11.5.2 Use two-handed pressure on the uterus
If bleeding is very heavy and rubbing the uterus does not stop the bleeding, try two-handed pressure on the uterus (see Figure 11.5). Scoop up the uterus, fold it forward, and squeeze it hard (you will be shown how to do this in your practical skills training). Cup one hand over the top of the uterus. Put your other hand above the pubic bone and push the uterus towards your cupped hand. You should be squeezing the uterus between your two hands.
If you have been trained to do so, you can apply two-handed uterine compression by inserting one gloved hand inside the vagina and clenching your hand behind the cervix, while the other hand is pressing on the abdomen to compress the uterus.
As soon as the bleeding slows down and the uterus feels firm, slowly stop the two-hand pressure. If bleeding continues, refer the woman to the nearest health centre facility. Try to keep two-handed pressure on the uterus while you are transporting the mother. Do not leave the baby behind – have someone carry it. Make sure you take possible blood donors from her relatives with you as the woman may need a blood transfusion.