Midwifery Management of Postpartum Hemorrhage Due to Uterine Atony Using Helen Varney’s Framework

A Case Report

Abstract

Uterine atony is the leading cause of postpartum hemorrhage and remains a major contributor to maternal morbidity and mortality worldwide. Although evidence-based guidelines for postpartum hemorrhage management are well established, reports describing the systematic implementation of comprehensive midwifery care in primary maternity settings remain limited. Objective: This study aimed to describe the implementation of Helen Varney’s seven-step midwifery management framework in managing postpartum hemorrhage caused by uterine atony in a primary maternity clinic and to demonstrate its role in supporting timely clinical decision-making and maternal stabilization. Methods: This study employed a qualitative descriptive case report design involving a 35-year-old woman (G3P1A1) at 39 weeks of gestation who developed uterine atony during the fourth stage of labor at Pratama Kasih Bunda Clinic, Deli Serdang Regency, Indonesia. Data were collected through anamnesis, physical and obstetric examinations, direct clinical observation, labor monitoring, and documentation review. Data were analyzed narratively using Helen Varney’s seven-step midwifery management framework. Findings: The patient developed postpartum hemorrhage characterized by continuous vaginal bleeding, a soft uterus, fundal height at the level of the umbilicus, decreased blood pressure, and increased pulse rate shortly after placental delivery. Immediate interventions, including uterine fundal massage, uterotonic administration, bladder emptying, external uterine compression, and continuous monitoring, successfully restored uterine contraction, controlled bleeding, stabilized maternal vital signs, and prevented hypovolemic shock. Implications: The findings reinforce the importance of structured postpartum monitoring and rapid evidence-based midwifery interventions in improving maternal outcomes at primary healthcare facilities. Originality/Value: Unlike previous studies that primarily focus on risk factors or treatment recommendations, this case report integrates clinical assessment, diagnostic reasoning, emergency management, and evaluation within Helen Varney’s seven-step framework, providing a practical model for evidence-based midwifery management of uterine atony in primary maternity care.