Hemorrhage After Birth Will Happen Again

In July 2017, Ashley Byrnes gave birth to Carter. That was the like shooting fish in a barrel part, she says now. But virtually a calendar week afterward, she nearly bled to death from postpartum hemorrhage.

Eight days after giving birth, Ashley Byrnes nearly died from postpartum hemorrhage (PPH) – excessive blood loss that tin can occur inside 24 hours to 12 weeks subsequently delivery.

PPH is the leading crusade of maternal death worldwide. Nigh cases of PPH occur when, after delivery of the placenta, the uterus fails to contract enough to shrink the haemorrhage blood vessels where the placenta was attached. This leads to uncontrolled haemorrhage, decreased blood pressure, and increased centre rate.

Though PPH affects three to 5 per centum of new mothers, non all hospitals have specific, team-based procedures in place for managing obstetric hemorrhages. PPH causes approximately 8% of maternal deaths in developed countries such as the U.S. Some providers are not specifically trained in treating PPH and do not encounter cases of it often. These process and educational gaps trickle downwardly to patients, leaving many women in the dark almost the risks they might face when they go dwelling house.

Today, Ashley lives in the San Antonio area, and she advocates for patients and providers to receive more education about postpartum hemorrhage. Though UT Southwestern has specialized teams and procedures to handle PPH, nosotros invited Ashley to share her moving story with our staff in July 2019 to reinforce the short- and long-term implications of how nosotros brainwash and engage with patients nether our intendance.

I encourage you to read Ashley's story and start a conversation about PPH with your doctor – and with a woman in your life.

Ashley's story of postpartum hemorrhage

My son, Carter, was born July 18, 2017. The pregnancy was fairly like shooting fish in a barrel. I was healthy, though I was classified as a loftier-adventure pregnancy because of a few existing medical weather. Other than a few fainting episodes, which turned out to be important subsequently, everything was normal.

On commitment day, I was induced at 9:xxx a.m. I had an epidural at 10:05 a.m. (thank goodness for those!), and Carter arrived at 7:47 p.m. I call back telling my husband, Bryan, "Having a baby was easy compared to how it looks on TV. I could totally practice this over again."

Little did I know, I wouldn't go the hazard. After delivery, the nurses checked on me regularly and pushed on my stomach to release blood from my uterus. On the last twenty-four hours, the nurse didn't button every bit much. I didn't retrieve much near it – I trusted they knew what was best, and I was focused on my new baby.

Nosotros went home when Carter was three days old. I was still bleeding, which is supposed to happen. Typical blood loss for a vaginal commitment is 500mL; for a cesarean section, it's 1,000mL. The infirmary at which I delivered didn't give me that context. And honestly, it would be hard to mensurate claret loss at home. In other words, I didn't know I was losing too much claret.

Related reading: How much bleeding after delivery is normal?

'Something is wrong with me'

5 days later, on my wedding ceremony, I started to feel...off. I'll never forget that day. I lost my ambition, and I had an unshakeable feeling that something bad was about to happen.

While watching Bryan and our dog out in the yard, a surge of feet swept over me. I'k going to die. Something is wrong with me.

The awful awareness didn't subside by evening, and Bryan took me to an emergency room virtually our business firm (not the hospital at which I'd delivered). We sat in the ER for eight grueling hours. Though I told the dr. I'd recently given nascence, he didn't do a pelvic exam. Instead, he suggested I was an overwhelmed new female parent and sent me home.

The whole experience was frustrating, especially because I used to work in a children'southward emergency room. I decided to get a second opinion.

I went to my Ob/Gyn the next day, but my regular doc was out. The on-telephone call doc examined and said she didn't find anything incorrect. Then she asked if I was "bleeding enough." As if I was supposed to know.

This doctor also said it was probably merely my emotions. She suggested I come up back and see my regular doctor the following week. At that point, I began to question myself. Two doctors had told me nothing was incorrect. Maybe I'1000 just tired. Perchance I'k losing information technology.

'Call 911'

The next night, after some other unsuccessful attempt at making myself eat, I tried to relax and watch a pic with my mom. All of a sudden I felt a massive gush between my legs. I rushed to the bathroom and discovered a claret clot the size of a pineapple in my pants.

Shock set in as I called for my mom. When she saw the aftermath, the colour tuckered from her face. Wide-eyed, I mumbled, "What do I do?"

Nosotros called my Ob/Gyn's office. It was after hours, so a nurse answered. We frantically explained what was wrong, and she told me to telephone call back in 30 minutes if the haemorrhage didn't stop.

I said, "Absolutely not. Call the physician at present and call me back." The nurse didn't realize how bad the situation was. Manifestly, neither did the on-call doctor, who suggested I lie down for a while and see if the blood loss would irksome down. If it didn't, he said, call 911.

Bryan had been at the gym, and he got home inside an hour. I was still bleeding. He hopped in the shower apace, and the last thing I remember was getting upwards to use the toilet. When Bryan got out of the shower, he found me passed out on the floor surrounded by enough claret to make full an IV bag. After a moment I came to, then looked at him and stammered, "Call 911."

