BusyMamaMD

As an obstetrics and gynecology resident, one sees a lot of crazy things.  I have delivered babies in the car outside and in the trauma bay of the ER, performed countless emergency Cesarean deliveries, and taken care of everything from appendicitis to kidney failure in pregnancy.  Most of the time obstetrics is fun, but when things go bad, they really go bad.  I will never forget “Megan.”  She was twenty-two having her first baby.  She almost died after her baby boy was born from a postpartum hemorrhage.  I remember wheeling her back to the operating room, begging “Please don’t let me die.”  Megan lived, but countless others are not so lucky.

What is postpartum hemorrhage?  Why do I care about it?  Why should you?  It is a global health problem that kills millions… that’s why.  Many women around the world die from hemorrhage, or excessive postpartum bleeding, trying to get to a hospital.  We are lucky in the United States to have easy access to medical care.  Yet, postpartum hemorrhage kills here too.  Sadly, up to 50% of those deaths are preventable, often caused by a delay in care.  Early intervention and preventative measures can be the difference in a healthy mom and baby to a baby without a mother.

In order to understand hemorrhage, one needs to understand what should happen normally.  A full term uterus receives up to 800mL A MINUTE of blood flow.  That is almost a full liter going to the uterus every single minute.  When the baby and the placenta deliver, where does that blood go?  Normally, the uterine muscle contracts down, shrinking the uterus rapidly.  This muscle contraction essentially causes the blood vessels to collapse down so that blood is shunted elsewhere in the body.  It’s like cutting your finger and holding pressure on it.  The pressure causes the blood to stop coming out of your finger and continue on its way through the rest of your body.  A problem arises when the uterus does not clamp down like it should.  This is called uterine atony.  If the uterus stays large and non-contracted, those blood vessels stay wide open.  Worst case scenario, a woman can lose close to a liter of blood EVERY MINUTE.  That is why postpartum hemmorhage is a big deal.

How often does this happen?  Studies show it’s around 5% of pregnancies.  Scary!  But, there are things we can do to prevent it and treat it quickly.  The best thing you can do is deliver in a hospital.  Sure, a home delivery may sound nice… and after all, there is a 95% chance you will not have a hemorrhage.  But if you are a member of the 5% that will, there may not be time to make it to a hospital before you lose a large amount of your blood volume.  The second thing that is important is receiving oxytocin (also known as Pitocin) after your baby delivers.  This helps the uterus shrink down faster and has been the only thing proven to decrease the incidence of postpartum hemorrhage!  The American College of Obstetrics and Gynecology, the California Maternity Quality Care Collaborative, and the Association of Women’s Health Obstetrics and Neonatal Nurses all recommend postpartum Pitocin for ALL deliveries.  You can have a natural birth without oxytocin or without anesthesia, but please accept the oxytocin after you deliver!  It might save you a blood transfusion or even your life.