Bionic Mamas

you're not losing a vagina, you're gaining a son

Bloody Business

24 Comments

Before I begin, I want to just say, in a small voice, how crushed I feel by May’s latest news, by the utter un-rightness of it, by how badly the universe is flubbing its lines. This is not how the story is supposed to go, dammit. I know we talk a lot about how unfair all of this business is, but sometimes the unfairness is just so fucking unfair. It is not the only thing that has been Not Right lately; that doesn’t make it any less wrong.

I am wondering if any of you happens to know what counts as a normal postpartum drop in hemoglobin and what doesn’t. Imagine you have this patient who, after two days of fairly heavy vaginal bleeding, arrives at a hospital in labor. Her hemoglobin at that point is 13; her hematocrit is 37.8. Following a vaginal delivery, her numbers are 7.3 and 21.7, a drop in the neighborhood of 44%.

Question one: Is that normal? If not, how abnormal?

Question two: Are there causes of postpartum decreases in hemoglobin other than blood loss? Does the placenta itself (or the baby) in some way count towards the starting number?

Question three: Do you do anything about those numbers, beyond suggesting an iron supplement? Do you do anything if the patient calls three weeks later complaining of continued extreme fatigue, dizziness, breathlessness, etc.?

Question four: Supposing a patient with this history is pregnant again. One likely source of postpartum bleeding (vaginal septum) is gone, though possibly the vaginal wall where it attached has scar tissue. Is postpartum hemorrhage in such a case likely to recur? Do you do anything in particular to lessen the chances of her feeling terrible for months again? Is there anything you can say to her to help her feel less frightened?

Question five: Is this patient a good home birth candidate? Just kidding.

My hospital records — the short version only — from the Bean’s birth arrived this week. I’d put off ordering them for a couple of years, which I guess is good, considering that I find myself a little taken aback anyway. This is just the abstract — test results and some nonsense from the lactation consultant, an extremely silly person. There are errors: I am listed as having a didelphic uterus (nope, not that normal), and hemoglobin and hematocrit are reversed in one place. (I flatter myself that a hematocrit of seven might have been more worthy of note.)

Also this week, I finally tracked down a picture I didn’t know existed until recently, of Sugar cutting the Bean’s umbilical cord. That is to say, it’s a picture of my crotch, post delivery but prior to the arrival of the placenta. I thought it might feel sort of empowering to see that, since I was scared to look at that part of my body for weeks after birth, not wanting to see all the stitches. Maybe it would have been, but I found it hard to pay much attention to my flesh, finding the pool of blood I was apparently lying in rather visually distracting. When I say pool, understand, I mean pool. I don’t mean the bed was a mess. I mean liquid. I mean depth. I mean volume.

I thought I was done finding new things to feel angry and scared about, regarding the Bean’s birth, but I guess I was wrong.

I haven’t written in much detail about how sick I was after the Bean was born, partly because at the time, I was filled with confusing hormones, alternately elated and distraught, and, well, sick. I’d been pretty thoroughly conditioned to believe that only people with (unplanned) c-sections were allowed to feel sick or sad after birth, anyway; the websites said I should be exulting in my all-powerful womynhood and resuming my exercise routine while teaching the baby French. All that matters, as you know, is that the baby is healthy. The vessel has done its job.

So, here: I was pretty sick after the Bean was born. For the first week or so, I had an annoying tendency to black out every time I tried to nurse him. The nurse I asked about it told me that was “oxytocin, filling your body with feelings of well being.” Later I realized that was the only time I wasn’t lying flat. I couldn’t hold him during the lactation class and was grateful that lesbian privilege meant I alone among the women there had someone to help. (Men weren’t allowed.) We left early because I couldn’t sit up anymore.

