This three-year, cluster-randomized trial involved teaching providers the early detection of PPH coupled with the proposed WHO first-response bundle for postpartum hemorrhage (PPH), and then evaluating the bundle—a sequence of care components delivered in total, in rapid succession, without waiting for any individual component to work.


  • The WHO PPH first-response bundle includes massage, uterotonic, tranexamic acid, IV fluids, and examination. While each individual component had been studied in the past, the bundle approach had not.
  • The research project modeled the Helping Mothers Survive training approach—low-dose, high-frequency—to build the capacity of health care professionals through a single-day training for the PPH clinical bundle.
  • The E-MOTIVE trial demonstrated that after near-universal uptake of the bundle by providers, use of the bundle significantly reduced bleeding and improved maternal health outcomes related to PPH – a 60% reduction in severe PPH outcomes.

How to Use

This study is well positioned to help inform the WHO’s official recommendation about PPH, as well as potential endorsement of the capacity-building approach as the methodology to be used to implement the bundle.