Thursday, December 22, 2011

Blood Loss.

They aren't smiling... but they were happy. At least I think they were...
Apiu is one of my prenatal girls. Although she lives far away, she decided to move to town her last month of pregnancy. She explained that she had had 3 days of heavy bleeding after her last child and was worried it would happen again.

So when her labor started yesterday morning, she slowly made her way to us. She arrived quite active and delivered two hours later on her knees.

Her precious girl looks just like her. Same sparkling eyes. Same playful mouth.

Although she had some initial bleeding postpartum, I controlled it with fundal massage and oxytocin.

But just when I thought it was over, she started bleeding again. Clots. Heavy clots. 

So I decided on intravenous oxytocin to keep things firm and had her breastfeed. This improved things dramatically and I figured we were through the roughest patch.

Once stabilized, I moved her to the postpartum room to rest. She’d only lost about 600 cc by this point and she wasn’t dizzy.

But during her recovery (roughly 2 1/5 hrs postpartum), she started bleeding again. Heavy, thick clots.

I got there to find her lying on the floor COVERED in blood. Several large blood clots lay beside her. And she was dizzy. Too dizzy to even sit.

In all my time here in Sudan, this is the first case quite like this. She’d lost at least another 600-800 cc by this point.

Something was keeping her uterus from clamping down on itself, leaving me with few options. There was just one thing left to do -a manual exploration.

(For those who don’t know, this procedure requires me reaching inside the woman’s uterus with my gloved hand and systematically removing anything remaining inside, i.e. placental parts, sequestered clots, etc.)

I hate doing this, but I couldn’t let her bleed to death either. So I readied the room, started more IV fluids, then reached inside her body.

Her screams brought looky-loos (of course), but it couldn’t be helped. She needed to stop bleeding. This was the only way left to do it.

I quickly removed several large clots, then massaged her uterus shut.

Painful? Yes. Anyone who has ever had this procedure knows it’s crazy painful. Some say it’s worse than giving birth.

Effective? Yes. It stopped her bleeding almost immediately.

It took me some time to convince Apiu that I didn’t hate her... and that I wasn’t an evil person determined to cause her endless pain. But I’m not sure she believed me.

“I didn’t want to hurt you, Apiu. I just didn’t want you to bleed to death, either. Can you understand that?” I asked pleadingly.

She just stared at me with hardened eyes. So I continued.

“If I had let you continue to bleed, you would have needed a blood transfusion,” I explained. “This was the only way I know how to help you stay alive...”

More hardened stares coupled with whimpers, but then a slight nod of her head.

Once the pain subsided and the bleeding finally stopped, I think she forgave me. But I’m not sure. She looked at me with fear-tinged suspicion the rest of the night.

But did I care? Not really... I did what I did to save her life. She might not get that now, but I do.

We kept Apiu overnight for observation, but by morning she was strong enough to be discharged. Please pray she regains her strength quickly. Thanks.

Afterward, all I could think of were my midwifery teachers in the Philippines who taught me this procedure. If they could see me now...

To all my teachers at Newlife School of Midwifery: I love you and thank you from the bottom of my heart! This women is well because of the countless hours you spent teaching me. I love and appreciate you ladies so much!

Lord, bless the faithful midwives who worked so hard to teach me these skills. Bless them for their dedication and patience. Help them remember when they are tired and frustrated that their service is quite literally saving lives half way around the world! May they never forget that. Amen.