For the endless rounds of pediatrician visits for weight checks in the first few weeks, I took cabs. One day Sugar had a work meeting, and I couldn’t carry the Bean in his carseat. I could barely carry the car seat. We tried to take the subway once. Sugar carried the baby while I shuffled behind her, hips still entirely disconnected, like a troll aunt of some kind. (Sugar got lots of congratulations for her new baby in those days. She deserved them, but my own invisibility beside this gorgeous, healthy, thin woman and her perfect baby was sometimes hard to take. “Don’t worry, honey,” one woman said, “you’re next!”) Sugar went to the store for a different kind of iron supplement for me while I took the dwindling Bean to a lactation group. I remember feeling such utter hatred for the other woman there, so pink and healthy with her fat, pink baby, who was younger than the Bean. While Sugar was gone, I started shaking convulsively. I was losing my vision, trying to figure out how I was going to get myself onto the floor without dropping the baby, who was so, so heavy. Sugar arrived just in time, and held him while I lay my head on the desk and shook. No one asked if I was okay. I took a cab home.

It’s hard to write this without feeling I am exaggerating things, but this happened. Other things happened, too, many of them good. I stayed conscious for the ride home from the hospital, even if I did have to go immediately to bed and so missed the cats greeting the Bean. Friends came over, and I sat and talked with them. But it was months before I could walk around the neighborhood normally. Going up the gentle incline of the train station left me breathless, my vision blotchy. I feel existentially queasy looking at pictures of me with the Bean in the early weeks, because I am so very grey.

I got better. The human body really does have amazing powers of restoration. But does the patient’s recovery mean the treatment regime was wisely chosen? The heroic medicine doctors, the bleeders and purgers and givers of mercury, thought their treatments worked because their patients often survived, when the truth is those patients recovered in spite of the medicine. Regardless of whether I should have had different treatment in objective terms — and I gather from google that sources differ on the guidelines for iron infusions and blood transfusions and so on — I feel sure the other aspects of treatment could have been better. Only one nurse, when I was already in the process of being discharged, mentioned my hematocrit drop and asked if I really felt okay. (Desperate to leave, I said yes.) The nurse practitioner at my OB office told me I should expect to feel tired when I described my trouble breathing while walking. At the infamous postpartum appointment, Dr. Russian didn’t know my hematocrit levels and dismissed my questions on the topic. None of that was helpful, even if it was the case that the best course of action was waiting for my body to rebuild itself. It’s a kind of gaslighting, I think, not to tell a patient that how she feels is not in her head or her weak moral constitution.

Besides angry, I feel a bit scared by these new documents, in particular the picture. My septum is gone and presumably won’t break and bleed again. I expect it caused some of the trouble, in addition to other tears. The midwife at my new clinic says that didelphic cervices can bleed a lot, and suggested they might try rectal cytotec in addition to pitocin if it seems necessary. (I haven’t talked numbers with her, just my experience of being anemic.) If the pre-labor bleeding was a placental abruption — and we’ll never know, since the head of the OB practice didn’t see fit to take it seriously — there’s a chance that won’t happen again, and a 100% chance I won’t let it be ignored this time. I have the reassurance that I did survive, however sick I got. But there is still that nauseating feeling of almost having been run down by a bus, not realizing it was even there until it passed.

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24 thoughts on “Bloody Business

  1. Gah, Dr Russian, bloody woman. I don’t have useful information to offer, but I want to say *I* believe your account of your experience and I am so sorry it was such a misery. I can’t believe you got so little support from That Bloody Woman, amongst other medics, and that there was no one who even asked you if you were okay at the group that day. (People! GAH.)

    Do tell your new clinic about your concerns and the reasons for them, won’t you, Bionic?

  2. Holy Hell. I wondered why you never really finished out the birth story. I’m glad you made it through all of that, and that you did so still willing to go through (some easier, more pleasant, less awful version of) it again. I wish I had any knowledge or reassurance about the bleeding. I also wish I had some about the incredibly insensitive jerks who apparently were pretending to care for you–from Dr Russian down to whoever thinks it’s a good idea to exclude men from lactation groups. Ugh. Also, I am so glad to have very few delivery pictures, and none of me from the waist down. My wife still gets queasy when she describes the blood, and I didn’t have more than the usual bleeding. Here’s hoping you get some good advice, and some better medical care this go around.

