Pregnant? Know the Signs of Postpartum Hemorrhage

A.K.A Seat warmers make me feel like I’m dying.

This is how much snow there was in Buffalo in 2001!
This is how much snow there was in Buffalo in 2001!

It’s the last day of the year, and I tend to get a little contemplative. Not because of that whole New Year’s resolution thing, screw that. Like I need another thing to beat myself up over. I’m practicing kindness toward myself in 2016. I am defending myself to myself like a goddamn mama bear. (Thank you so much, Jill, for sending me the link to this blog post from Midlife Blvd “Beyond Self Acceptance”. Love it. You rock.)

I get think-y at this time of year because it’s cold outside, and I have seat warmers in the car. When I turn them on, at that weird moment when the heat kicks in, I feel like I’m dying. A warm rush in the nether regions would make some people feel like they are wetting their pants, but I’ve never wet my pants as an adult. (Yet. Who am I kidding. Three kids. Pelvic floor. I’ll hit that bridge, no doubt.) But I have felt more warm blood soak my lap than anyone should.

So what happened?

Well…as a superstitious first-time mother, I skipped the postpartum hemorrhage chapter in “What To Expect When You’re Expecting.” Because I was an idiot. If you are pregnant or trying to get yourself knocked up, please be smarter than I was. Read that freaking chapter. If you have a birth partner, make them read it. Get knowledgable. That’s the first step, the second is prepare yourself to be your own advocate. Doctors and nurses don’t know everything. I really wish they did. That would be spectacular. Unfortunately, most of the people trying to care for you won’t know you. But YOU do. If something feels wrong, it very well might BE wrong. What’s the worst thing that will happen if you insist on seeing or speaking with a doctor? Someone will think you are pushy? Bitchy? A worry wart? Or maybe…healthy? Alive?

What are the signs? This is a well-written article from babycenter that explains postpartum hemorrhage in detail. Basically, excessive bleeding is the biggest sign (soaking through more than one pad an hour for several hours in a row, bright red blood for more than just a few days, passing blood clots bigger than golf balls). Some bleeding is normal after a vaginal delivery, and your nurses will let you know if yours is “within normal limits.” Unless you are me. Then you have an induced, no drugs, vaginal birth with a fourth degree tear. It takes the doctor an hour to sew up your hoo-ha. You’ve been through so much trauma the doctor doesn’t want to stick his hand up there to make sure all of the placenta detached. Guess what?

It didn’t.

Childbirth wasn’t pain. It was pressure. A metric shit ton of pressure, but just pressure. You know what hurt? My freaking back after delivery. Why did it hurt? Because I retained placenta. When you retain placenta, your body thinks there’s still a baby there that needs blood, so it keeps sending blood. My blood was clotting inside my uterus, it wasn’t spilling out between my thighs for the nurses to see. I complained of pain. They checked my pad. Within normal limits. #not

This is me in pain. I'm, like, "Baby? What baby? My back is KILLING ME!"
This is me in pain. I’m, like, “Baby? What baby? My back is KILLING ME!”

Also not normal was the fact that I couldn’t pee. You should be able to pee after you deliver. If you can’t, then something has swollen up, another bad sign. My nurse kept giving me water so that I would pee, but it’s super busy on holidays. I think she lost track of how much was going in and not coming out. By the time the doctor came in the next morning, my bladder was holding two and a half times as much as it should, and my uterus was full of blood clots. For me, the biggest sign of postpartum hemorrhage was PAIN. I begged for drugs, drugs I did not request at any point during delivery. Begged. My nurse wouldn’t give me anything because she knew I wanted to breastfeed. I remember tapping on the bedrail with my fingers because I needed a focus point to get through the pain. I couldn’t get comfortable. If I had a low pain tolerance, then all of that MIGHT have been “normal.” But I don’t have a low pain tolerance. If anything it’s too high, and when my poor doctor checked my uterus the next morning, he went white as my bed sheet. That’s the last thing I remember before I came out of surgery. That’s how fast they took me into the operating room for a D&C, so they could scrape out that sticky placenta.

I lost half the blood in my body that day. They replaced it with four units of matched blood and platelets, which apparently can’t be typed. Because nothing could go right, I reacted to the platelets at the exact moment no one, but NO ONE, could be found in the intensive care unit. One point in our favor: we’d asked what might happen if I had a bad reaction, so we knew all I needed was Benedryl. We just couldn’t find anyone to give it to me. When I stopped shaking, my husband started. The guy held our perfectly healthy eight pound seven ounce baby the entire time I was getting my D&C, pretty much convinced it was just going to be him and her forever, and THEN he had to watch me go into fits just when he was starting to relax? Poor guy!

Eventually we made it home. I love this shot.
Eventually we made it home. I love this shot.
My very relieved husband. Baby? Check. Bourbon? Check. Dog? Check. Whew!
My very relieved husband. Baby? Check. Bourbon? Check. Dog? Check. Whew!

I always thought I’d take my horrific delivery experiences and put them in a book, but you know what? It’s been fourteen freaking years, and I haven’t done it. I’m still traumatized. I’m still angry that I wasn’t informed enough to be my own advocate. Furious. I can feel my blood rising when I think about it. Because I didn’t learn my lesson. It happened AGAIN.

