Midwife Life, Part Eight: Four Cups of Blood

Through my last post in this series we walked together through Emma’s long and difficult labor, and rejoiced with her over the birth of her sweet baby boy. Today I invite you to join me as we faced the trouble that followed him and wiled away the hours of the child’s first night on earth – your opportunity to see how midwives and the families they serve handle the complications that occasionally do arise.

Yes! Emma and Robert’s son was born in a wash of rejoicing!

But he also was born in a wash of blood, and one that continued to flow.

Normally babies are born in a flood of amniotic fluid, and then we’ll see a gush of blood five to twenty minutes later when the uterus sheds the placenta. Adam’s placenta, for so the baby was named, appeared to have been pulled from his mother’s womb with his birth.

I hated to disturb Emma and Robert as they ooohed and aaahed and wept over the squirming, squalling manifestation of their love for one another, but active bleeding in a freshly birthed woman can rapidly spell disaster.

“Emma. Robert.”

I didn’t raise my voice, but I spoke sharply enough to cause both to look at me. In the afterglow of her stunning accomplishment and under the spell of the gorgeous baby rapidly turning pink against her heaving breast, the pupils of Emma’s eyes were dilated so wide I could scarcely see the blue of her irises. Her lashes and brows shimmered with tiny droplets of moisture, sweat had pasted strands of her blonde hair into flattened curls against her forehead and neck, and her tear-streaked cheeks wore a rosy blush of joy. Her beauty took my breath away, but the hint of pallor creeping in behind the flush snapped my attention back into the moment.

I stood to my feet and looked at Robert. “Emma’s bleeding, Robert, and I want her on the bed this minute…”

I was going to instruct him to help me get her up and moving, but the new father, overflowing with passion and love and vitality, almost instantly understood me. In one swift motion, he gathered his wife and child to his chest, crossed the room in a single stride, and laid the two gently upon the chux pads Mary had spread over the sheets before I could finish my sentence.

Mary had also fetched an alcohol pad and the syringe I’d filled with Pitocin earlier and, once I’d fairly leapt up beside Emma, I took it from her. I could have counted on my left hand the number of times I’d given a shot of Pitocin before the expulsion of an afterbirth, but I gave that fact nary a thought as I swiped a spot clean on Emma’s thigh, grasped the cleansed space firmly between my thumb and fingers, flicked the needle into the bulge of flesh, drew back on the plunger to check for blood, and pressed the medicine home.

I helped Emma place her feet flat on the bed with her knees apart – one leaning against her husband, and one leaning upon me – then I touched the space above her pubic bone, was pleased to find it firm enough, took up the slack in the slippery cord with a fold of paper towel, pressed it lightly toward the bed, and told her to give me a mighty push. I felt the subtle shift I was looking for.

“Good, Emma! That’s the way! Sniff your baby’s head and bear down again! Let’s get this over with!”

I don’t know where she found the strength, but Emma sucked in a great draught of air, ducked her chin, and pushed, and I felt the placenta begin to slide the length of her vagina. I lifted the cord as the shimmering organ surfaced, paused, and slipped from her into the chux pads I had waiting to receive it. It came with an impressive surge of blood, and I noticed the membranes were trailing along behind.

“Mary, hand me my ring forceps and then rub up this uterus.”

Mary, who had unobtrusively dried and assessed the baby as soon as the two were on the bed, fished a packet from my tote and dropped it beside me. I turned the placenta over a few times in my hands, twisting the membranes into something of a rope. I hoped that would be enough to tease them free, but they remained within Emma, even though she continued to bleed. Mary went to work on Emma’s weary uterus, encouraging Emma to kiss her little one and snuggle him close to one of her nipples while I tore the package open, grasped the twist of tissue with the forceps, trimmed it away from the body of the afterbirth, and continued to twist and tease, twist and tease, until the whole coil of delinquent sack slithered into view.

Emma’s bleeding tapered off, and Mary told me the uterus had firmed beautifully to her touch. I was pleased but, knowing how tired Emma was after a night without sleep and so very many hours of labor, insisted Mary keep gently massaging it till we were confident the Pitocin was in full effect.

I took a cursory look at the placenta before I bundled it into the zip lock bags I’d stashed in a corner of my tote, and set it at Emma’s side. It looked like it was all there. I looked up at Robert and asked him to fetch a glass of Gatorade for his wife, and he bounded off toward the kitchen.

“Mind if I check your vitals, Emma?”

Her blood pressure was still pretty good at 90/54 – not too much lower than her usual blood pressure, but her pulse was fast at 118. Fast, but strong. I glanced at Emma’s face. Though she was pale, she appeared stable. I’d check her vitals again in a bit, knowing her blood pressure would likely dip a bit further.

“How do you feel, Emma?”

“Happy!” She beamed at me. “And tired. And yucky. Very yucky.”

“Yucky?” I hoped she didn’t mean nauseated. I’d learned the hard way through my years that a hemorrhage followed by nausea is a horrific combination, as fluids by mouth was the primary tool I used to combat hypovolemic shock. I knew how to start an IV, but had so seldom had a client truly in need of one, I’d long since abandoned carrying the fluids. All I did was order them and pitch them as they passed their expiry dates.

“Yes, just so wet and sticky!” And she flashed another radiant smile my way.

I smiled back at her, relieved. “Well then, why don’t we change the pads beneath you? You’re resting in a puddle of goo.”

“Ah, let’s! I’m none too fond of goo!”

“Okay. On the count of three, push your feet onto the bed and lift up your hips. One, two, three…”

I pulled the soiled pads from beneath her. “Keep your hips up, Emma – up, up, up!”

