Tag: postpartum hemorrhage

Ashley: My name is Ashley Lewko, I’m from British Columbia, Canada I live in Langley, and I just moved here actually at the beginning of this month away from my hometown in Penticton, so it’s a bit of an adventure for me.

P: It’s Beautiful there, right?

A: yes it’s gorgeous it’s very green

P: sounds lovely.

A: Yeah.

P: And how many kids do you have

A: I just have one His name is Liam and he’s about 21 months.

P: Oh, nice.

A: Yeah.

P: And before you before you became pregnant, you probably had ideas about what pregnancy would be like, what do you imagine it would be like?

A: I honestly I thought it would be a lot harder than it was, but it was difficult in different areas than I expected it to be. Like I expected being big to be like the issue but it was really like the morning sickness and just being tired. That was the hard part for me. It was not what I expected at all.

P: Yeah, I think that’s most people’s experience, so you get pregnant easily,

A: I got my IUD taken out, and then I had one cycle and then I was pregnant. So it happened very easily for me and I know that’s not the case for a lot of people but it just happened we weren’t expecting expecting it to happen that quickly like we took the idea and we’re like okay well like we won’t be careful. And then we weren’t expecting it to happen like right away, but it was all good,

P: and then did you find out you were pregnant with like a home test.

A: I did, I’m like an obsessive tester. So I took like many tests and like I still have it. It’s, I kept it for some reason. And you could like barely see the line on there and I’m like I’m pregnant. He’s like, No you’re not, like, Yes, I am. And you made me go to the doctor and I was.

 P: And you said the pregnancy was pretty easy.

A: Um, for the most part. Yeah, it was. I didn’t have any complications or anything just the normal symptoms like morning sickness I had all day sickness for 40 weeks. But that was about it.

P: That seems like a lot.

A: Yeah, it was. You kind of just get used to it in a way. you just adapt.

P: So why don’t you take us to the birth like start with, you know, feeling contractions or wherever the contractions come…

A: So I was, I think I was 39 weeks, and six days. And me and my mother in law, we went to Walmart to get some last minute things. I’m like, Oh, I’m not feeling, right, like I feel different. And then we were literally in the baby aisle. And my first contraction happened in the baby aisle of Walmart. I’m like, Okay, well, I think, labor might be happening because I manifested that I would deliver on my due date, the whole pregnancy. And I’m like, it’s happening I’m delivering on my due date because I’m not going over 40 weeks I’m done. And I kept walking around just trying to make it progress and we walked around Walmart and then we went to our little mall in Penticton, and just kept walking and they kept getting stronger and then like okay well I think maybe I should go back home and just rest because I feel like it’s gonna be a long night, and I got there and I just had the urge to just keep walking so me and my partner walked up and down our driveway like, I don’t know how many times. And they kept getting stronger and stronger and like this is it, it’s happening, gonna have a baby on my due date, I called it. And, yeah, basically I did that for hours like this, my first contraction was at 11am on the 26th of January. And I had, I was laboring at home until. Gosh, I don’t even remember exactly but I think I went to the hospital for the first time at around midnight.

P: Wow.

A: And then, or maybe like 10, I went around 10:10pm, so I was laboring at home that entire time and then things started to get pretty painful. So I went to the hospital. And they checked me out and they’re like, no, you’re not in active labor yet you have to go back. So we went back home, thank goodness it’s only like it was a two minute drive. Yeah, went back home and then my mucus plug so that was a whole nother story. I don’t know how in detail you want me to go.

P: Yeah, You can tell the story.

A:Okay, the whole thing? in depth?

P: Blood and guts are welcome.

A: Okay, so I got back from the hospital and I decided to have a bath, I’m like I’m in pain I need to like control this somehow I wanted to do a natural birth, I didn’t want medication that was just the choice that I made. I don’t know if I would have done better with medication, but it was what it was, I did it. And so I had a bath, and then I’m like something doesn’t feel right, and the only place I was comfortable was on the toilet in that position like squatting on the toilet. That was the only place I could like handle my contractions. So, I’m sitting on the toilet and my partner Travis is sleeping in bed because it’s like we’re gonna have a long night and like I’m fine just go sleep. Like, you need to come here right now because something is coming out, like somebody is coming out. I don’t know what it is, and he’s, and we think like, this is my first baby I’ve never done labor or anything before, and he sticks his hand underneath. And there’s massive mucus plug just falls out of me. And it’s like, in his hand. We’re like, what is that. So I like called my midwife I’m like something just came out of me. I don’t know what it is it’s like a huge. Well, a booger. Basically, it’s gross it’s bloody it’s like, it was like, I have a picture of it, because we were like, Whoa, what the heck is this.