  3. this is shocking to read. shocking. i hemorrhaged after birth and my hematocrit was at 25, which i was told was the cutoff for needing a blood transfusion. they held me at the hospital and it went up to 26 so they decided i was ok. i’ve often felt disbelief and anger that no one – not the OB, not our midwife, not my GP – ever checked again to make sure it was ok. but i wasn’t having any of the problems you describe. a friend of mine also recently hemorrhaged after birth and hers was at 21, so she got a transfusion. i CANNOT BELIEVE they didn’t do something for you. it is shocking and disturbing and i don’t even know what i would do if i were you. i feel so upset for you that people who were supposed to be helping you let you down so thoroughly.

    one other thing – i have always been anemic, sometimes better, sometimes worse. and recently (after i requested the test) my iron levels were extremely, dangerously low. my doc recommended infusions so i tried that and the two most dramatic changes were that i stopped chewing on ice cubes (to rachael’s unending joy) and that my milk supply shot up. i had noticed when pumping that what i got had reduced dramatically but wasn’t sure if it was just because willa was older, etc. after the infusions it was as high as it was at about 3 months pp. i asked an LC about that recently and she said there’s no connection between anemia and milk supply. which seems like an incredibly stupid thing to say in that circumstance. people told me hemorrhaging could give me supply issues, but my guess is that no one has specifically studied iron deficiency and milk supply and it’s something i now mention to every mother i know who has had blood loss and it having trouble with breast feeding.

  4. Ugh, I am so, so sorry for your experience. This sounds so terrible.

    Don’t have medical knowledge but can give you another point of reference maybe. Looking back at my own bloodwork (planned c-section with twins – no complications), my #s were as follows:
    HGB day before c sec: 12.5/ day after: 10.4
    HCT before: 36.6 / day after: 31.2

    So yeah, I’d say your decrease seems pretty extreme… Especially since I would think that a c section might normally cause more blood loss than a vaginal birth (but I could be wrong), and if the placenta question you asked contributed significantly to the decrease then mine with twins would probably have been more extremely affected.

    In any case I hope that your current doctors can help you to avoid repeating this experience. Maybe you could make a special office appt with the doctor to specifically discuss these concerns and this information. Just thinking they might take it more seriously than if tacked on to a regular appointment? I’m sure you have been strategizing this, though. Good luck!!!

  5. Oh, wow.

    Sorry. That’s all I got.

  6. Um. I received two units of blood immediately after labor when they were stitching me up and I almost passed out, thanks to my anesthesiologist.

    They gave me another two units on slow drip when trying to stand made me dizzy 8 hours later.

    I don’t remember my exact counts, but I think they were comparable to yours.

    Also, I know it’s a hard place to go, but I really think you should consider pelvic floor physical therapy. It will do wonders for the scar tissue and hopefully help make the next delivery less traumatic. At least, that is why I’m going and what I’m hoping for. My blog post on the experience is still half-written, but I will send you the draft if you’re interested.

    • When I say thanks to the anesthesioligist, I mean that without verbal irony. He asked me how I was doing when I was turning white and insisted on the transfusion. He was my hero in the OR.

  7. I want to say here that I was extremely shocked and upset to discover some of the real numbers and details from Bionic’s records when they arrived last week. My experience of her delivery and subsequent recovery was that she was very sick and I was very frightened, but I told myself over and over that no one else seemed worried and I was just being my paranoid self. Now that I have more information, it seems that, no, I was reading the situation accurately and should have advocated more for her with more people. Perhaps this merits a post, but I didn’t want to bump Bionic’s post by writing another one right away. Also, if I ever see Dr. Russian again in the flesh, things may get seriously ugly.

    • I would happily help you track her down and give her a beatdown if I’m ever in BK. The more we learn about this woman, the more I’m horrified. My birth story is traumatic in its own right, but the lack of medical care received by Bionic is seriously lawsuit-level horrifying and appalling.

    • POSTPARTUM HEMORRHAGE!!!! THE DOCTOR IGNORED A POSTPARTUM HEMORRHAGE!!!!!! There are not enough exclamation points in the world. The worst part is it wasn’t *your* job to worry about this. (I do not think any blame attaches to either of you in any way, to be clear. Your jobs were to be parents. The people at the hospital, their job was to monitor the health of their admitted patients.) It was the job of any number of licensed professionals who all fell down on the job.

