Issues‎ > ‎vol23n1‎ > ‎


The impact of breastfeeding during the third stage of labor on postpartum haemorrhage according to Higham Chart among women Attending Maternity Teaching Hospital in Sulaimani City

Mahabat Hassan Saeed1, Atiya K. Mohammed2,*


1 Department of Maternal Neonate Nursing, College of Nursing University of Sulaimani, Sulaimani, Kurdistan Region- Iraq

2 Department of Maternal Neonate Nursing, College of Nursing, University of Sulaimani, Sulaimani, Kurdistan Region-Iraq *Corresponding author's e-mail: 

Original: 3 December 2020 Revised: 24 January 2021 Accepted: 2 March 202Published online: 20 June 2021

DOI Link:

One of the most important factor influencing the maternal health is postpartum haemorrhage. Immediate breastfeeding after birth is beneficial for releasing natural oxytocin that led to contracting uterus and reducing hemorrhage. To identify the impacts of breastfeeding on postpartum haemorrhage based on Higham chart. The design, a quasi-experimental study, post-test, only control was applied. Non- probability purposive was as sampling technique. Data collection was continued from 26th of February 2020 to 30th of July 2020. Three hundred women were selected from labor word, in the labor ward; these parturient women were equally divided into experimental group, applying early initiation of breastfeeding and control group, following the routine hospital care. In addition to a questionnaire, Pictorial Blood Assessment Cart (PBAC) was used to investigate the postpartum bleeding pattern of women in the labor's third stage. The chart of pictorial blood assessment is according to the presence of clots and the visual appearance of stained pads. According to Higham chart, in the experimental group, within 300 mothers 130 (86.7%) had a mild postpartum haemorrhage, 18 (12.0%) had a moderate postpartum haemorrhage and only 2 (1.3%) had severe postpartum haemorrhage; where in the control group, 32.7% and 30.7% of the women developed severe and moderate postpartum hemorrhage respectively. It is revealed that the extent of postpartum hemorrhage of the experimental group was greatly lower than the control group. Breastfeeding immediately after the birth is effective for decreasing the postpartum hemorrhage.

Key Words: Breastfeeding, Higham Chart, Postpartum haemorrhage, Third stage of labor


[1] J. O. Sotunsa et al., "Maternal near-miss and death among women with postpartum haemorrhage: a secondary analysis of the Nigeria Near-miss and Maternal Death Survey". BJOG An Int. J. Obstet. Gynaecol. Vol. 126, No. S3, pp. 19–25. (2019). doi: 10.1111/1471-0528.15624.

[2] M. N. Norhayati, N. H. Nik Hazlina, Z. Sulaiman, and M. Y. Azman, "Severe maternal morbidity and near misses in tertiary hospitals, Kelantan, Malaysia: A cross-sectional study". BMC Public Health, Vol. 16, No. 1, pp. 1–13. (2016). doi: 10.1186/s12889-016-2895-2.

[3] S. Y. Al Sabati and O. Mousa. "Effect of Early Initiation of Breastfeeding on the Uterine Consistency and the Amount of Vaginal Blood Loss during Early Postpartum Period". Nurs. Prim. Care. Vol. 3, No. 3. (2019). doi: 10.33425/2639-9474.1108.

[4] I. P. Setyatama and I. E. Anggraeni. "Early Breastfeeding Initiation of Postpartum Hemorrhage Events". J. Kebidanan. Vol. 9, No. 2, pp. 108–113. (2019). doi: 10.31983/jkb.v9i2.4332.

[5] R. A. Salam, T. Mansoor, D. Mallick, Z. S. Lassi, J. K. Das, and Z. A. Bhutta. "Essential childbirth and postnatal interventions for improved maternal and neonatal health". Reprod. Health. Vol. 11, No. Suppl 1, p. S3. (2014). doi: 10.1186/1742-4755-11-S1-S3.

[6] C. M. Visness and K. I. Kennedy. "Maternal employment and breast-feeding: Findings from the 1988 national maternal and infant health survey". Am. J. Public Health. Vol. 87, No. 6, pp. 945–950. (1997). doi: 10.2105/AJPH.87.6.945.

[7] P. Abedi, S. Jahanfar, F. Namvar, and J. Lee. "Breastfeeding or nipple stimulation for reducing postpartum haemorrhage in the third stage of labour". Cochrane Database Syst. Rev. Vol. 2016, No. 1. (2016). doi: 10.1002/14651858.CD010845.pub2.

[8] K. Güngördük, Y. Olgaç, V. Gülseren, and M. Kocaer. "Active management of the third stage of labor: A brief overview of key issues". Turk Jinekoloji ve Obstet. Dern. Derg. Vol. 15, No. 3, pp. 188-192. (2018). doi: 10.4274/tjod.39049.