P: You may not meet your mucus plug in as intimate a way as Ashley and Travis did some women don’t even notice they’ve lost their mucus plug the mucus plug is made up of a jelly like substance secreted by the cervix, it acts as a protective barrier that closes off the cervical canal shielding the uterus from bacteria and other sources of infection. If you do lose it. It also means that the cervix is softening, meaning it’s behind the thinner and wider in preparation for labor. Although losing the plug alone does not mean that labor’s imminent.

A: And then, yeah, as soon as that came out the contractions really picked up. And then my midwife ended up coming to my house and checking me there because things were getting pretty intense and I, I started having the urge to push. Basically right after that mucus plug came out, and it was not fun at all and it’s really scary because you’re not supposed to push on a cervix that’s not ready. So that was an issue so because that was happening and I think I was about five centimeters dilated. They took me to the hospital–worst driving my life—we’ve got two speed bumps, out of our driveway. I’ll never forget them. Like every speed bump you’re like, waiting for the next one as you’re contracting and like, yeah, it was, it was an episode. And then he insisted he stopped at the gas station to get some energy drinks. So I’m sitting in the gas station parking lot, screaming in pain, as he’s getting energy drinks at like, I think it was like, 1am No.

P: Oh wow.

A: Yeah. So, going to the hospital we get there, and immediately get checked and they started giving me the only medication or medication I took was laughing gas. And they started like.

P: Does that feel like anything like you feel better or nothing at all.

A: Um, It kind of, for me personally I know a lot of people don’t like it but I did it the whole time. It makes you basically like just mentally relaxed, like it doesn’t really like take away the pain, necessarily, but it just kind of like helps you calm down. The weird thing about laughing gas is when you inhale it you know how you inhale helium and your voice gets super high. So when you inhale, laughing gas your voice gets super deep, and I had no idea I thought it was in my head because it kind of makes you a little bit high, but not nothing crazy in the last like minute. So I’m inhaling this laughing gas and talking and I’m like laughing at myself because I think in my head that my voice is deep but everyone around me is also laughing I’m like can you guys hear that, like, yeah, it makes you laugh, it makes your voice like super deep and I’m like sitting there on a, on a birthing ball with my huge tummy out just like, yeah, making jokes and stuff it was fun. And, yeah, laughing gas is a hoot. And then basically just labor that the hospital, my mom ended up coming I’m like I just want it to be me and Travis and I don’t need my mom Yeah, as soon as I started feeling the contractions I called my mom and she was there

P: one thing I found kind of interesting about your story that you wrote about in your blog is that you talk about kind of the terror of it all, which I think it is really scary.

A: It’s terrifying,

P: no one really says scary everyone says painful, but you don’t really know what’s happening to your body and it’s so massive and powerful and out of your control. Yeah, like I think terror is kind of the right word.

A: Yeah. Birth is terrifying you don’t know what’s happening you don’t know when things are going, you don’t like you don’t know anything. You don’t know if your birth is gonna be successful, the way you want it. You don’t know if you’re gonna have complications like. And like the pain of contractions without anything. When you are in like transition which is like seven centimeters on is like massive ocean waves is the best way I can describe it like it just comes on and you just, you have to embrace it, you can’t fight it because if you fight it it’s gonna be worse but you want to fight it because you don’t want it to happen. And that’s pretty it is terrifying but it’s also like really exciting. And, you know, I just kept telling myself one bad day, and this is going to end. Like, it’s going to end the baby’s going to come out and it’s going to end. I can just like get to that point, it’s going to end and I’ll be done.

P: Yeah, that sounds like good self talk.

A: Yeah, I I honestly I don’t know, I did tolerate it like decently. But I was pretty loud. I could have for my next child when we decide to have another one I’ll definitely know what to do and what not to do. with Like, my voice, because they tell you to like make deep moaning voices and I was like screaming high pitch which doesn’t help anything. Yeah. Anyway, where was I.

P: So we are. We’re having the waves come and you just called your mother.

