University of Birmingham

Seven minutes.

Seven minutes is, apparently, the average time it takes people to fall asleep. According to some research, it’s the ideal time span to concentrate and learn, the optimal read length for an article, and scores of articles tout the benefits of a seven-minute workout.

Seven minutes is also, tragically, how often a woman around the world on average dies from excessive bleeding during childbirth.

Excessive bleeding, or postpartum haemorrhage, affects 24 million women every year, leading to 70,000 deaths. Losing too much blood during childbirth is one of the biggest causes of maternal mortality and mostly affects low- and middle-income countries.

Some 27% of maternal deaths worldwide are caused by or involve postpartum haemorrhage.

For nearly 30 years as a doctor and reproductive medicine specialist, I have been interested in how the medical community can make dying in childbirth a historic, rather than a present-day tragedy.

With colleagues from the University of Birmingham and the World Health Organization, and funded by the Bill and Melinda Gates Foundation, we have now published a trial of a set of interventions and tools that could dramatically reduce the numbers of women dying from excessive bleeding during childbirth.

The intervention is deceptively simple.

Central to the package of care for expectant mothers going into labour is a low-cost drape that collects blood, providing an objective measure of blood loss that can be acted upon quickly.

The $1-2 drape is complemented by an immediate treatment bundle, which includes uterine massage, medicines to contract the womb and stop the bleeding (oxytocic drugs), a medicine to clot the blood (tranexamic acid), intravenous fluid administration, more thorough medical examinations and, where needed, an escalation to advanced care for those women who need it.

One of the biggest challenges that has been identified for responding to excessive bleeding during childbirth is that blood loss is often detected too late, often based on visual inspection, which can underestimate the amount of blood loss. It is the ticking of time that kills a woman who is bleeding after childbirth, and the drape provides an opportunity for early intervention.

My team from the University of Birmingham have been in a uniquely privileged position to evaluate the effectiveness of the package of care, called the E-MOTIVE intervention, working with the World Health Organization with the support of the Bill and Melinda Gates Foundation to carry out this research.

Over 200,000 women from 80 hospitals across Kenya, Nigeria, South Africa and Tanzania took part in our trial published in the New England Journal of Medicine to find out how effective the package of care was at reducing the risk of excessive bleeding, as well as complications or fatal haemorrhage.

The E-MOTIVE intervention led to a staggering 60% reduction in the number of women with heavy bleeding and demonstrated that the intervention could save some 22,000 lives every year, or a life saved every 24 minutes, somewhere in the world.

I am immensely proud of the team here at the University of Birmingham and partners around the globe who delivered on this trial, even working right through the COVID-19 pandemic.

UK universities including the University of Birmingham continue to enjoy a world-leading reputation for expertise in maternal health, and this research exemplifies the best of what we can do with that expertise, collaborating with researchers and clinicians around the world to find and test the best solutions for the most pressing problems in global health.

Implementing the E-MOTIVE intervention will give us the chance to make the seven-minute statistic history.