“How’s that uterus, Mary?” I asked as I whisked a fresh pad beneath her, helped her straighten her legs, and drew the top sheet from the foot of the bed, over Emma’s legs, and up to Mary’s hands.

“It’s firm, but it still threatens to relax. I’m going to stay on it.”

I rocked back on my heels to take in the scene. Mary was standing next to Emma with one knee on the bed and her sturdy, warm hands on Emma’s belly – one pressing into the space above her pubic bone to provide counter-pressure to the one that was pressed into the flesh just below Emma’s navel. With a firm, fluid motion, Mary rubbed her top hand forward and back over Emma’s fundus. I peeked beneath the sheet and to make sure she was no longer bleeding. I glanced at Emma’s face to see how she was handling the massage.

Surprisingly, she appeared to hardly mind it. Robert had brought her a quart mason jar filled with the neon yellow drink, and she was sipping it through a straw as she and Robert talked to their tiny son.

“Oh, little Adam, you’re finally here.” Emma cooed as she ran a fingertip along the downy lines of his furrowed brows. He was blinking bright eyes, trying to look at his mother’s face.

“What do you see, son?” Robert asked, bending nearer, and the baby blinked and turned his pools of endless soul toward his father.

“Oh, Robert! He knows you!”

“Do you think so?”

“I know so!”

And on they went, and I sat awhile in silence beside them, soaking in the enchantment, allowing the waves of love that rippled from the three to lap at the edges of my psyche, and to settle and soothe it.

“I think her uterus is okay now, Kim.”

“Let me see a minute.” I reached out my hands to replace Mary’s, and breathed a sigh of relief. Just my light touch revealed a rock-hard organ between Emma’s umbilicus and pelvis. I pulled the sheet back again for another assessment of blood loss.

“Good. It looks and feels good.” I reached for my blood pressure cuff and stethoscope.

“Okay, your blood pressure is 88/52 – a little bit lower than it was – and your pulse is 124 – a little higher than it was, though strong and steady –  so you definitely lost more blood than you could afford to lose. But, as of the moment, you’re doing alright. We’ll check your uterus every five to ten minutes the next while, and re-check your vitals in a half hour. For now, drink up all that Gatorade and, Mary, would you please fix Emma a plate of eggs and toast?”

Mary had her hands on her hips, and was turning from side to side in an attempt to stretch the muscles that had kinked from her long stint bent over Emma. She straightened and flashed a smile at the sweetness before us. “You bet.”

Adam still hadn’t nursed, but he’d begun bobbing his head and licking at his mama’s nearest nipple with his tiny pink tongue.

“Shall we get him nursing?”

The bright-eyed parents thought that a grand idea as did, we soon learned, their son. He latched on with ease, and was nursing like he’d been nursing forever by the time Mary returned with Emma’s meal.

We left the family alone then, though we kept the door ajar and every so often one of us tip-toed in to run a hand over Emma’s middle and to take a peek at her chux. I’d gathered up the saturated pads and spread them on the floor beneath the hissing kerosene lamp hooked to the ceiling. I estimated Emma had lost between 750 – 1000 cc of blood.

“Well, it was a good hemorrhage.” I put my hands on my knees and shook my head. “At least three cups. Going on four.”

“She seems to have handled it pretty well.” Mary observed.

“Yes. But she’s on her back! I doubt she’ll be able to get up. Even three cups would’ve been a lot for her to lose, she’s so slight. I think I’ll have to spend the night.”

Even as I said it, my heart sank a degree. I wanted to go home. I was grungy, I was hungry, I was spent.

But I halted that train of thought nearly as quickly as it rose to my mind. I knew better than to allow it.

Though midwifery usually is wonderful – and so very wonderful at that – it isn’t all stars and sunbursts. While I’d found my calling a fulfilling one, I’d also found it to be one that could at any moment require every last scrap of strength and endurance, selflessness and love within me – often, more strength and endurance, selflessness and love than I’d have guessed I possessed. Ironically, it seemed the existence of those qualities in my life had been engendered by those moments.

I knew I’d find what I needed to stay on, if I needed to stay on.

“Okay, Mary, let’s tidy up and do the paperwork. Then we’ll see if Emma can get to her feet after the newborn exam, and I’ll decide what to do from there.”

The names of the clients in this story have been changed, and some of the details of their lives have been altered or combined or exchanged with the details of other clients’ lives in order to adequately protect Emma and Robert’s identity.

Photographs by Brezi Merryman of Captured by Brezi, and by Kim.

Thank you so much for the gift of your time!

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And be sure to poke around here a bit, as there are lots more stories awaiting you.

Kim Woodard Osterholzer, Colorado Springs Homebirth Midwife and Author

Books by Kim:

Homebirth: Safe & Sacred

Homebirth: Commonly Asked Questions

A Midwife in Amish Country: Celebrating God’s Gift of Life

Nourish + Thrive: Happy, Healthy Childbearing

One Little Life at a Time: Recommendations + Record Keeping for Aspiring Homebirth Midwives

7 thoughts on “Midwife Life, Part Eight: Four Cups of Blood

  • My deep admiration for all of you midwives only deepens because of times like this, Kim. You all remain so calm and poised under pressure. I respect you all tremendously.

  • Quite amazing! So glad you have the knowledge and wisdom to handle such events so beautifully! What effect does excess blood loss cause a mother long-term??

    • Thanks, Aubrey! And what a good question! The long-term effects of an excessive loss of blood at birth, thankfully, are usually not too long-term, though they can be significant. A slower recovery, a reduced resistance to infection, fatigue, and milk supply issues are the big four. And we do function on a bit of a heightened alert when serving women who’ve suffered past postpartum hemorrhages.

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