Get access


A 90s Approach to an Age-Old Problem


  • Susan Akins cnm, msn

    Corresponding author
      210520 Estate Lane, Dallas, TX 75238.
    Search for more papers by this author
    • 1 Susan W. Akins is a staff nurse-midwife at Parkland Memorial Hospital and a recent graduate of Parkland School of Nurse-Midwifery in Dallas, Texas.

210520 Estate Lane, Dallas, TX 75238.


Severe hemorrhage occurs in less than 1% of all pregnancies; however, it remains one of the important causes of maternal morbidity and mortality. Although the importance of hemorrhage has been recognized in obstetric circles for years, in the last decade or so, research has been conducted that has disproven long-held beliefs, Nurse-midwives must be knowledgeable about the etiology, management, and treatment of postpartum hemorrhage. This article presents an overview of postpartum hemorrhage and its pharmacologic and nurse-midwifery management. The overview includes definitions of postpartum hemorrhage, identifies risk factors for hemorrhage, and addresses problems associated with estimation of blood loss. The mechanisms of action of ergots, oxytocin, and prostaglandins are described, and criteria for selecting a medication are presented. Herbal remedies for hemorrhage are discussed briefly. Also discussed are the optimal time for drawing the hematocrit and what this laboratory value can tell the nurse-midwife.

Get access to the full text of this article