OBJECTIVE A case is reported in which a paravaginal hematoma spread to the anterior abdominal wall after a first-time mother’s spontaneous cephalic labour, resulting in maternal hemodynamic instability. Case(s) The patient experienced persistent and worsening lower back and buttocks pain two hours after delivery, but despite close monitoring, no large hematoma was initially observed. However, nine hours after labour, the patient became hemodynamically unstable. The shock index was used to monitor maternal hemodynamics, and bedside ultrasound was crucial in diagnosing the hematoma. A manual examination confirmed the diagnosis, and conservative treatment involving vaginal tamponade with a uterine balloon catheter and two Foley catheters. CONCLUSION Due to the rarity of this postpartum complication and the lack of established guidelines, sharing clinical experiences can contribute to successful decision-making.