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Estimating blood loss during a bath birth

Monitoring blood loss

Estimating blood loss in childbirth is complex. Outside the bath, the most accurate possible method of measurement is to weigh cellular mats of blood loss. A caveat is that this may involve urine or amniotic fluid loss that is weighed in. In a bath birth, blood loss is determined by visual assessment by the obstetrician.

The white ground is an important aid in estimation, as this color provides the best contrast between the bath itself, the barer and the blood loss. Blood loss and any clots stand out well because of the light bottom. A different color bottom would negatively affect visibility and estimation of blood loss.


Most training scenarios for estimating blood loss in the bath are performed with fake blood. This can give a distorted view of reality. An Australian organization therefore realized a visual aid in which real blood was used in a 2-person Birth Pool in a Box birthing pool filled with 37°C water at maximum fill level. In this situation, it was found that when the white bottom is no longer visible, there is +- 1000 ml of blood loss.

The images taken serve as a guide for health care providers to make a rough estimate of blood loss. 

Please note that we are aware that blood loss, particularly in a bath birth, is poorly measurable. When combined with other factors, this guideline can help determine policy during labor.

Always have this information at hand or share it with others? Then download the information sheet including visuals for estimating blood loss.

Reference: Visual Estimate of Blood Loss in an Inflatable Birth pool. (July 3, 2020). Pregnancy Birth & Beyond.