INTRODUCTION:: Postpartum hemorrhage (PPH) is an important cause of maternal morbidity. Identifying women at increased risk for PPH can help reduce morbidity. The aim of this study was to determine if women over 45 years (very advanced maternal age, VAMA) are at increased risk for PPH. METHODS:: Retrospective study of term, nulliparous women with singleton fetuses in vertex presentation who delivered at Kaiser Permanente Northern California Hospitals from 2010-2017 with complete data recorded. Incidence of PPH (estimated blood loss >500 cc for vaginal delivery, >1,000 cc for cesarean delivery, or other definitive chart evidence) among women over 45 years was compared to incidence of PPH among younger women. Logistic regression was used to adjust for confounders. RESULTS:: There were 98,922 women included, including 177 women over 45 years. PPH occurred in 33.3% of women >45 years as compared to 15.6% of women 45 years had significantly increased odds of PPH as compared to women <35 years (OR 1.88, 95% CI 1.35–2.61). CONCLUSION:: These data demonstrate that VAMA is an independent risk factor for PPH. This knowledge provides physicians with an opportunity to counsel patients over 45 years regarding the risk for PPH and to prepare for delivery with strategies including optimization of blood count, planning for delivery location and procurement of appropriate blood products before delivery.