I mopped the blood of dying mothers: One cleaner’s story of hope after zero PPH deaths

For a decade, Josephine Mbinya was a silent witness to the life-and-death struggles inside the maternity ward of Sultan Hamud Sub-County Hospital in Makueni County. As a hospital cleaner, her job was not merely to maintain hygiene but to manage the gruesome aftermath of a daily occurrence: postpartum haemorrhage (PPH). The World Health Organisation (WHO) defines PPH as blood loss of 300ml or more.

"The work was exhausting. It reached a point where I wanted to quit. Mothers were dying. My job was to help them to the toilet or the bath, and the physical strain left me with chronic back pain. But the emotional strain was worse," Mbinya recalls.

Before 2024, the floors of the maternity wing told a story of constant emergency. Out of every 10 or 11 women who gave birth in a single day, Mbinya estimates that at least eight would suffer from severe bleeding.

"When a doctor was delivering a baby, we cleaners had to be on standby, not with towels, but with a mop and a bucket. The blood would soak through everything. Thirty minutes after delivery, I would have to make a mother sit on a basin first, just so the blood wouldn't spill all over the floor as I changed her cotton wool to move her," she says.

Also read: The midwife who refuses to let women bleed to death during childbirth

"It is a heavy thing to mop the blood of a woman who has died giving birth. Some cleaners would just break down and cry. The floors would stay reddish; it felt like we couldn't wash the tragedy away."

She eventually resigned and retreated to her home in the village.

Then, a clinical shift changed the trajectory of the ward. About a year after she left, a doctor informed her that the hospital was moving away from the standard use of 
oxytocin to a new drug, and promised that this would reduce bleeding and, as a result, ease her work. Her position, she was told, was still open.

The "saviour drug" was heat-stable carbetocin (often referred to locally as Kausha, Swahili for "dry up"), an injectable medicine designed to stop severe bleeding after childbirth. Introduced in 2022 by the county government in partnership with Jhpiego, it replaced oxytocin, a globally recognised drug for preventing postpartum haemorrhage (PPH) by helping the uterus contract firmly after birth. Oxytocin is typically administered immediately after delivery, either intramuscularly (IM) or intravenously (IV).

Research shows that carbetocin is generally considered superior or at least equal to oxytocin in preventing PPH, thanks to several advantages: a longer duration of action (up to five hours, compared to oxytocin's 1.5 hours), a reduced need for additional interventions, improved heat stability, and a simpler single-injection administration. 

Oxytocin, by contrast, often requires a continuous infusion. The impact on the hospital floors was immediate and visible.

"Once they deliver and get that injection, the bleeding stops. The workload has transformed. I used to be right there waiting for the spill, but now, I don't have to be nearby. When the delivery is finished, we just clean the normal waste. There is no more 'red floor'," she says.

Heat-stable carbetocin does not require refrigerated transport or storage, remaining stable at 30°C for up to 36 months. This makes it far more practical in many rural Kenyan facilities and environments where maintaining a cold chain for oxytocin is difficult.

The change has been so profound that Mbinya, who once looked for any excuse to leave the maternity wing, now refuses to go anywhere else.

"I told the person in charge, 'Do not try to move me. I want to stay here now. I have seen the medicine work, and I have seen the mothers survive,'" says Mbinya.

However, the introduction of heat-stable carbetocin was only one pillar of the reduction in postpartum bleeding among mothers in Makueni County. A combination of initiatives led the county to record zero maternal deaths from PPH in 2023 and 2024.

Other initiatives included reducing the cost of the drug from Sh540 to Sh90 per dose for the public sector through government negotiations with suppliers, bulk procurement via the Kenya Medical Supplies Authority (Kemsa), and partnerships with health organisations. The county also procured 11,000 calibrated drapes to accurately measure blood loss during delivery, replacing unreliable visual estimations.

Health facilities also began to implement the E-MOTIVE intervention, a WHO-recommended approach that uses calibrated blood-collection drapes to measure blood loss accurately, triggering action at 500 ml (or 300 ml with signs of shock). Health workers then massage the uterus to stimulate contraction, followed by administration of a drug to contract the uterus and aid blood clotting. The mother is then examined for tears and placental remnants and, if needed, referred for advanced care.

Also read: Kenya injects Sh1bn to slash maternal and child deaths ahead of global health summit

The county also engaged 45 community influencers and 40 assistant county commissioners to raise awareness about the importance of facility-based births and recognising danger signs in pregnancy.

Rose Betty Mukii, monitoring, evaluation and learning lead at Amref Health Africa in Kenya, explained to the Council of Governors that PPH is primarily caused by four major factors, often summarised as the "Four T's": Tone (uterine atony): the uterus fails to contract adequately after delivery, leading to continuous bleeding, Trauma: physical injuries to the birth canal, including tears or lacerations, can result in substantial blood loss, Tissue: retained placental fragments prevent the uterus from contracting properly, causing persistent bleeding, and Thrombin (blood clotting disorders): conditions that impede the body's ability to form clots, exacerbating bleeding.

Data show that before these interventions, Makueni County recorded six maternal deaths due to PPH in 2020, two in 2021, 12 in 2022, and zero in both 2023 and 2024. In 2025, the county recorded three deaths. As of early May 2026, the county has maintained zero maternal deaths from PPH.

Nationwide, the Ministry of Health reported in 2024 that PPH remains a significant challenge in Kenya, accounting for between 25 and 45 per cent of maternal deaths.

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