A: Right, so she shows up, and I got in the shower, just to get some like hot water and I calmed myself down cannot at this point hard to remember because you start to get into that like weird days where you’re just like half sleeping half contracting. And I remember going on the bed and my mom and Travis were like taking turns pushing my hips together. And I was having super painful contractions and I wasn’t dilated enough to push I think I was like a seven, which is like cutoff to start to get like really bad. And my midwife checked me. And she’s like, you’re not dilated enough and you keep pushing on your cervix it’s not ready and it can damage it and then you can have a C section I think you need to have an epidural like Okay. Fine, whatever. And in our like appointments prior to my birth, they made me come up with a safe word because I didn’t want to have an epidural, so I had to say the safe word. And for some reason I chose the word brussel sprout. So imagine me with laughing gas with my deep voice, and they’re like you have to say your safe word or we’re not doing it and like brussel sprout. And so I had to say that, and then everyone started laughing and so they call that anesthesiologist, and I’m so proud of myself for saying that word. And I’m still laboring and he takes like felt like an hour to get there probably was a bit less but I took his time, I’m pretty sure he was on call shows up I’m like starting to freak out at this point and like maybe just check me one more time to make sure I’m not like there. And so my midwife checks me she’s like you’re at a nine but I can stretch you to a 10 like sweet, screw the epidural let’s do this. I don’t want an epidural right now like what’s the point of that when I can push. And so the anesthesiologist, had a fit in the room, as I at 10 centimeters, with no pain medications screaming and labor gets his epidural cart slams it against the door slams the door and like slammed it out in the hallway. It was like the most ridiculous childish thing I’ve ever seen in my life,

P: Yeah, that seems bizarre.

A: Yeah, it was like really weird. And we had to actually make like a formal complaint to the hospital because it was like, yeah, it was totally uncalled for

P: you can’t be the first one.

A: No

P: right? to turn away an epidural because it’s too late

A: Like, aren’t you Glad I don’t need to get an epidural like I’m sorry that you had to leave you’re ….At this point, it was like 7am. Yeah, like, yeah, it was not like it was the middle of the night it was 7am. He had to come from his house because he was on call like. Either way you would have had to leave your house like I’m sorry you didn’t get to do the epidural but like I don’t want it.

P: Yeah, yeah

A:  you don’t need to throw a fit, like just move on. Anyway, yeah, it wasn’t not a good experience. It’s like, it’s definitely one way to make your stress levels skyrocket when you’re about to push out a baby.

P: Yeah.

A: As I’m like laying there half naked screaming and pain and this guy’s like throwing a fit slamming stuff. I don’t think I’ll ever forget it.

P: Yeah, I’m impressed that you still said no because a lot of people have stories where once they’ve called the person they feel like they have to go through with it.

A: Yeah,

P: I’m glad that you didn’t, that you said like it. Now I don’t need it right it’s that’s like a.

A: Yeah, I, I just, I had it so deeply planted in me that I was not going to get an epidural I was more scared of the epidural that I was of naturally pushing out a baby was more terrified of that needle going into my spine than doing what my body was naturally meant to do. There’s nothing wrong with epidurals I was just mentally scared of that needle going into my spine.

P: More than 60% of women in labor use an epidural, which is an anesthesia, that blocks pain in a particular region of the body. In the case of labor, usually everything below the waist, it can have some negative side effects like itching, infection, bleeding or headache, these consequences are short lived and uncommon, less than 1%. According to the British Journal of anesthesia. The estimated risk of permanent harm from an epidural for a woman in labor is lower than one in 80,000, to try to put that in perspective, you’re much more likely to be struck by lightning in your lifetime. Regardless of the statistic. No one likes the idea of a needle in their back And I remember being worried about getting an epidural before getting both of mine, but the risk of unintended harm is low.

A: And also just like advocating for yourself and what you want is so important, like, I don’t care that he got upset that he didn’t get to do an epidural I’m sorry this is my labor my story. And I’m not gonna let you ruin it by causing a fit, like,

P: well, but that’s why I’m impressed by because you’re, you’re, you’ve got other things going on.

A: Oh yeah Oh,

P: so, so it’s kind of amazing that you were still able to like most people say, for their second one, they’re going to get a doula because they imagined that they would, you know, be self possessed and have control over everything and then when it actually happens there’s so much going on that it’s hard to maneuver so so good for you to make that happen your way.

A: Yeah, my midwife. She was also a huge part in that like she. As we get through the story, you’ll see but she is such an incredible woman and like my, my team wanted me to have a natural birth if possible so they were also on my side, which made it that much easier.

P: Yeah, that’s awesome.

A: And they dealt with him and they just told him to leave but, yeah, so I didn’t get the epidural. And then it was time to push that that was honestly most the most terrifying part. Well no, it wasn’t the most terrifying part but as far as

P: of the birth

A: yes, of the birth. Yes, that was the most terrifying part, just like feeling, everything and pushing and you have to do it like you have, you have to bear down and push no matter how bad it hurts. And like all you want to do is just not push.

