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.