Prof Andrew Weeks , Anna Melamed and Sonia Richardson on the rising rate of postpartum haemorrhage, and the factors associated with it Your report ( Risk to women of severe bleeding after giving birth at five-year high in England, 13 December ) rightly points out that the risk to women of severe bleeding after giving birth is at a five-year high. The article suggests that this is due to the declining quality and safety of NHS maternity care. But this is not true. The problem of increasing haemorrhage after birth is not simple, and neither women nor the quality of maternity care should be blamed. In a recent World Health Organization analysis , the largest influence on the rate of haemorrhage was caesarean birth, and the only two factors that reduced the haemorrhage risk were home birth and early skin-to-skin contact/breastfeeding. Increased rates of haemorrhage are a natural consequence of high caesarean section rates. Sensationalist quotes of the “terrifying” risk to mothers of haemorrhage will only make the problem worse, as women seek to avoid labour in the NHS, either by choosing a caesarean (which increases the risk of haemorrhage) or by opting out of maternity care altogether (which increases the risk of death if haemorrhage occurs). Continue reading...