P: Yeah,

A: because like, yeah, a baby is coming out, and it is excruciating. And you just have to stick through it and push and I pushed for. I think I pushed for 45 minutes, not very long, and my partner and that’s probably because I didn’t get an epidural and I could feel what I was doing.

P: Yeah,

A: because that I know that when you get an epidural you do you have, most people push for longer because you can’t feel your body.

P: So this is a good question. Does an epidural slow down labor studies in the 20 teens suggested Yes, an epidural does lengthen labor, but most of those studies are observational, meaning that they compared the length of labor between women who chose to have an epidural and those who didn’t. So if this is your sample, the issue becomes did these choices reflect other differences between the groups that could have led to longer labor’s. In 2017, there was a randomized control trial of women, who either received an epidural or saline solution and the lengths of labor were the same. So perhaps the jury’s still out on this one.

A: And my partner actually caught her son, so he he birthed her son.

P: Wow.

A: Yeah. And that’s something that like made him feel like so connected to that moment. So I the midwives birthed the head and made sure that he was good and then he did the rest.

P: That’s amazing.

A: Yeah, it was really cool. And then he put our son Liam on my stomach, and they got them all. Situated, and I will never forget birthing the placenta. It was such a weird feeling like after you birth a baby, and then they like toggle an umbilical cord and like you birth the placenta. And it’s like this, just feels like jello. And they like lifted it and showed me the placenta I have a picture of that too, such a weird thing you’re like I grew that.

P: Yeah, amazing.

A: Yeah, and it looks like it looks like the tree of life.

P: That’s cool, you mean all the veins going through yeah that’s cool.

A: Yeah, so they inspect your placenta to make sure that nothing was left inside of you. Yeah, and it looked fine, I was fine I was doing okay. And then, my mother in law went and got us food. Obviously I’ve just been laboring for 20 hours, and I ate everything so fast I was so hungry and like so weak and like dizzy and shaky. And I don’t know where Liam was at the time I think he might have been like on the warmer, like getting checked out. He was perfectly fine like he was born and he was good to go, like nothing happened with him he was perfect. And then the nurse wanted me, this is about an hour after I delivered. She wanted me to get up and go to the washroom because they like check your uterus and like your bladders too full you need to drain it and then come back and I stood up, walked to the washroom with helped because I was so dizzy. Yeah, and I sat down and literally like, I don’t know 12 Golf golf ball sized clots just fell out of me. And I looked at the nurse and you could just tell in her eyes that something was wrong and that it wasn’t normal she’s like, oh, okay well let’s get you back to the bed, like, okay, and as soon as I stand up, I start to feel extremely dizzy. I feel dizzy talking about this right now. And I lay on the bed and like immediately I just started like profusely bleeding everywhere. And, like,

P: okay, that’s scary.

A: Yeah, it was. I didn’t really understand what was happening at the time, because I didn’t know I didn’t even know that hemorrhaging was a thing. I didn’t really understand it, and nobody really talks about it because one that’s terrifying and I’ve gone through counseling to get over it. But, yeah, it is terrifying and so

P: is it like a, is it like a rip of the uterus or like what exactly is bleeding?

A: Um, there was left over amniotic sac stuck to my uterus.

P: I contacted an OB, Dr Nicole Wilcox, to get details about some of the medical issues Ashley encountered. Hi Dr. Wilcox thanks so much for coming on to talk to us again.

Dr. Wilcox: Thank you. Happy to be here.

P: Can you explain to us how the amniotic sac could still be stuck to the uterus after delivery, even if the placenta is examined.

Dr. Wilcox: So, after delivery, whether it’s vaginal or C section, but more commonly with vaginal, the placenta after the baby’s delivered the placenta needs to be delivered and usually there are signs that it’s starting to detach from the uterine wall, and at that point you know you sort of gently guide guide the delivery of the placenta out of the uterus but it, you know it has membranes that was in a was the sack that surrounded the baby that are attached to it and those either the sort of meaty part of the placenta which implants into the uterine wall or those membranes, sometimes that a piece can can remain in the uterus, as it’s being delivered. And so one cause of postpartum hemorrhage can be a little bit of retained retained placenta or retained membranes. And so if you, you know, notice that a woman is continuing to have bleeding after delivery of the placenta that’s one of the things you would evaluate for it is sometimes you can just gently feel even feel up inside the uterus to make sure everything has been delivered we always examine the placenta to look to make sure it looks intact although you know it’s not that’s not foolproof you can certainly have a piece left behind and not be able to detect that just visually inspecting

A: so your uterus is trying its contracting and trying to get that out so it’s trying to expel it which is causing it to bleed, and basically making me bleed to death. Yes, is what would have happened. So, I’m laying on the bed and I had pushed so hard when I was delivering that I pushed my IVs out.

