Background: There is no adequately sufficient evidence to determine the effectiveness and safety of mechanical and surgical interventions for treating primary postpartum hemorrhage (PPH). Objective: To assess the safety, efficacy and acceptability of uterine packing with gauze compared to Bakri balloon tamponade for treatment of atonic PPH after cesarean section. Patients and Methods: A prospective observational study. A total of 176 patients with atonic PPH after cesarean section were treated either with uterine packing with gauze (n=84) or Bakri balloon tamponade (n=92). The success rate together with early and late complications were recorded and statistically analyzed. Results: 90.4 percent of individuals with uterine packing were able to cease their active bleeding compared to 75 percent of those with the Bakri balloons (p < 0.05). The uterine packing group's surgery took longer time, and the Bakri Balloon group's requirement for further vascular ligation was much higher, indicating a significant difference in procedure duration and need for further intervention (p < 0.05). There were no significant differences in other operational and postoperative statistics between the two groups of patients. Uterine packing patients were more likely to be accepted by the patients (p < 0.05), more satisfied with the surgery (p < 0.001), and more likely to recommend it to others (p < 0.001). Conclusion: Although uterine packing with gauze may require longer time to insert with similar safety to Bakri balloon, yet it is more effective and more acceptable, less costly and readily available.