Objective To investigate the effect of autologous blood transfusion on the recovery of coagulation function in patients with massive hemorrhage after cesarean section. Methods Patients who were admitted to Department of Obstetrics, Suqian Maternity and Children's Hospital with massive hemorrhage after cesarean section from January 2020 to July 2022 were included. According to the stratified randomization method, the patients were divided into two groups (n=30): a control group (group A) and an observation group (group B). Group A underwent homologous blood transfusion, while group B underwent autologous blood transfusion. Their blood routine indicators such as red blood cells (RBC), hemoglobin (Hb) and hematocrit (Hct), coagulation function indicators such as prothrombin time (PT), activated partial prothrombin time (APTT), thrombin time (TT), and fibrinogen (Fib), and thromboelastogram (TEG) R value, K value, angle α, and maximum amplitude (MA) value were recorded 12 h before and 12 h after surgery. Patients with bleeding volume>2 000 ml in both groups were compared for the blood routine and coagulation function indicators 12 h before and 12 h after surgery. The incidences of postoperative adverse reactions (fever, infection, allergy and hemolysis) in the two groups were recorded. Results Compared with group A, group B showed increases in Hb, Hct, RBC and Fib (all P<0.05), and decreases in PT, APTT and TT on postoperative 12 h (all P<0.05). On postoperative 12 h, patients in group B with a bleeding volume>2 000 ml presented increases in Hb, Hct, RBC, and Fib, compared with those in group A (all P<0.05), and decreases in PT, APTT, and TT, compared with those in group A (all P<0.05). On postoperative 12 h, the R value and K value in group B were lower than those in group A (all P<0.05), while the angle α and MA value were higher than those in group A (all P<0.05). The incidences of fever and allergy in group B were lower than those in group A (all P<0.05). There was no statistical difference in other indicators (all P>0.05). Conclusions For patients with massive hemorrhage after caesarean section, those undergoing autologous blood transfusion may show better recovery in terms of postoperative blood indicators, faster recovery of coagulation function, and lower incidences of adverse reactions than those with homologous blood transfusion.