P: Oh wow

A: So I didn’t have IVs and my veins are collapsing. So I had, because every nurse can try twice, I believe, so I had, I think five nurses tried to get IDs into me. So that’s ten times. I had an IV poked into my arm I had bruises everywhere. So they got the IVs in, and then my midwife started doing bi-manual compressions.

P: What’s that mean she’s like pressing on your uterus

A: so one hand is inside of me.

P: Oh wow,

A: like in a fist, pushing against my uterus. And then the other hand is folding my uterus overtop of her fist from the outside, on my stomach folding it trying to contract it and trying to make it stop bleeding. She did that for about an hour. I was literally screaming on the top of my lungs. And like, passing in and out of consciousness, and like my blood pressure, I don’t remember the numbers it’s on the blog.

P: It was super low, it was like yeah 75 over 45 or something

A: it was Yeah, it was super low and my, my heart rate skyrocketed. And that was scary and my Travis was sitting beside me holding my hand. Like I don’t know how he did it but he just just like you’re okay like it’s fine. And I’m pretty sure that his mom had Liam, I have no idea I don’t know where Liam was at the time

P: wait let’s pause for a second. kudos to Travis man, he is obviously lying, and doing a great job.

A: Yeah, he did incredible i don’t i don’t know how he did it I would have been terrified and crying. If I was in his shoes because like my mom said it looked like a murder scene. And then the bimanual compressions didn’t work. And I was still bleeding and they’re like, you have to have surgery. So, they call the OB, and she comes up to me she goes okay so we have to do the surgery, there’s a chance it might not work. Do you still want to do it I’m like, Okay, well, what options do I have either I do it. And it might not work and I die, or I don’t do it and I die. Let’s just do it like you’re talking to me. Let’s go.

P: Yeah, yeah…

A: I’m in pain here like let’s just do the thing, never had surgery in my life, and I ate so much food that I couldn’t have. I couldn’t go under anesthesia.

P: Yeah, yeah, you couldn’t have general because you had food

A: right, yeah, so they couldn’t knock me out, which I was like,are you kidding me. Now I have to get an epidural after all of that I have to get an epidural, are you? It was kind of defeating, in a way, but I’m also glad I had it, because it was like a nice like this take away the pain for a minute after all of that. So I get wheeled into the operating room never been in the operating room in my life. I get a new anesthesiologists they just switch shifts, I get this amazing, incredible gentle kind hearted man and he’s like okay like we’re gonna do this, it’s gonna be okay. I’m going to give you some medications so your anxiety goes away you can relax, and he gave me the dose and like,can I have more? This isn’t enough. I need to like, go by by.

P: Yeah.

A: And so he gave me another dose and I was like falling asleep. Oh my gosh, I totally forgot to mention this so my midwife. She came with me she got in her scrubs she came with me to my surgery. She held my hand at the entire time. And like comforted me like I’ve never experienced anything like that I didn’t even know that they could do that. And she came with me because I was so scared and like one point I’m like, Am I gonna die. She’s like, No, no, you’re fine You’re fine It’s okay, and everyone was just so like comforting and yeah so she came with me. I’ve got the medication so I was calm and then I got the spinal, which is the weirdest feeling of my life.

P: Yeah,

A: because I was one high on drugs, and I take really well to any medication so I was my whole body was. I couldn’t feel myself breathing. It was terrifying.

P: That’s scary.

A: Basically I could just blink. I couldn’t like move my arms like nothing. And it’s only supposed to be from like the waist down yeah and then like my whole body was numb. And it was like that for like hours,

P: yeah that’s that’s very scary.

A: And then they like move you from your bed to like the operating table and I just remember like being so lifeless and just like. Obviously I’m drained because I lost so much blood. I don’t like I actually didn’t faint at all. I don’t know how I stayed awake. Yeah, like I was like, kinda like passing out but like I didn’t. I was awake the entire time. And they like move you and you’re like this lifeless numb body and all you feel like your head like wobbling, and they move you to the operating table and they like strap your legs up and they did a DNC. Yep. So they basically cauterized my entire uterus.