  8. I feel faint, shaky, and queasy just reading about your experience. It’s hard to imagine how awful it must have been to live through it and get so little support from the medical professionals charged with looking out for your wellbeing. I’m glad that I don’t know what Dr. Russian looks like, because if I did, I’d be tempted to hunt her down, and then text Sugar Mama to invite her to meet us in a dark alley.

    You are very brave. It seems that there are many reasons to think that the experience will be different and better this time.

  9. Holy crap. I’m not an OB (I’m a diabetes doctor) but I can tell you that the drop in your hemoglobin should have had MULTIPLE people noticing. And if nothing else, someone should have noticed that you weren’t right after – not Sugar, like she says, she thought she was being overly worried, and quite honestly, she doesn’t see postpartum women every day. But the OB? The nurse? Someone at the lactation group? The pediatrician? These people see postpartum women all the time – I imagine that any one of them should have been able to look at you and know you weren’t well.

    I’m so sorry you had to go through that awful experience. It sounds like you have much better care this time, and even in the unlikely event that you lose that much blood again, you’ll get the appropriate treatment for it and it won’t be anywhere nearly as bad.

  10. Wow… Not much more comes to mind. I’m sorry, what a horrible experience.

  11. You should’ve had at least one transfusion with numbers like that, and Dr. Russian ought to be beaten senseless with a bottle of iron supplements.

  12. Gosh. I’m so sorry you had to go through this awful experience. And none of the medical professionals even noticed. I hope you have a better team this time round, and that you and Sugar and as many people as possible can advocate for your health.

  13. The fucking hell. I’m pretty sure that number should trigger a ‘results critical, call patient immediately, clinic director gets message if not done within 12 hours’ result through the medical record system, if any. (On paper, they should trigger someone paying a little fucking attention to the lab results that come back printed in RED.) From some very brief reading, there is NO reason for HCT to be below-normal postpartum EXCEPT hemorrhage, i.e., what was going on.

    Also, I’m pretty sure that ‘difficulty breathing’ is never something that medical professional should ignore.

  14. Like many of the others, I feel weak and trembly reading about this, and VERY SAD, and VERY ANGRY. VERY VERY ANGRY. I am so deeply sorry you had to endure this, and I wish I could have at least appeared at your doorstep to ferry you where-ever you needed to go. When I think about how incapable I would have been of taking my baby around to my many lactation appointments on public transit in my pink and glowing condition, I feel positively tearful imagining you doing this while basically clinging to life.

    I am grateful you did not DIE. I am NOT SURPRISED the whole thing resulted in PTSD. (Not that I was before…) I feel like the WHOLE WORLD needs to gather round to make sure your next birth experience is perfect and amazing.

  15. I am SO sorry I only got to this post now (I wasn’t reading my feedly while on holiday in our last week in the U.K.). There’s so much here for me to process, so I can’t even imagine what it must be like for you and Sugar to have to look at those numbers and correlate them with your birth experience.

    I am so so sorry that you went through this, and so angry on your behalf, and I hope your new doctors take everything you have to say so very seriously and that you get a wonderful, positive birth experience with 2.0. Not to whitewash what happened with the Bean, not at all, but my birth experience was so positive, and I feel so miserable thinking about that, and assuming that any 2.0 would go equally smoothly, and I just want you to have a chance to feel good about bringing a baby into the world.

    And you are wonderful and brave for trying again.

  16. Wow. It really sounds like there were a number of medical professionals who missed the boat. Sure, women with brand-new babies tend to be tired, but they don’t tend to pass out all over the place. And when confronted with actual numbers that showed why you felt so awful, Someone should have done Something. It sounds like things are unlikely to repeat themselves (both because things are likely to turn out differently this time and because this time around you’ll know that feeling that awful is Not Normal). But it’s horrible that it happened.
    I second the suggestions above to talk it all through with your current OB/midwife. It seems like they should know about it because of its impact on your physical health, but also on your mental health as you prepare for this new (and hopefully drastically different) birth experience.
    One other thought–have you considered having doula? It might help to feel like there was someone else around who has lots of experience with what’s normal vs. not-normal, and could help you advocate for your needs. They wouldn’t necessarily be there every minute post-partum, but would be there at the birth and would likely check in with you afterwards.