[9] J. L. Magnay, S. O'Brien, C. Gerlinger, and C. Seitz. "Pictorial methods to assess heavy menstrual bleeding in research and clinical practice: A systematic literature review". BMC Womens. Health. Vol. 20, No. 1, pp. 1-15. (2020). doi: 10.1186/s12905-020-0887-y.

[10] S. Y. Kareem. "The impact of Breastfeeding on Breast Cancer among women in Sulaimani city". Vol. 7, No. 3, pp. 437–452. (2016).

[11] E. F. D’Artibale and L. O. Bercini. "The practice of the fourth step of the baby friendly hospital initiative". Esc. Anna Nery - Rev. Enferm. Vol. 18, No. 2, pp. 356–364. (2014). doi: 10.5935/1414-8145.20140052.

[12] R. M. Cantrill, D. K. Creedy, M. Cooke, and F. Dykes. "Effective suckling in relation to naked maternal-infant body contact in the first hour of life: An observation study". BMC Pregnancy Childbirth. Vol. 14, No. 1. (2014). doi: 10.1186/1471-2393-14-20.

[13] E. Dashtinejad, P. Abedi, and P. Afshari. "Comparison of the effect of breast pump stimulation and oxytocin administration on the length of the third stage of labor, postpartum hemorrhage, and anemia: A randomized controlled trial". BMC Pregnancy Childbirth. Vol. 18, No. 1, pp. 1–8, (2018). doi: 10.1186/s12884-018-1832-z.

[14] S. Inal, Y. Aydin, and N. Canbulat. "Factors associated with breastfeeding initiation time in a baby-friendly hospital in Istanbul". Appl. Nurs. Res. Vol. 32, No. 1, pp. 26-29. (2016). doi: 10.1016 /j.apnr.2016.03.008.

[15] K. E. Svensson, M. I. Velandia, A. S. T. Matthiesen, B. L. Welles-Nyström, and A. M. E. Widström. "Effects of mother-infant skin-to-skin contact on severe latch-on problems in older infants: A randomized trial". Int. Breastfeed. J. Vol. 8, No. 1, pp. 1–13. (2013). doi: 10.1186/1746-4358-8-1.


[17] K. Safari, A. A. Saeed, S. S. Hasan, and L. Moghaddam-Banaem. "The effect of mother and newborn early skin-to-skin contact on initiation of breastfeeding, newborn temperature and duration of third stage of labor". Int. Breastfeed. J. Vol. 13, No. 1. (2018). doi: 10.1186/s13006-018-0174-9.

[18] D. "Comparison of oxytocine and suckling on length of the third stage of labour and first day hemorrhage". Vol. 66, pp. 37–39. (2012).

[19] C. H. W. Bullough, R. S. Msuku, and L. Karonde. "EARLY SUCKLING AND POSTPARTUM HAEMORRHAGE : CONTROLLED TRIAL IN DELIVERIES BY TRADITIONAL BIRTH ATTENDANTS levels that occur during preparations for breast-feedinglO". Measurement. pp. 522–525. (2012).

[20] G. Westhoff, A. M. Cotter, and J. E. Tolosa. "Prophylactic oxytocin for the third stage of labour to prevent postpartum haemorrhage". Cochrane Database Syst. Rev. Vol. 2013, No. 10. (2013). doi: 10.1002/14651858.CD001808.pub2.

[21] A. Ekin, C. Gezer, U. Solmaz, C. E. Taner, A. Dogan, and M. Ozeren. "Predictors of severity in primary postpartum hemorrhage". Arch. Gynecol. Obstet. Vol. 292, No. 6, pp. 1247-1254. (2015). doi: 10.1007/s00404-015-3771-5.

[22] J. Durham et al. "Misoprostol for the prevention of postpartum hemorrhage during home births in rural Lao PDR: Establishing a pilot program for community distribution". Int. J. Womens. Health. Vol. 10, pp. 215-227. (2018). doi: 10.2147/IJWH.S150695.

[23] A. I. Frolova, M. J. Stout, M. G. Tuuli, J. D. López, G. A. Macones, and A. G. Cahill. "Duration of the third stage of labor and risk of postpartum hemorrhage". Obstet. Gynecol. Vol. 127, No. 5, pp. 951-956. (2016). doi: 10.1097/AOG.0000000000001399.

[24] M. E. Helmy, T. M. Sayyed, and A. A. Abdo. "The effect of the duration of the third stage of labor on the amount of maternal blood loss". Menoufia Med. J. Vol. 32, No. 1, pp. 212-216. (2020). doi: 10.4103/mmj.mmj.