Design and use of postpartum haemorrhage kits in the NHS: a qualitative study

What is a postpartum haemorrhage kit?

Postpartum haemorrhage (PPH) – or severe bleeding post-birth – is a leading cause of death worldwide in women who have just given birth. Managing a PPH effectively depends on a multi-professional response happening within minutes, and this includes being able to access the correct equipment and medications quickly.

A postpartum haemorrhage (PPH) kit is a ready-made emergency kit designed to be used in maternity units for situations when a woman is bleeding heavily after giving birth.

It usually contains:

• Medicines to help stop the bleeding
• Equipment doctors and midwives need to manage the situation
• Step-by-step guidance to aid the maternity team during the emergency

The kits used to manage PPH are often designed locally, sometimes without considering the different contexts in which they might need to be used. Because of this, their design, usability, and integration into clinical workflows have remained largely unexamined. This is an important gap, as evaluation of design and use of PPH kits can inform developments that may improve the outcomes for women during an emergency.

What we found when we examined the contents of postpartum haemorrhage (PPH) kits

We drew on photographs of kits in situ, field observations, and 19 interviews with professionals to examine PPH kit design and usability. We also looked at the contextual factors (the specific tasks, users, physical environments, and organisational settings) to see how kits were used in six maternity units within the NHS.

The research revealed that the kits’ design features varied a lot across different maternity units and were used in a wide variety of contexts.

We also discovered that many design features, including the format of the kits, the way that items were grouped within them, item visibility, and kit portability, varied between the PPH kits we studied.

• Kit format: We found that different units used different formats for kits, such as shallow or deep plastic boxes, PPH drawers within general maternity trolleys, or dedicated multi-drawer trolleys.
• Item grouping and visibility: Some kits lacked internal structure, with all the necessary items kept in one container – others grouped items by task to make them easier to identify quickly.
• Portability: While box-format kits were highly portable and could be placed within arm’s reach, larger trolley-based designs could be difficult to move around in crowded labour rooms.

How contextual factors affected PPH kit use

The usability of the PPH kits was influenced by contextual factors including the physical environment of the labour room and storage areas, medication access, staff skill mix, and restocking procedures.

• Physical environment: The layout of the room, its available work surfaces, and storage constraints, and more, dictated where PPH kits were placed and used.
• Medication access: Time-sensitive responses required access to temperature-controlled medications in fridges, or medications that were kept in locked cupboards.
• Staff skill mix and training: PPH kits were used by a wide range of staff with varying levels of experience; however, training (particularly for maternity care assistants who are often sent to find the kits) was often informal or inconsistent.
• Restocking procedures: systems for checking and replenishing supplies varied from manual paper records to electronic software, with some systems more efficient than others.

Poorly designed kits can potentially delay life‑saving interventions during PPH, so should they be standardised?

Our findings suggest that while this is a good idea in principle, in practice there needs to be a degree of flexibility, because imposing a one‑size‑fits‑all kit could risk clashing with local workflows and environments.

We suggest a modular approach instead, collaboratively designed with end‑users to ensure that PPH kits reflect real clinical practice.

Kits could include a standardised core module, along with additional items which are tailored to local needs and constraints. This balanced model would support both safety and flexibility, helping maternity units to respond faster, more confidently, and more effectively.

The approach could involve:

1. Co-design with end-users – ensuring that PPH kits are collaboratively designed with end-users to align with real-world clinical practice and local work systems.
2. Establishing standardised core components – a central module containing essential items for initial response tasks, grounded in ergonomic principles like task-based grouping and clear labelling.
3. Adaptable elements: flexible components that can be tailored to meet the specific needs and constraints of individual maternity units.

This approach offers more flexibility and could improve readiness for emergencies in different maternity settings.

Acknowledgements

We’d like to acknowledge the input and guidance of the PPH Kits Contributor Group, which included obstetricians, midwives, design specialists and researchers: Arlene Wise, Chloe de Souza, Imogen Brown, Katie Cornthwaite, Lauren Morgan, Louise Swaminathan, Lydia Ufton, Nuala Lucas, Sarah Bell, Sarah Hookes, Sharon Murrell, Sian Harrington, and Steve Summerskill.