  17. OK, so as for the numbers. We typically transfuse below a Hgb of 8 but I work in oncology so our patients aren’t losing blood. Blood loss 15-30% would usually be treated with something like Lactated Ringer’s. 30-40% would earn you some packed RBCs and a volume expander. Any greater blood loss would require a blood transfusion and volume expanders. We certainly would not discharge a patient with a Hbg that low!

  18. This one is thorny for me- I can see it from the formal best practice transfusion guidelines bible, from your symptomatic perspective, from the perspective of the sin (at the very minimum) of appalling clinical communication with you and so on.

    Mostly I need to pull my head out of my transfusion guidelines arse and say how sorry I am this happened- things could have been done differently and should have, also- IV iron should have factored in along the way, takes a long time to replenish without the building blocks…… Follow up seems lacking.

    I see PPH’s to your kind of hb not infrequently, but my job means I see that sort of thing. It is NOT the normal delivery experience. ALso, it’s amazing how blood looks like so MUCH all over the place.

    Finally, this is unlikely to happen with 2.0.

    The causes of PPH go atony, atony, atony other stuff- you’ve had other stuff once/septum gone and I don’t think it’ll be a factor again.

    xx

    g

  19. I’m so sorry for your experience. I didn’t have the crappy doctors or the traumatic birth experience you did, but I did have the postpartum hemorrhage, a HGB of 7, passed out twice in the hospital each time they handed me my daughter and started to move me from labor and delivery to the mother and child ward, and was on the verge of fainting for weeks and miserably dizzy and headachy for months following. In my case, my wonderful doctor was on top of it– I was the idiot!

    I didn’t know that I was being monitored for blood loss the first day — only that without my requesting it, they kept bringing me f—ing cheeseburgers. But by day two in the hospital, my doctor explained that my blood count was dangerously low and they wanted to do a transfusion. I don’t have religious or moral or eeby jeeby objections to transfusions, but I was so afraid that if I somehow wound up with an infection, I would be separated from my baby, and as a single mom, I was desperate for that not to happen. I hadn’t even let them taker her away from me for a second to be bathed or hearing tested, so there was no way I was going to risk anything worse. So I ate the f—ing cheeseburgers and I promised to eat lots more, drink lots, take iron supplements, and swore I had adequate support from family and friends, and eventually, my doc agreed to discharge me to the care of my parents who had come in for the occasion despite my still transfusion-worthy bloodwork three days later.

    So, here’s the part that might or might not be helpful — early on with pregnancy number two, I talked to my doc about doing autologous blood donation because I knew I couldn’t risk being separated from both of my children or go through months of postpartum anemia again, so banking my own blood in the event that I might need a transfusion seemed like taking control and planning. There was some confusion when I actually showed up to make the donations and was informed I couldn’t donate blood for myself or anyone else because I was pregnant and I had to explain that was precisely WHY I was donating blood, but eventually, this got worked out and I was allowed to bleed into a bag, eat my cookie and drink my juice, and be on my way.

    I also had a birthplan and a doula, which I also recommend. I wrote up a birthplan in which I explained, among other things, the postpartum hemorrhage experience and aftermath with baby #1 and my desires should that recur with #2. All the docs in the practice were therefore aware before my delivery (I circulated my birthplan to all the docs in the practice and asked that they sign off and/or let me know if any of my wishes or concerns gave them cause for concern) so nothing could slip by them, and my doula presented laminated copies to the nurses of labor/delivery when we got there. I also included the autologous blood account # on the birthplan so if things got crazy in labor/delivery, this wouldn’t get overlooked.

    I didn’t wind up needing that blood and birth number two went much smoother in the bleeding department, as will hopefully be the case with you too, but knowing it was there and that there would be no chance for anyone to overlook a fairly important piece of my previous labor/delivery history gave me peace of mind.

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