Strategy to reduce the danger of bleeding after birth
SOME 160 women a year in Wales are avoiding the need for a blood transfusion after giving birth thanks to a pioneering project.
The Obstetric Bleeding Strategy (OBS) Cymru project aimed to reduce harm from postpartum haemorrhage through the use of a new checklist requiring midwives to measure blood-loss throughout childbirth by weighing the amount of blood on a patient’s sheets and in collection containers.
This process means midwives know as soon as a patient is bleeding abnormally, enabling early interventions to prevent the need for a blood transfusion. Before this, blood-loss wasn’t measured consistently in Wales.
Due to its success, OBS Cymru has been adopted into the AllWales Postpartum Haemorrhage Guidelines. Midwives, obstetricians, anaesthetists, haematologists and healthcare assistants throughout health boards now follow the same process for management of blood-loss during childbirth. In 2021, OBS Cymru was given the Health and Care Research Wales Research Impact Award.
Sarah Milosevic, 35, from Llangattock, near Crickhowell, experienced a major haemorrhage with her first baby in November 2021.
She said: “I saw an advert on the Health and Care Research Wales website asking for people with experience of postpartum haemorrhage to help plan further research into the effectiveness of OBS Cymru. I believe maternity research is vitally important, and as the discussions were online it was easy to take part with a small baby.
“Even though I had severe bleeding when I gave birth to my son, it was clear the midwives and doctors knew exactly what they were doing and I felt like I was in safe hands. However, I know this isn’t the same for every mum, and that postpartum haemorrhage can be a really difficult experience. I wanted to give feedback so that I could help contribute to the improvement of maternity care throughout the UK.”
Speaking on International Day of the Midwife 2022, Professor Julia Sanders, specialty lead for reproductive health at Health and Care Research Wales, said: “Major bleeding is one of the most common complications experienced by women during childbirth, and faced by midwives and obstetricians.
“The OBS Cymru project has improved the management of postpartum haemorrhage in maternity units throughout Wales, resulting in better outcomes for the women in our care.
“Although the OBS Cymru approach to postpartum haemorrhage has been shown to work in Wales, guidance and practice still differs across the UK. To get the strong evidence needed to support the OBS Cymru approach, research is now required on a larger scale involving the other UK nations.
“An application for this larger study has been developed and I am hopeful it will be funded. I’m so proud of developments like this which show how the multidisciplinary maternity teams in Wales work together to develop and test pioneering improvements to maternity care and midwifery practice.”
Dr Sarah Bell, consultant anaesthetist at Cardiff and Vale University Health Board, who is leading on this work, said: “The OBS Cymru project is the result of 10 years of research into the best ways to identify and treat major bleeding after childbirth.
“We know patients in Wales are benefiting from this change in practice and through further research we hope to change future postpartum haemorrhage guidelines across the UK so that this approach can benefit all women.”
Maryanne Bray, lead research midwife at Cardiff and Vale University Health Board, said: “Research into interventions like this is so important because it shows how small changes in our processes can have a big impact. What we do as a maternity team can affect a mum and her baby for the rest of their lives, so it’s important that we get it right. I believe that there is still so much we can do to improve care and outcomes for women in the future and research is the answer.”
The OBS Cymru project was an improvement programme from 2016-19 based on the results of the OBS2 study, led by Professor Peter Collins, and run by the Centre for Trials Research, part of the Health and Care Research Wales funded community.