Not everyone can be a midwife.
I realized this the other day. Really realized it. It was a thought that began to form for me following a desperately terrifying birth a few months ago, and finally hardened into a diamond hard mass as I probed gently, performing a postpartum inspection of a sweet client's perineum, and unexpectedly found a clot which stretched far, far back.
The first time I felt a decent sized blood clot (as I inspected a placenta for the first time months ago) I wondered at it's extraordinary texture. It kind of splits in this otherworldly slipperyness under finger pressure. There was that sensation again, and then, as I reached in further to see how big this clot was the dam burst and a whole lot of blood flowed over my hand. A whole lot, is just that: a hot, slithering, velvety, red lava flow of semi-clotted blood. I reached in, far in, with deliberate resolve as my preceptor massaged her uterus deeply, agressively and I'm afraid painfully, encouraging it to contract into a rock-hard ball. A good 250cc's of blood and clots slid out, easily matching the amount of blood she'd lost to that point, emptying her uterus, allowing it then to involute properly, stopping the bleeding.
In case you didn't know 500cc (about 2 cups) technically constitutes a hemorrhage.* Further, when (like me) you haven't seen a whole lot of bleeding this looks like a helluva lot of blood.
As I apologized to the client afterwards, I did so knowing absolutely that while I was sorry for her pain, I was not sorry for sweeping her vagina and cervix for clots. I did what I needed to do quickly, decisively and effectively. I was tentative for about 2 seconds, and then went for it. This is, for me a very different feeling from the heady rush of feeling a baby's head crown and then slip out under your hand, then waiting for the shoulders to slide free. Catching babies is usually the easiest part, they almost always do that without any help from anyone else but their mother. But handling and stopping heavy bleeding (when it happens) is a big part of what midwives do as guardians of maternal health. I feel really good about this part.
In that moment with this mother's hot, red blood gushing between my fingers past my hands, I had this realization that few people would be able to do this, and along with that: my realization that I, in fact, could.
Feels pretty good.
*While a 500cc blood loss is the number usually given to a hemorrhage, it's worth noting that not all women handle blood loss the same way. In this case the woman handled her 500+cc hemorrhage beautifully, she felt good, and was able to replace her fluids by mouth without any problems. Other women will get shock-y after a 400cc loss, or less, and require IV fluid replacement and possibly transport for more treatment.
The first time I felt a decent sized blood clot (as I inspected a placenta for the first time months ago) I wondered at it's extraordinary texture. It kind of splits in this otherworldly slipperyness under finger pressure. There was that sensation again, and then, as I reached in further to see how big this clot was the dam burst and a whole lot of blood flowed over my hand. A whole lot, is just that: a hot, slithering, velvety, red lava flow of semi-clotted blood. I reached in, far in, with deliberate resolve as my preceptor massaged her uterus deeply, agressively and I'm afraid painfully, encouraging it to contract into a rock-hard ball. A good 250cc's of blood and clots slid out, easily matching the amount of blood she'd lost to that point, emptying her uterus, allowing it then to involute properly, stopping the bleeding.
In case you didn't know 500cc (about 2 cups) technically constitutes a hemorrhage.* Further, when (like me) you haven't seen a whole lot of bleeding this looks like a helluva lot of blood.
As I apologized to the client afterwards, I did so knowing absolutely that while I was sorry for her pain, I was not sorry for sweeping her vagina and cervix for clots. I did what I needed to do quickly, decisively and effectively. I was tentative for about 2 seconds, and then went for it. This is, for me a very different feeling from the heady rush of feeling a baby's head crown and then slip out under your hand, then waiting for the shoulders to slide free. Catching babies is usually the easiest part, they almost always do that without any help from anyone else but their mother. But handling and stopping heavy bleeding (when it happens) is a big part of what midwives do as guardians of maternal health. I feel really good about this part.
In that moment with this mother's hot, red blood gushing between my fingers past my hands, I had this realization that few people would be able to do this, and along with that: my realization that I, in fact, could.
Feels pretty good.
*While a 500cc blood loss is the number usually given to a hemorrhage, it's worth noting that not all women handle blood loss the same way. In this case the woman handled her 500+cc hemorrhage beautifully, she felt good, and was able to replace her fluids by mouth without any problems. Other women will get shock-y after a 400cc loss, or less, and require IV fluid replacement and possibly transport for more treatment.
posted by Louisa at 9:22 AM
8 Comments:
I have the creepy crawlies just reading about it. Your mamas are truly lucky that you chose this path.
Or perhaps that this path chose you.
Hi there, I am a midwife from New Zealand. Its scary that first time (actually, its scary all the time)you have a PPH. However, it sounds as if you managed it really well so well done for that - you're on the way to being a midwife. cheers Sarah
Hey Louisa,
Just in case no one has come right out and said it recently, YOU ROCK.
Miss you, love you.
You know what? I'm so glad that you recognize this, and I'm even more glad that there is enough love in this universe for a midwife like you.
Rock on, Mama. Now if only you lived closer to Florida....I could use a midwife like you. :) Say, about the end of July??
Angela
Sounds like you did beautifully, Morag-- and I am proud of you, as always :)
We concentrate on the women so much, rightfully so, but I want to say:
You did good.
Real good.
So proud.
LP
wow.
yes, you did it and you are cut out for this service.
sometimes i think i could, but after reading this, i may just be someone in awe of the midwife's work.
blessings,
mb
I'm very proud of you and haven't yet faced the same thing but will this year I think. You'll be there at my shoulder when I do!
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