Birth Story Act V: the hemorrhage

Cast of Characters
(see Act I through IV)
Gwenneth: our friend who is also a midwife 
Dr. Kind: lovely OB who did my D&C when I had the m/c in 2011. I also saw her in triage a few days before Gummy's birth.
Dr. Coffee: The OB who cared for me during this hospitalization

Are you tired of all this drama yet? I am. I just have to write out this last part, which, by the way, is the MOST dramatic. And then I promise I'll go back to the business of writing a meek little pedestrian blog with unicorns and rainbows and a cute baby, and the occasional first world rant. But lest I keep avoiding this hardest episode, here goes...
(and if you are about to give birth or sensitive to stories involving guts and blood, you should skip this)

Scene 1
It's now March 6, our third wedding anniversary. And Oat's birthday. We are home and planing on staying home until we feel ready to emerge, which right now is unimaginable. We are feeling a bit lost with the breastfeeding, but our friend Gwenneth, who is a midwife, has offered to come over and help us.

When Gwen comes over on Thursday, she very patiently listens to the whole birth story and how breastfeeding has gone so far. She is encouraging and makes great suggestions. She helps with the latch. She feels that not all is lost, and that my milk will come in. She has a wealth of information to offer, but does not overwhelm us with it. As you can see, she is a total pearl.

That's about all for March 6, 7 & 8. I do remember thinking that March 8 was the day I was supposed to stop work. Ha!

Scene 2
We all go to bed tired on Friday night, us in our bed and Gummy in her little bassinet beside our bed. At 2:45 am, Gummy starts to issue her little sounds of hunger with increasing insistence. Mr. A and I are sleeping the sleep of the dead. We are exhausted, of course, and when we go to bed, we sleep so profoundly that each time we wake up, we aren't sure where we are. This is exactly how we wake up this time: disoriented. Mr. A gets out of bed before me and heads to the bathroom. I am becoming aware that I am quite wet, and my underwear feels like jello (sorry about that image). Mr. A thinks I have peed myself. I pull the covers and see a lot of blood. A huge fucking pool of blood. I get up and the blood follows me to the bathroom. As I sit on the toilet, I feel like I'm about to pass out and say so. Mr. A quickly comes to get me, making footprints in the blood. He takes me back to the bed, and lays me down on the (white) duvet cover. We have a quick back and forth about next steps. Should we call an ambulance? Yes, I think that's the thing to do. Gummy stays quiet. Does she sense that things aren't right?

Mr. A tries to tell the 911 operator what is happening. He is afraid they won't understand what he means by blood. I have not passed out, so I can say 'hemorrhage'. He is able to tell them our address, but not the nearest intersection. I am staring at the ceiling, trying to focus on what he is saying and not passing out.

The ambulance gets there quick. The first responders (a man and a woman) are in my room. I am naked from the waist down. They ask me when I had the baby. They ask me if I have pants. Mr. A said the woman asked to see all the blood, and though she didn't say anything, her facial expression was tense apparently. Mr. A gets me the grey jogging pants I got in first year university and which I wear on random Sundays when nothing else is clean. The first responders walk me down the stairs very slowly and carefully. They put on my coat front to back (arms in, back of the coat to the front of my body). They help me put on my boots, but as you saw in the last post, because my feet are still so swollen, it requires work. We walk out to the stretcher on the sidewalk. I cannot look back at my house or my husband or my baby upstairs. My focus has narrowed greatly.

I am awake in the ambulance and try to guess what intersection we are at when it stops. I can feel the blood gushing out of me.

Scene 3 
I am at the ER of Pleasantville General Hospital, stopped at the spot where ambulance arrivals are triaged. I am directly facing the cot on which I spent 10 hours on Tuesday. This time, the resuscitation pod (ICU) is to my left and the nursing station to my right. An ICU nurse sees me and remembers me. Yes, I was just here this week, I say. The blood is still gushing. I think about Mr. A and Gummy. I hope he will take her to our close friends with a toddler.