When I woke up, eight emergency responders surrounded me. They packed me with massive diapers and loaded me into the ambulance. They gave me a drug that can stop bleeding when people are shot. It didn't work. My blood force per unit area was dropping. "I need you lot to talk to me, Ashley," one responder said. "I can't take you fall asleep."

'No, I am not OK'

Claret rushed from my body every bit they transferred me into the ER. A trauma md was the first ane to say the words "postpartum hemorrhage." Then he said, "This happened to my married woman. She was OK, and yous volition be, also."

I remember thinking, "No, I am not OK." He had good intentions, merely he seemed too coincidental while I was haemorrhage out in front end of him.

They rushed me into the trauma room where nurses surrounded me, giving me a blood transfusion and hooking me up to monitors. The attending Ob/Gyn looked exhausted. She did a vaginal ultrasound, verified I was hemorrhaging, and repeated that I would be fine.

Once I was somewhat stable, they moved me to the intensive intendance unit. I spent the nighttime gushing blood. No one seemed to grasp the seriousness of the situation.

'Only practice it – give me the papers'

By the next morning, they had given me nineteen numberless of blood, four bags of plasma, and four bags of platelets. My blood type is O negative and the infirmary supply was running low. And then, they were giving me different combinations of claret, which threw off my body chemistry. I was a wreck.

When the Ob/Gyn came back around, she was shocked at my condition. She stood in the hall, talking with Bryan and my mom, who were both crying. Before they fifty-fifty came in, I had a gut feeling that hysterectomy was the only option to save my life.

The Ob/Gyn came to my bedside, nervous and teary. When she started to speak, I cutting her off. "Just do information technology – requite me the papers. I'm not fifty-fifty going to talk to my hubby most this." Then I told her to be calm. "You can't operate on me if you lot're nervous."

I had the hysterectomy shortly thereafter. When I woke upwardly, I learned the massive blood loss had damaged my kidneys and I would need to go along dialysis. My heart too was not functioning well.

I stayed in ICU for ii weeks. My kidneys recovered afterwards more than two weeks of dialysis, and I did more than 2 months of concrete therapy to regain my strength. I was also diagnosed with mail service-traumatic stress disorder from the ordeal.

However, there was a argent lining. The trauma that nigh killed me might have saved my life. Retrieve the early pregnancy fainting I mentioned? Information technology turns out I had an underlying heart condition that wasn't related to the hemorrhage, and I had to get a pacemaker. My cardiologist said if I had been able to conceive once again, my centre likely would have failed during a 2d pregnancy.

An advocate for awareness, education

Every day for months later on I was discharged from the ICU, I thought about what could have been done better. Truth be told, it all circles back to awareness and education.

If the providers were more aware of PPH, they would accept identified the state of affairs faster. And if they were more educated about PPH, they could have controlled the bleeding sooner.

Ideally, providers should share their awareness and education near PPH with their patients. When I looked back through my prenatal care paperwork, at that place was no mention of mail-delivery trauma similar PPH. As a first-fourth dimension mom, I had no thought what to expect every bit far as bleeding and recovery.

So, I started talking about my experience with friends who were pregnant. Certainly, it's more enjoyable to talk well-nigh baby names and food cravings. But women need to know about potential risks like PPH.

After we moved to the San Antonio area, I shared my story with Texas AIM. This maternal health advocacy initiative is a articulation effort between the Department of State Wellness Services, the Texas Hospital Association, and the Brotherhood for Innovation on Maternal Health (AIM), a group that works toward consequent maternity treat PPH and other conditions. In July 2019, I was invited past, Jamie Morgan, M.D., at UT Southwestern to speak to the staff at Clements University Infirmary about my experience.

Every time I tell my story, it's a reminder to expect for a silver lining. While it'southward depressing that I won't exist able to carry another child, I know I've found my calling – helping educate women and providers so nosotros can reduce maternal death and trauma from postpartum hemorrhage.

Ashley Byrnes, left, was invited to UT Southwestern this summer by Jamie Morgan, Thou.D., to share her story nearly postpartum hemorrhage.

What women need to know well-nigh PPH

Ashley's right – tough conversations are of import. Providers must be realistic and honest about the potential risks involved with childbirth. We must remain calm and act quickly to get women appropriate care in obstetric emergencies.

And we must retrieve the long-term ramifications of these experiences. We care for patients for a short amount of time, only trauma can affect women for the rest of their lives.

While in that location has been some momentum regarding PPH education, the medical community even so has work to practice. Texas is ane of 27 states that participate in AIM, which means we are collaborating with organizations beyond the U.Due south. to improve statewide maternal care.

UT Southwestern is an academic medical middle, and we prioritize listening to our patients. We partner with Carter BloodCare, a local blood bank, to avoid transfusion crises like Ashley went through. And our doctors and nurses are trained to lookout man for signs of PPH – and educate women about their risks.

Postpartum hemorrhage can happen even if a woman has had smooth pregnancies and deliveries in the past. As a patient, never allow a dr. to disregard your concerns. Always trust your gut and persist when you know something is wrong.

Exercise you want to learn more virtually potential risks during and after childbirth? To visit with an Ob/Gyn, telephone call 214-645-8300 or request an engagement online.

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Source: https://utswmed.org/medblog/postpartum-hemorrhage-patient-story/