P: Can you describe what a DNC is?

Dr. Wilcox: Yeah, that’s a pretty typical step in, in a hemorrhage, if it’s not being resolved with, you know, massage medications, it definitely if you suspect that there might be some retained retained placenta or retained tissue or membranes, and the uterus, a DNC is a dilation a dilation of the cervix which is actually at that point is is typically already dilated; a curettage is a is really a scraping or a cleaning up the lining of the uterus. So it’s actually done in the setting of of postpartum but it also is done in women who aren’t pregnant, who are having bleeding issues but in that setting postpartum hemorrhage if the hemorrhage is ongoing. It’s very common to take a woman back to the operating room and you know if they have an epidural that can be used for pain control but to really evaluate, you know, take an instrument to gently feel inside the uterus to make sure that there is not some placental fragment piece of placenta or membranes that is that is remaining inside and sometimes that tissue can be sticky it can be sort of stuck to the wall and you have to, you know, kind of gently remove it and that can resolve resolve the hemorrhage.

A: And it worked. Thank goodness. And then I was wheeled into the recovery room and I’m like, I don’t know where my baby is that I just birthed like, Where’s my baby I’m not pregnant anymore like freaking out. And my midwife was with me the entire time and we were just talking and, yeah, I if she wasn’t there I probably wouldn’t have done, as well as I did. She really like changed it for me and made me feel comfortable and like cracking jokes and just making me happy. And like reassuring me that my son was safe and that he’s good. Yeah, that was fun.

P: Well that sounds, that sounds amazing to have had her there. Like it made a real difference.

A: Yeah, it was. like you remember when you had your epidural when it was wearing off.

P: Yeah.

A: Were you shaking?

P: I shook a little bit but it sounds like that as much as you did.

A: Okay, so they wheeled me back up to my room, and I got to hold my son and I was like, pale as a ghost like I couldn’t, like, you know how you put your hands down you like scootch your butt up on the, on the bed. I couldn’t do that. So I could like barely hold him and like I’m trying to breastfeed him and all of that. And I was like, as soon as like the spinal block started to wear off like my body was like, like shaking it was so weird. So I could like barely hold him I’m like shaking and like you’re, it’s like you’re, you know when you get that really intense shiver.

P: Yeah

A: and you can’t stop, it was like that, and it. I don’t remember how long that lasted but quite a while.

P: Can you explain to us why some woman. Shake as the epidural wears off,

Dr. Wilcox: it’s very common to have shaking, particularly around the time of delivery, but a lot of women will get that, after delivery and generally a reflection of, you know, I always tell patients it’s you know your it’s like your body’s, you know, running a marathon it’s, it’s just been through a physically very grueling event, to some degree, it’s hormonal but it’s also just, you know, the endorphins and to some degree, you know, exhaustion. and it’s not necessarily triggered or related to the epidural, although that can play a small role but it is a very common thing to see and after the delivery, whether it’s a vaginal delivery or C section.

A: And I totally forgot to mention this, but right after I delivered I signed an early release form for the hospital. I had a midwife as doing it naturally I wanted to go home and just be home, and they’re like okay, like you can leave in an hour and then that hour when I was supposed to leave this all went down. It’s just crazy like what if I did go home.

P: Yeah, no kidding. No kidding.

A: Yeah, um, delayed postpartum hemorrhage doesn’t happen very often either. It’s usually like right after delivery. And I think my blood clots so fast that it was just pooling inside of me when nobody noticed.

P: Wow.

A: Yeah, so probably going to the washroom saved my life.

P: Yeah, that’s amazing.

A: Yeah.

P: How long are you in the hospital when did they release you. For real.

A: Um, I got to the hospital. The early early, early morning of the 27th, and we went home on the 29th.

P: Oh, so you weren’t there very long.

A: No. I kept asking you to leave. It was I hated being there. It was like this tiny little room, and it was hot, and I was not feeling well and the bed was uncomfortable and like I woke up from surgery and I had a catheter I had all these IVs everywhere and like bruises on my stomach from them pushing on it and doing the compressions. I had bruises on my arms because the IVs. And

now I have to take care of a newborn and I can’t even scootch my butt up to sit up yeah it was, it was really hard. And when you lose, I lost 2.65 liters of blood, which I didn’t even know was possible. Like that’s a lot,

P: Ashley lost more than two and a half liters of blood. Is that a lot?