I am moved to the observation pod, where there is 1 nurse to 8 patients. I am transferred to a hospital bed so the first responders can get their stretcher back. I note that my grey jogging pants now have a saddle-shaped blood stain down to the knees. The nurses draw blood (one can think of an easier access to my blood at this point), start an IV for fluids and start to clean me out. I tell them to throw the pants away. My mental acuity is sharp in many ways. I ask questions, I engage the nurses. I ask them all for their names. I am holding on to consciousness with all my might. After cleaning me out once, it seems they have to do it again.

At this point, I hear they are moving me. Nurse Kim, who had gotten me some supper and chocolate pudding on Tuesday wheels my bed over. She is still nice, but she looks tense. I don't understand, but I thank her again for the pudding*. I am moved to the resuscitation pod, or their version of ICU. Full circle.

I have my very own nurse who won't take her eyes off me. The emerge doc comes to see me, in between two blood clean ups. He is upbeat and makes a joke. He tells me they are waiting on my hemoglobin results, and once they have that, they will connect with the OB on call. I brace myself. Who is the OB on call, I ask? (please don't let it be Dr. TdC. PLEASE don't let it be Dr. TdC). It's Dr. Kind. IMMENSE relief. Dr. Kind is very trustworthy in my eyes. She is a seasoned OB. She will know what to do.

I am told my hemoglobin has come in and it's not too low, for now. The emerge doc says he's called Dr. Kind and that she's ordered I be given oxytocin and misop.rostol. By the time she gets down to emerge, I am having nasty cramps, which is exactly the point: make the uterus contract to stop the bleeding. I reach my hand out to her and she takes it. I am so relieved to see her. She takes my covers off and asks me where my pregnancy weight has gone. I don't have an answer. Dr. Kind says she has just read Dr. Smiley's notes from the c-section, and that they say the placenta was sticky and that this leads her to believe there are retained products of pregnancy in my uterus. She says that she hopes the blood will stop with the meds, but that if it doesn't, I will need a hysterectomy. I say I'd rather not, but  that between my uterus and my life, I pick my life since I have a newborn to parent.

I don't know what time it is now. Maybe 5-5:30am. Mr. A arrives. He is muted. He later tells me that my lips were completely white and that it scared him. He says Gummy is with our friends with the toddler, the ones I was hoping she'd go to.

The blood has slowed down. They need to put a cather in. Because the cramping is pretty bad, Dr. Kind asks if I want any pain medication. Sure. She gives me dem.erol and I stop being able to put words together.

It is now 6am and I am being moved to the Family Birthing Unit. Nurse Eileen is there waiting. More sweet Irish pet names. She is talking fast, and saying something about us bringing gummy as soon as we want, and everything being ok. She is saying that she will put us in a better room later on in the morning.

Scene 4  
We are in a shared room with east facing windows. Mr. A is on a chair next to me, and I am somewhat aware that he is there. The sun is rising brightly. He makes a few phone calls with a muted voice. At 9am, an army of nurses come in my room, including Nurse Kelly. There is this tension in the room, and I come to understand (knowing something about hospital politics by now) that there is a porter here ready to take me to have an ultrasound, but that the nurses have barely just finished shift change. In their deep empathy, the nurses were hoping to clean me up before I go down to have an ultrasound because I am a bloody mess. Nurse Kelly decides that she will do a cursory job of it for now, but that she is not sending me through the halls of the hospital like that, thereby royally pissing off the porter. Bless her.

The abdominal ultrasound doesn't say much, and (you all know where I'm going here) the technician very apologetically asks if we can do a vaginal ultrasound. Yes. I've had one (ahem, 30) done before. She's pretty sure she sees stuff in there. One last (more modest) pool of blood when she removes the vagcam. The bleeding has all but stopped. Thank all the deities.

