients reported feeling well informed by their midwives during an emergency, which translated to positive feelings of control and autonomy. Informed choice, continuity of care, and regular postpartum follow-up were all cited as factors contributing to a positive experience of an adverse event.


postpartum hemorrhage, postpartum hemorrhage psychology, midwifery, postpartum period psychology, stress disorders, post-traumatic, breastfeeding


This article has been peer reviewed.


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