Dr. Wilcox: It is a lot because she probably in her body has maybe five liters, so she couldn’t last five to six she probably lost half her blood volume so that’s a postpartum hemorrhage is defined as being more than 500. milliliters which is half a liter if it’s between 500 and 1000 if you identify that you’ve likely lost more than 500, and the hemorrhage is ongoing you start mobilizing a hemorrhage team. And, you know, making sure you have good IV access you’re doing IV fluids and then after 1000, you are, you know, likely considering blood products, two and a half liters is. Yeah, that’s a significant significant hemorrhage and she’d likely needed a transfusion.

A: And they said, you can get a transfusion you don’t need it but there’s a chance that you could get AIDS.

P: There are things you can get with a blood transfusion.

A: Yeah. And I didn’t know that I’m like

P: Yeah,

A: I had no idea and I’m like, if I’m alive and I’m okay like I will reproduce blood. Yeah, whatever. Let’s not do it because I just I don’t think I need to risk that right now if I was going to like literally die then give it to me but

P: obviously everyone gets to make their own decision about whether to get a blood transfusion. I respect Ashley’s decision. I include this to give a sense of the risks of infection from transfusion.

Dr. Wilcox: So if someone’s had blood loss to that degree, and they’re what we call symptomatic meaning, she’s, you know, maybe a high heart rate low blood pressure, dizzy, dizzy tries to sit up or get up, then we’re really encouraging a blood transfusion which are really they’re very safe the risk of getting HIV from a blood transfusion is about one in a million to one and 2 million hepatitis, hepatitis B is about one and half a million risk. We’re screening you know so the blood is screened very carefully.

P: Dr. Wilcox is quoting rates from the US and looking at the rates in Canada where Ashley is from in a 2015 report on the risk of infection from transfusion. It’s one in 21 million for HIV and one in 7 million for hepatitis B.

A: I’m okay so it didn’t get the transfusion so I was really really weak for about two or three weeks. And I remember being in the hospital and I couldn’t even like walk to the bathroom without help, let alone like sit up and get my son out of the little bassinet they put him in and then lay down and breastfeed him like my midwife had to come and teach me how to breastfeed laying down, because I couldn’t hold him. Yeah, I could barely sit up. And, yeah, it was really tough recovering from that but I’d do it again.

P: Yeah, yeah, yeah,

A: it’s crazy what you do for your children.

P: Yeah. So you’re home Three weeks later, you’re, you have the baby you’re starting to feel better…you are good to go

A: Yeah Basically, going through that definitely gave me. I didn’t really recognize it until about a year after he was born that I had postpartum depression and anxiety, but we’re dealing with that now and I’m getting better, but it was, yeah it was a journey.

P: I mean, given all that you’ve been through, I mean, pregnancy is like is a huge transformation. Right? And then yeah, kind of chemistry change. And you had this pretty traumatic post birth experience.

A: Yeah.

P: That sounds terrifying, despite all the support. So that kind of, you know, it sounds like a rational reaction to all that.

A: Yeah, yeah, I remember. It was the third day postpartum. So the day after we got home, we actually got home on Travis’s birthday. And the day after was my little sister’s birthday, I’m like, I’m going to my mom’s house to say happy birthday to my sister. And the day after we get home, I could barely walk to the truck. I go out to my mom’s and I sat down on the couch, I was there the whole time. I didn’t move, but up to the truck, could barely get in. I walked back to our house, sat down and just started crying. And that’s when the baby blues hit it kicked in. Because everybody kind of goes through that after that, like hormonal change. And like, you’re like, no, you’re not pregnant. And now my baby’s out. And I’m not sleeping, and I’m hurting and my parts are hurting.

P: Yeah, yeah

A: my nipples hurt. Like all of that. It was never forget that either. Just that it was like a wave of emotion literally just took over me. It was it was intense. And nobody like talks about that. And how hard that can be.

P: Yeah, it’s super hard. That’s the thing, right is that so many people have babies, that in some sense that those numbers make it seem like it’s easy, but but almost nothing about it is easy. And it is so physically trying and taking care of a baby is just a ton of work. And you had such you had to build up your blood stores and all that I have a lot to overcome when you’re waking up every three hours and you know, had been up for the previous 20 hours. It’s a lot.

A: Yeah, totally. It’s more than a lot. There’s so many things that happen. And then bleeding and pain with that like, yeah, thank goodness, I didn’t tear at all. Not a single tear. I didn’t need stitches or anything. So I’m grateful that that didn’t happen on top of what happened.

