Scary Shit Series: Postpartum Hemorrhage

My pregnancy with my second child was pretty uneventful. Like many moms chasing a first child, I sometimes even forgot I was pregnant again—I was young, distracted by #momlife, and not especially nauseous this time around. My ob/gyn kept chiding me to take excellent care of myself now that I was going to be a mom of two, but I gave that idea a hard pass—taking a time-out from momming to get in touch with my own body had become totally foreign to me.

The peripartum period? I got this, I knew.

But I was caught with my pants down (literally) by what happened when my baby was less than a week old. Our older son, James, was thirteen months old, Will had just been born, and I had made two humans in less than two years. My uterus probably wasn’t so much a pear-shaped organ anymore as it was a stretched-out tube sock. Two seven-and-a-half pounders had passed through there—two sons. And two placentas. If the cervix is the front door of life, the placenta in the immediate postpartum period can be an overzealously attached Grandma who sits in the foyer and offers too many oatmeal cookies. It needs to stop doing its nourishing thing and just let everyone go.

And, after Baby Will made his entrance, let go it did—mostly. The cord had been clamped, the placenta delivered. A typical sort of postpartum bleeding began, and my husband, Joe, and I packed up our newborn and toddler and headed home, promising that I would defer to others if I needed to carry anything (or anyone) heavier than my baby. The standard warnings were issued about seeking medical help if I ended up passing any clot larger than a lemon, blah, blah, blah. Thank you, nurses and doctors. All was well.

But now I had two babies.

And I didn’t slow down my physical activities enough to let myself heal properly. A few days after Will was born, my mother-in-law visited and we wanted to bring her out to a chips-and-salsa joint we loved. I was still riding the high of bringing someone new into the world. And, let’s be honest, I didn’t feel like cooking for anyone.

Parking was always dicey in that part of town. We had to cross a large field. Joe carried James, and I insisted on carrying Will in his bucket seat, envisioning a sleeping, cherubic paperweight of an infant during a peaceful dinner. I had been an athlete in prior days, so I didn’t think it was a big deal to wake up the old abs and biceps a little by muscling it 100 yards across the grass with about twenty-five pounds in the crook of one arm.

When we got home from dinner I was feeling a little funny and had some heavier (bright red) bleeding, which I shrugged off.

Will was sleeping again so I’d get an hour’s respite from breastfeeding, and I wanted to watch Spanglish with my mother-in-law. Instead, I couldn’t keep my eyes open (normal with a newborn!) and went to lie down to take the edge off of my gnawing stomach discomfort and cramps.

I wasn’t alarmed until I started soaking through pads and having to change them inside of an hour.

I was passing large clots, too, and one was baseball-sized. I quickly decided to have Joe bring me to urgent care, and they sent me over to the ER. They ultrasound-wanded me, and not with the “fun” wand that goes over the abdomen. As it turns out, I still had a little chunk of the placenta in there, and had generally done way the hell too much too soon of carrying people and things. An IV with fluids and oxytocin helped me pass the fragment safely. And finally, I found myself with a “good enough” excuse to rest.

Obstetric hemorrhage (or Postpartum Hemorrhage—PPH) is one of the most common reasons for maternal death around the world.

It can happen for different reasons, but often it’s due to retained placenta. If a piece of placenta tears off from the rest and is left inside the uterus after delivery, the uterus can’t clamp down the way it normally does after childbirth to stop the bleeding. This is part of what happened to me. My doctor had carefully examined my placenta after it had been delivered, but the placenta is sometimes ragged-looking and difficult to account for completely.

Uterine atony, which is a lack of muscle tone and contractions in the uterus, can also be the cause of a postpartum hemorrhage. Your uterine muscles don’t contract as well when you have already given birth a few times. Delivery before 34 weeks’ gestation, older maternal age, a blood disorder, placenta accreta (a condition where the placenta grows into the uterine wall), twin gestation, having been induced for labor, and other factors can also contribute to this bona fide emergency.

I didn’t lose, to borrow a phrase from Spanish, “ríos de sangre.”

Sometimes PPH isn’t a rapid flood of blood but rather a moderate amount of bleeding over a long time. I could have needed a transfusion or developed an infection (or, more catastrophically, sepsis, shock, and/or death) as a result of all this. If I could go back in time I would have worn Will in a wrap or had someone drop me off at the front door of the restaurant. Due to my retained fragment of placenta, it’s likely I would have had a dangerous bleed, anyway.

By the time our third child was born I was better prepared to take care of me.

Letting go of the need to entertain anyone when I’d just pushed out a baby was crucial, as was hiring a postpartum doula who was committed to maternal wellness. I made sure to remind my providers that PPH had happened in a prior pregnancy, and because it was likelier I’d have one again, they monitored me closely.

Signs of PPH include vaginal bleeding that is “too much” (a vague description—when in doubt, call), feeling faint, getting chills, or having blurred vision, nausea, paleness, or confusion. This most often happens within a day or so of giving birth, but can take place at up to 12 weeks postpartum. If you think you may be experiencing a postpartum hemorrhage, call 911.