Recovering from a Shocking Hemorrhage, Part 1/4
Important, read first: This article was written to teach homebirth midwives and other birth professionals about effective naturopathic responses to excessive blood loss in childbirth. If that’s not you, this frank discussion may be alarming. It’s not gory or anything, but I would normally protect pregnant clients from doing a deep dive (and getting the mental imprint) on such a topic (unless they had a past event and needed this info.) But I’m old-fashioned this way. On the other hand, as women who’ve hemorrhaged in their hospital births are often sent home with very little guidance and just a prescription for constipating iron, this info is desperately needed out in the world!
Full article first appeared in Midwifery Today, Issue 132, Winter 2019.
In spite of everyone’s best efforts,
Every once in a while
(Hopefully only very rarely)
There may be a catastrophic postpartum bleed.
We had an experience long ago that drove home how mamas truly need recovery help between the immediate stopping of bleeding and eating iron-rich foods for the next month. This story has a good ending and we learned from it, so no need to get triggered, okay?
Mama was having her first homebirth; she and all her relatives had only had induced and Pitocin-managed hospital births previously. After a very “normal” six-hour labor, on the heels of the baby came the torrent of red. It was the kind of heart-stopping, catastrophic flow that brought every response at our disposal, including bimanual compression and a 911 call—all within a few moments.
The paramedics were swift, cheerful, young, and inexperienced. In spite of my objections, after they loaded mama onto the gurney for transport they routinely and quickly raised her to a sitting position. Mama did not have sufficient circulation at that moment to support blood getting all the way up to her raised head; her eyes rolled back, she had a bit of a seizure, and everyone got scared. Coming to in less than a minute, she nonetheless took several minutes to remember who she was, recognize her husband, and back down from a reflexive fight-or-flight combative survival response. And that’s what scared her the most.
The medical response and results were good and baby was quickly brought to the hospital to rejoin mama skin to skin. Everyone was tucked in for a 24-hour stay to get IV fluids and monitor the range of the inevitable drop in hemoglobin (Hgb).
And then … 10 hours later came a 4:00 am phone call. Dad was asking for help. ”My wife is afraid to go to sleep. She hasn’t been able to close her eyes since the birth. She’s anxious and afraid she won’t wake up. She keeps remembering the seizure and loss of consciousness; she really thought she was going to die. She feels scared and transparent. “Also, the hospital is just waiting to see how low her hemoglobin goes, to determine if she needs a transfusion. It’s already down near 6, and they say the next check in the morning will be lower still.… But we don’t want a transfusion; isn’t there anything we can do besides just waiting for things to get even worse?”
I brought along homeopathics, essential oils, flower remedies, liquid iron supplementation, and my hands and heart. This combination allowed mama and baby to peacefully fall asleep in less than 10 minutes, and we continued to use many of these remedies over her weeks of recovery. Her hemoglobin five hours later was 7 g/dl, something quizzically deemed “impossible” by the medical staff. Early nutritional and remedy-based intervention does make a significant difference in recovery!
A mother such as this one—once the immediate bleeding has been stopped and she is stabilizing—may have additional risk factors and challenges in her postpartum recovery that go well beyond low hemoglobin. These potential risks include a much-extended recovery period, days of severe headache, prolonged iron-deficiency anemia, a milk supply that is insufficient or never comes in, a weakened immune system, and postpartum depression. The more swiftly we can move this mother back from the physiological and energetic edge of the danger and fright she has experienced, the more stable she will be, the better she will feel, and the more swiftly she will recover.
However, before we hustle in with restorative help after the conclusion of such a frightening event, we must slow down to remember that this mother/baby unit is now especially vulnerable and highly sensitive. Even as we helpfully care for her, we must be extra gentle, extra kind, and speak and move quietly and more slowly. This may take some conscious intention—because babbling and bustling are common stress-discharge responses.
In the immediate postpartum, these mother/babies usually do best with a minimum of speech and movement around them for a time. They are easily jarred at every level, and being jarred distracts, or even diverts, from their immediate stabilization. Remember, mother/babies are a unit; the baby is also having feelings and experiences and laying down memory, just like mom. In one of my first births as an apprentice, every time the mother had another gush, the baby’s breathing also faltered. There are no secrets from the baby; they both need reassurance and matter-of-fact calming presences to reestablish equilibrium.
You can get an idea of how vulnerable such a mother is by observing the following:
What is her “actual” measured or estimated blood loss? Adults generally have around eight pints of blood, which will normally expand by 20–24 weeks of pregnancy by about 50%, or to around 12 pints. Loss of 500 mLs (~1 pint/+2 cups) is generally considered a hemorrhage. Also, if her bleeding looks thin and watery by the time the blood loss is controlled, be extra concerned about reduction of clotting factors.
How are her vital signs, both in numbers and behavior? How far from her normal is her blood pressure and pulse? Is she able to sip fluids through a straw without nausea? Is she asking to sit up and able to do so without wobble or wooziness, or is she instinctively remaining lying down with the smallest head cushion?
What is happening with her color? When blood loss is still occurring, her color may go from pale to white, to even yellow and then green. In my experience, green is very grave. When the situation is no longer worsening and blood loss has been stopped, her circulatory system can get traction as it works to acclimate and compensate. Mother’s color will return in reverse order: hopefully the rather ghastly green stage was brief and swiftly returns to the sallow yellow, and moves back toward pale. Things are usually going well when she has color in her cheeks and her lips return to her normal version of pink tone (depending on her usual skin tone/color). It may take an hour, or a few days, to get pink lips. Some mothers have a yellow cast for weeks.
How is her vitality? What level of interest is she taking in her baby? She might have handed him off or have been clutching him tightly when things became serious … when does she ask for her baby back or open her eyes to return to curiosity and engagement with her baby? Is she talking to her baby or interacting with family members?