(Baby number two was just your garden variety obstetrical disaster. Complete placenta previa. That means the placenta sealed the exit to my uterus. Emergency cesarean at thirty-five weeks and a week in the NICU. All good now.)

But baby number three? OMG. (You’re wondering why I kept having kids, aren’t you. Excellent question. The answer? I saw my son in a vision. True story. And I’m not very bright. Obviously.) Let me tell you, there is nothing like being wide open on the delivery table at the end of a festive cesarean section in which they have just pulled out the first grandSON among seven grandDAUGHTERS. By kid number three, I knew I made funny placentas, at least. I spoke up. I begged the doctor to make sure she scraped my uterus bare. I was assured all traces of placenta were clear.

I do not think that word means what she thought it meant at that crucial moment.

My uterus wouldn’t clamp down. When the placenta (and baby) is gone, the uterus clamps down and starts strinking back to its normal size. Hospital staff encourages it to shrink by massaging it. It feels like a monster menstrual cramp and makes you want to punch them. If it doesn’t shrink, they give you a drug to help. If it still won’t shrink they do bi-manual massage, which means one hand up your hoo-ha and one hand on your belly. They massaged until my spinal wore off and I’d lost half the blood in my body again. My uterus finally clamped down, I got transfusions, and they said I was fine. #not

What it looked like the second time around. Look at all that blood going into my arm!
What it looked like the second time around. Look at all that blood going into my arm! I look blood drunk. Wheee! And OMG, that’s a 2006 cell phone in my lap! It doesn’t even flip!

In the weeks after delivery, when I complained of excessive bleeding, I was told it was “within normal limits.” When I complained of pain, I was denied a refill of my Lortab (goddamn it). When I woke up in a pool of blood, dreaming that I was pulling alien baby doll parts from between my legs, and discovered the entire space between my knees and my crotch was full of blood clots, we called 911. After a midnight, black-ops ultrasound by a plucky resident, they sent me home. Just a bunch of junk in my uterus. It happens. Even my father, a retired OB, said it happens.

I was a teeny, teeny bit smarter this time. My doctor didn’t call me to check on me after the 911 call (WTF?) but I insisted on a follow-up. And another ultrasound. And…drum roll…they found retained placenta. And I had another D&C. Six weeks postpartum. I walked around bleeding to death for SIX WEEKS. What were THOSE signs? Pain. Fatigue. A sweet smell in my discharge but I swear it didn’t smell rotten. All that middle of the night blood. (My friend Melissa cleaned it up while we were at the hospital so the girls wouldn’t wake up and see it. Thanks, man. Ewww.)

So THOSE are the signs of postpartum hemorrhage they DON’T put in the books. Oh! One more: I had trouble breastfeeding #3. By that time, I felt like a pro because I breastfed each girl for a year. But my nipples were cracking, nearly hinging and falling off, and I couldn’t figure out what I was doing wrong. As it turns out, when your body is fighting infection from retained placenta, having trouble breastfeeding…happens. Ugh. (Pure lanolin on the nips is the only thing that helps the cracking, btw. At least it was ten years ago.)

Having babies is the best kind of fun, but it’s also dangerous. Hospitals are busy places. Let me be a cautionary tale. If reading this prevents even one person from going through any part of what I did, then my work is done. Be informed about the signs of what can go wrong during delivery (and then hopefully it won’t). Excessive pain is not normal. Make sure you can pee. If you can’t…don’t drink two quarts of water. Most of all SPEAK UP! Be loud if necessary. Being a squeaky wheel is better than possibly bleeding to death. Put THAT on a greeting card!

Sooooo…happy birthday to my Teen! She doesn’t like cake, so we half-baked a chocolate chip cookie cake and then put brownie batter on top of it and finished baking it. I’m going to pour chocolate ganache all over that puppy, and we will take it to a New Year’s Eve party tonight. I’ll let you know what degree of heaven it is.

Happy, Healthy, Whole New Year to YOU and YOURS! I love birth stories, so if you want to share yours in the comments, please do. There is nothing more fun than having babies! (Except making them…)

4 Replies to “Pregnant? Know the Signs of Postpartum Hemorrhage”

  1. Hi! My name is Michelle and I wrote the article that you referenced…thank you so much for including me in your post! I LOVE this…what a wonderful and unexpected read this afternoon.

    Here’s to hoping you and yours have a wonderful 2016

  2. Wow. Just…wow. I’ve heard your story aloud in bits and pieces, in the wonderful way you have with storytelling. But to read it all in one chunk – powerful. Terrifying. Humbling. You deserve a medal of bravery, my friend. Thank you for sharing – it is scary info but essential.

    1. Thanks, Jess! I don’t know about brave, but share, I will! I’m surprised by how many have had similar experiences. I’m grateful my body feels strong again. That took quite a few years of chiropractics and yoga. I’m glad I feel like I have enough blood to donate some again. I’m so happy to have friends (like you, luv!) talking to me about their lives and experiences.

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