Was your postpartum haemorrhage handled correctly — and could the care failure be medical negligence?

Understanding postpartum haemorrhage: what normally happens

Postpartum haemorrhage — often called PPH — means heavy bleeding after giving birth. Clinicians define it as losing more than 500 millilitres of blood after a vaginal birth, or more than 1,000 millilitres after a caesarean section. Severe PPH involves losing more than 1,000 millilitres after any birth. It is one of the leading causes of maternal death worldwide, but most cases are preventable when clinicians act quickly.

After a baby is born, the uterus — the womb — normally contracts to push out the placenta and seal off the blood vessels where it was attached. When the uterus does not contract firmly enough, bleeding continues. Clinicians call this uterine atony, and it causes around 80 percent of all PPH cases. Other causes include tears in the birth canal, retained placenta (when pieces of the placenta stay inside the uterus), and clotting problems in the mother’s blood.

What proper care looks like

Midwives and obstetricians follow established protocols for managing the third stage of labour — the period after the baby is born but before the placenta delivers. Proper care includes giving a uterotonic drug (a medicine that makes the uterus contract) such as oxytocin, measuring blood loss accurately, and monitoring the mother’s vital signs closely. Clinicians also assess each woman for risk factors before labour begins, including previous PPH, multiple pregnancy, or a large baby.

For more information about postpartum haemorrhage and what recovery involves, Healthdirect Australia provides reliable, plain-English health information.

When things start to go wrong

PPH can develop very quickly. A woman can lose a dangerous amount of blood within minutes. The problem is that clinical teams sometimes underestimate how much blood a woman has lost, or they delay escalating to a senior doctor. By the time the severity becomes obvious, the window for simple treatment has already closed.

Some complications after birth are expected and manageable. Others are red flags that demand immediate action. Knowing the difference matters.

Each of these signs requires a clinician to act — not to wait and see. Delayed response to any one of these warning signs can allow a manageable bleed to become life-threatening within a very short time.

A common pattern — where care can break down

PPH cases that result in serious harm often share a recognisable pattern. The Australian Commission on Safety and Quality in Health Care has identified failure to recognise and respond to deteriorating patients as one of the most significant safety problems in Australian hospitals. PPH sits squarely within that category.

Below are the most common points where care breaks down in PPH cases.

Failure to identify risk factors before labour
Midwives and obstetricians must review each woman’s history and flag PPH risk factors before or at the start of labour. When a clinical team fails to do this, they enter the third stage of labour without a plan — and without the right medicines or equipment ready.

Underestimating blood loss
Clinicians frequently underestimate how much blood a woman has lost. Visual estimation is notoriously inaccurate. Hospitals should use objective measurement methods, such as weighing blood-soaked materials. When a team underestimates blood loss, they delay treatment — and delay costs lives.

Delayed escalation to senior staff
Junior midwives or nurses sometimes hesitate to escalate to a senior obstetrician. Protocols exist precisely to remove that hesitation. When a hospital’s escalation system fails — or when a junior clinician does not follow it — the mother pays the price.

Delayed administration of uterotonic drugs
Oxytocin and other uterotonic medicines must reach the mother quickly once PPH is identified. Every minute of delay allows more blood loss. A team that waits to confirm the diagnosis before starting treatment has already fallen behind.

Inadequate aftercare and monitoring
Even after the acute bleed is controlled, a woman needs close monitoring for signs of ongoing blood loss, anaemia, and shock. Some hospitals discharge women too quickly, or midwives check on them too infrequently. Secondary PPH — bleeding that begins again hours or days later — can also go unrecognised when aftercare is inadequate.

Why this matters legally

Every clinician who treats a patient owes that patient a duty of care — a legal obligation to provide treatment that meets the standard of a competent professional in the same field. This duty applies to midwives, obstetricians, anaesthetists, and the hospital itself.

Not every case of PPH is negligence. PPH is a recognised complication of childbirth, and even the best clinical teams sometimes face bleeds that are difficult to control. The legal question is not whether PPH occurred — it is whether the clinical team responded to it in the way a competent team would have responded. A complication that develops despite proper care is different from a complication that worsens because proper care was not given.

