Postpartum haemorrhage (PPH), defined as losing about half a litre of blood after vaginal delivery or one litre during caesarean section, remains a leading cause of maternal deaths globally and in Nigeria. According to the World Health Organisation, approximately 14 million women experience PPH annually, with about 70,000 resulting in death. In Nigeria, inadequate health facilities and delayed access to emergency care worsen outcomes. Consultant gynaecologist and Managing Director of Mother and Child Hospital, Lagos, Sunday Olarewaju, identified fibroids, multiple pregnancies, anaemia, and prolonged labour as key risk factors. He explained that multiple pregnancies overstretch the uterus, weakening its ability to contract, while fibroids make the womb "big and flabby," reducing contraction efficiency. Poor uterine tone, retained placental tissue, trauma during delivery, and blood clotting issues—summarised by the "four Ts"—are primary causes of PPH. Olarewaju noted that PPH can occur within 24 hours of delivery or up to three months postpartum. He stressed that women with high-risk conditions such as diabetes, high blood pressure, or unusually large babies should deliver in facilities with skilled healthcare providers to reduce risks.
Sunday Olarewaju's warning about fibroids and multiple pregnancies exposing women to postpartum haemorrhage cuts to the core of Nigeria's maternal health crisis—where medical expertise exists, but access does not. His explanation of the "four Ts" reveals a clinical reality that is well understood in urban hospitals like Mother and Child Hospital, Lagos, yet remains out of reach for millions of women in rural and underserved areas. The fact that PPH can occur weeks after delivery underscores how dangerous it is to treat childbirth as a one-day event requiring only a single hospital visit.
This is not just a medical issue but a reflection of systemic gaps in Nigeria's healthcare infrastructure. Even when women know they have risk factors like fibroids or anaemia, many lack nearby facilities equipped for emergency obstetric care. Prolonged labour, which weakens the uterus, often goes unattended in settings without skilled birth attendants. The result is preventable deaths, particularly among poor and rural women who cannot afford or access private care. Olarewaju's advice to plan deliveries in well-equipped facilities is sound, but it highlights a harsh truth: quality maternal care in Nigeria is increasingly a privilege, not a right.
For ordinary Nigerians, especially in remote communities, this means pregnancy remains a high-stakes gamble. Women with fibroids or multiple pregnancies face a double burden—managing their health while navigating a system that offers limited support. The wider pattern is clear: expert guidance is consistently issued, but without parallel investment in primary healthcare and emergency transport, such advice will continue to save lives only for those who can already afford protection.