As soon as we are in our new room, Dr. Patel arrives. I know that he is not even on call at the hospital, but that he saw (through the online hospital system) that I had been admitted and decided to come see me. He notes that I have taken the fastest way to decrease my blood pressure - by loosing litres of blood. 

Our friend Gwenneth is texting and calling, asking to come over. She arrives at 10am and stays for the day. She helps me understand what the hell just happened. She's not sure why someone who has a c-section then goes on to have a late postpartum hemorrhage. I tell her the placenta was described as sticky. Placenta accreta. It must have been.

Gwen is amazing. She has hospital privileges here, so she goes and checks my file. She helps me plan for what's next, for how to talk to the doctor. Is there still a chance that they will take my uterus even though the bleeding has stopped? She encourages me to tell the doctor I'd like to keep it if possible.

In the mean time, Gummy is with our friends with the toddler. Said toddler commences to vomit at around 10:30am. Our male friend takes Gummy out for a walk in the carrier, while our female friend cares for her son. Nobody wants Gummy to get sick, so Mr. A arranges to get her asap and bring her to the hospital.

Once the u/s results are in, Dr. Coffee comes in and talks with us (Gwen stays and helps me advocate for myself). He says a D&C will be required. My white blood cell count is high, meaning that whatever's in there is infected. He doubts that my uterus will have to be removed, since I have stopped bleeding.

Gummy arrives and she lights up the room. Oh, what a sweet girl she is. Breastfeeding is now on hold, but I still hold her and cuddle her as I wait for news of the surgery. No food. No water. Just ice chips and IV fluids. I'm not super happy about that situation. Nurse Kelly takes my order, and says she will have a large ice water and large ginger ale ready for when I get back from surgery.

I am finally wheeled down to the 3rd floor OR and am in surgery by 7pm. It's Saturday, and a bit harder to line up the crew for these things. In the recovery room, I am next to a young woman who has just had a D&C because of a m/c. My heart aches for her and I remember being there.

When I get back upstairs, Mr. A and Sattva and Gummy are waiting for me. Sattva has agreed to bring Gummy to her house overnight and I am infinitely reassured to know that Gummy will be looked after by her.

Scene 5 
It is Sunday now. I can eat again. Nurse Kelly says my hemoglobin is at 77 (should be between 120-140). I need a blood transfusion. I feel a bit uncertain, but she convinces me that's the thing to do. Gummy is brought back by Sattva and her eldest daughter Anne, who regales me with cute observations about Gummy. At night, my mom arrives from Montreal. She takes Gummy to the hotel with her for the night so that Mr. A and I can sleep through the night again.

Scene 6 
And now it's Monday, March 11: my due date. I wake up in the hospital, but not with my baby. My blood pressure is very high again. The nurses are coming in and checking it very often. Dr. Coffee has come in to check on me even though he is not on call. Nice. He insists that I call him at the office later on in the week to let him know how I am.

Dr. Kind also stops by and I tell her that it meant the world to me to see her in the ER, and that she took excellent care of me. She seems genuinely thankful to hear my say that.

Dr. Smiley is just back from vacation, and although she is also not on call, she makes an appearance. She looks more stressed than all the others and implores me to stop having postpartum complications. I want nothing more.

Right when I think I'm getting discharged, my blood pressure is just too high. It ends up being 3pm before I get discharged, not because it lowered, but because Dr. Smiley had to make the call and she said "Augusta knows what to do if she has more symptoms. If she wants to go home, let her"

We went home with Gummy, and had a few stressful days while my mom was there, the worst of which when we were also visited by my in-laws. But when they all left, my blood pressure started to go down. So far, I haven't had to go back to the hospital since March 11.

There are more reflections to share on this whole birth in 5 acts, but I am no longer reflective at this late hour. I do want to thank you for reading and commenting. It has helped me to write this all out, and to have that be witnessed. It was drawn out and detailed and I'm sure often boring. But know that it helped me to put words to those experiences and have those words read. Thank you, dearest women. 


*I guess I've come to think that she was worried for me at that point.