A 39 year old woman booked at 14 weeks’ gestation in her second pregnancy. Her first baby was delivered by vacuum without any complications. At the booking visit she reported that she was a Jehovah’s witness and made it clear that she would not accept blood products. Her antenatal course was complicated by polyhydramnios, fetal macrosomia, and abdominal discomfort. She presented at 40 weeks’ gestation with regular pains and was admitted to the labour ward. The cord prolapsed shortly after rupture of the membranes and she was transferred to the operating theatre for an emergency caesarean section. She gave birth to a healthy boy and the surgery was uneventful. She started to haemorrhage four hours after delivery on the postnatal ward. She was resuscitated by the on-call team without use of blood products. Mother and baby were discharged in good health on day five. 1. How would you counsel this woman? 2. What measures would you take to optimise her haematological status in the antenatal period? 3. How would you manage a postpartum haemorrhage in a woman who refuses blood products? ### Short answers 1. Women who refuse blood products should see a consultant obstetrician early in the antenatal period and have a frank discussion about the issues that may arise. This should be followed up by completing a documented detailed advance directive after a period of reflection. 2. Oral iron supplements should be prescribed throughout …