GM is a 24-year-old woman living in a small village in rural Malawi. This was her second pregnancy; her first delivery two years ago was uneventful. Grace received minimal antenatal care during her current pregnancy due to the distance to the nearest clinic and the belief in her community that childbirth is a natural process that doesn’t require medical intervention. She planned to give birth at home with the help of a traditional birth attendant.

GM delivered a healthy baby boy at home. However, shortly after delivery, she began to experience severe vaginal bleeding. The traditional birth attendant attempted to manage the bleeding using herbal remedies and manual uterine massage, but the bleeding continued. Grace became increasingly weak and dizzy.

GM lives in a village where access to healthcare is limited, and there is a strong reliance on traditional practices. The nearest health centre is over 20 kilometres away, and transportation is challenging. Her family’s primary income comes from subsistence farming, and they have limited financial resources.

When GM finally arrived at the local health centre, she was extremely pale, with a weak pulse and low blood pressure, indicating significant blood loss. The healthcare workers noted that her uterus was soft and not contracting properly, which is typical in cases of postpartum haemorrhage (PPH).

Due to the urgency of the situation, immediate resuscitation efforts were prioritised over extensive investigations. The clinical assessment indicated that the most likely cause of the haemorrhage was uterine atony, where the uterus fails to contract after delivery, leading to excessive bleeding.

The health centre had limited resources, but the medical team administered uterotonics to stimulate uterine contractions and started intravenous fluids to manage shock. Blood transfusion was necessary, but the health centre had no blood bank, requiring a further referral to the district hospital. However, the lack of immediate transport posed a critical delay. Despite the health workers' efforts, GM’s condition deteriorated during the transfer.

GM eventually reached the district hospital, where she received a blood transfusion and further treatment to control the bleeding. Although she survived, she remained hospitalised for an extended period due to the severity of the haemorrhage and the delay in receiving definitive care. This case underscores the critical challenges in managing postpartum haemorrhage in sub-Saharan Africa, where delays in emergency care and limited resources can put women's lives at serious risk.