For a care failure to become legal negligence, three things must be true. The clinician must have owed a duty of care. Their conduct must have fallen below the standard a competent clinician would have met. And that failure must have caused harm that proper care would have prevented or reduced. For more on how this works in practice, see Reframe Legal — Medical Negligence.

When postpartum haemorrhage may amount to medical negligence

The NSW Civil Liability Act 2002 is the main law that governs medical negligence claims in New South Wales — it sets out how courts decide whether a clinician’s conduct fell below an acceptable standard and whether that failure caused the patient’s harm.

Several specific scenarios in PPH cases may give rise to a negligence claim. Each one links a factual failure to a potential legal breach.

If the team failed to give oxytocin after delivery — and bleeding then became severe — that omission may represent a breach of the standard of care. Giving oxytocin routinely after birth is a well-established protocol. Skipping it without clinical reason is difficult to justify.

If a clinician dismissed your concerns — for example, if you told a midwife you felt faint or something was wrong, and she did not act — that failure to respond to a patient’s reported symptoms may be a breach. Clinicians must take patient-reported symptoms seriously, especially in the hours after birth.

If the hospital failed to have a PPH protocol in place — or had one but did not follow it — the institution itself may bear responsibility. Hospitals have an independent duty to maintain safe systems of care.

If a retained placenta was not identified — and ongoing bleeding resulted — the failure to examine the placenta for completeness after delivery may constitute a breach. Checking the placenta is a standard step that every clinician must perform.

When harm becomes long-term or permanent

For many women, the physical effects of a severe PPH do not end when the bleeding stops. The harm can reshape every part of life that follows.

• 1
  Immediate physical harmSevere blood loss can cause haemorrhagic shock — a state where the body’s organs begin to fail because they are not receiving enough oxygen. The kidneys, liver, and brain are all at risk. Some women require emergency surgery, including a hysterectomy — surgical removal of the uterus — which ends their ability to have more children.
• 2
  Weeks and months after birthMany women experience severe anaemia — a shortage of red blood cells — that causes exhaustion, breathlessness, and an inability to care for their newborn. Some require multiple blood transfusions. Recovery from major surgery adds weeks of physical limitation at a time when a woman is also adjusting to new motherhood.
• 3
  Psychological consequencesBirth trauma is a recognised and serious condition. Women who experience a life-threatening PPH frequently develop post-traumatic stress disorder (PTSD), postnatal depression, and severe anxiety. These conditions affect their relationship with their baby, their partner, and their ability to return to work. Many women describe feeling that they nearly died — because they did.
• 4
  Long-term and permanent harmA hysterectomy is permanent. Organ damage from prolonged shock may be permanent. Chronic fatigue, pelvic pain, and hormonal changes following surgical intervention can persist for years. Some women face ongoing fertility treatment costs or the grief of being unable to have further children — a harm that carries both emotional and financial weight.

What compensation can cover in postpartum haemorrhage cases

In New South Wales, compensation in a medical negligence claim can cover a range of losses. Courts and insurers consider pain and suffering, loss of enjoyment of life, past and future medical treatment costs, lost income, and the cost of care and assistance at home.

PPH cases often involve significant compensation because the harm is severe and the consequences are long-lasting. A woman who undergoes an emergency hysterectomy, develops PTSD, and cannot return to work for an extended period faces losses across multiple categories simultaneously.

Each case is assessed on its own facts. These figures are general ranges only. A hysterectomy, permanent organ damage, or severe PTSD may each place a case in the higher range. Time limits apply to medical negligence claims in NSW — generally three years from the date the person knew, or ought to have known, that they had a potential claim. Acting within that period matters.

Bringing it together — do the pieces fit?

You may be reading this because something about your birth experience has stayed with you. Perhaps the bleeding was worse than anyone prepared you for. Perhaps the team seemed disorganised or slow to respond. Perhaps you ended up in surgery and nobody has properly explained why.