P: Yeah, Yeah, no kidding. So this is a little bit of a tricky question. But if you could go back and give advice to your younger self, before the pregnancy, what would you tell her?

A: I’d tell myself, just to try your best to go with the flow of things instead of making expectations for yourself. Like, just have grace with things because as soon as your mother, nothing goes the way you want it to.

P: Yeah, yeah, I think that’s totally true. Although it’s hard because Yeah, right. So everything’s new. It’s such a surprise that it’s hard to not imagine a plan for yourself to think this is how I’ll handle it. But then

A: even now, like, he’s 21 months, and we’re going through the toddler sleep regression, and he was an amazing sleeper. I just put him down and he would sleep. And now it’s all different. I don’t know what I’m doing. It’s like, you can’t, you can’t stick to anything. Because babies grow so fast and change so fast. You’re schedules always changing, like, just go with it. And give yourself grace. And if you need to sleep on the couch for two hours while your child sleeps, do it. And do the laundry later because laundry can wait.

P: Yeah, that’s good advice.

A: Yeah.

P: What what’s your son into Now? What’s the What are his tricks?

A: He is a talker. He constantly talks he like I don’t he can say every word I say. And he really loves trucks. He loves like heavy equipment, trucks and he really likes the minions right now.

P: That’s cute.

A: Yeah. He is such a cute little guy. He’s so affectionate and kind already. loving it. Thank you to random people.

P: That sounds very cute.

A: Yeah, he’s adorable.

P: Well, I was so glad that it all worked out.

A: Yeah, me too.

P: Yeah, no kidding. And I totally appreciate you sharing your story because it is a you know, another narrative of how things can go.

A: Yep. I that’s why I made the blog post. I just felt like no one’s ever really talked about postpartum hemorrhage before. Like, I’ve never heard anyone go through that. And then I went through it and my grandma’s like, Oh, yeah, that happened to me. And like, why didn’t you tell anyone like?

P: how common is postpartum hemorrhage.

Dr. Wilcox: It’s it’s quite common, and it’s a It’s a leading cause of maternal mortality in this country. Yeah, well, it’s a leading cause in the maternal mortality that happens usually within the first day of delivery, certainly very common in outside the US as well. But But we it’s a significant issue in our country. And and and many people in the field have have developed protocols to really try and address prevention and accurately quantifying or really knowing exactly what the blood loss is probably the most important, one of the most important things is to recognize that it’s happening, and to act quickly, because women can lose a significant amount of blood very quickly. You know, the uterus is a very vascular organ. And it can, it can, it can bleed very quickly. But prevention in terms of knowing what a woman’s you know, blood count is going, you know, when they first arrive at the hospital, having that information, having IV access, identifying which women are higher risk, and taking appropriate steps, having the appropriate medications ready having blood products available. Because you you really need to stay on top of it.

A: No One Yeah, no one talks about it.

P: Did they say that there was any genetic component?

A: No. And they said for my next delivery, that they’re going to treat me like, I’m going to have one. So yeah,

P: well, that may be smoother.

A: Yeah. Which is kind of comforting. Because, like they can, I’ll tell I’m in a different city now. So I don’t have the same team, but. And I’m not pregnant, so I don’t have to worry about it. But it’s just nice that I can like tell whoever’s taking care of me that I had a massive hemorrhage. And just to watch for that make me get up sooner to make sure that I’m not bleeding. But yeah, I just it was terrifying. And I remember thinking like, I’m gonna die, and I just birth my baby, and I don’t get to meet him.

P: Yeah, that is that is scary. Yeah. Have you reached the point yet? of appreciating your strength?

A: Yes.

P: Okay, good.

A: Yeah. Yeah, I definitely had to do some counseling. And like, that’s also why I’m talking about it. Because talking about things like this helped me get through them. And just like sharing everything, and then meeting other people that had a hemorrhage to like, talking to other people. Like it just opened so many doors, and like, being able to be on a podcast and share what I went through on here. It’s going to help so many other people, and it’s just nice to not feel so alone.

P: Yeah, yeah, I totally agree. I totally agree. Yeah. So thanks so much for talking to me today. I totally appreciate it.

A: Yeah. Thanks for having me.

P: Thanks again to Ashley and thanks to Dr. Wilcox for her insights about postpartum hemorrhage. I’ve included links to the medical issues we discussed in the show notes. I’ve also included a link to Ashley’s blog think outside of the crib.com Thanks for listening. And if you liked this episode, feel free to like and subscribe and to leave a review. We’ll be back soon with another inspiring story about women overcoming the many obstacles to motherhood.