Thoughts on post-partum hemorrhage (PPH)

These are my thoughts on how I've chosen to homebirth despite having had PPH and how I try to reduce the chances of having one. It's certainly not medical advice but merely what led me to research evidence-based solutions since the solutions I was offered didn't add up to me. Pray and do your own research. What is an acceptable risk for our family may not be for others.

I'm thinking about post-partum hemorrhage again. Of all my birth experiences, this was the most scary because seeing and hearing your blood pour on the floor makes you terrified that at some point someone won't be able to make it stop. And your husband will be left with all these kids. And the baby won't have a mom. And you'll be dead.

I had PPH with at least baby #7, a miscarried baby, and baby #8. With baby #9, I did not hemorrhage.

Except, I haven't died from it yet and I've had at least 3 PPHs. Knowing that, and thinking about my experiences has led me to consider if it would be possible to prevent PPH rather than wait for a provider to stop it after birth.

Four years ago I started to research uterine atony which is what leads to PPH. This is what I learned: 1. It is common in moms of lots of kids and it happens because the uterus is a muscle and it gets tired from having so many babies. There are other causes, but this is *my* risk factor.
2. Moms who don't give birth in a hospital are putting their lives at risk because they could bleed out before they have adequate treatment for PPH.
3. The way to manage PPH is for a doctor is to actively manage the delivery of the placenta.


I believe that birth is designed by God and that it is really designed to work correctly most of the time. If it weren't, the human race wouldn't have survived until doctors started being involved in birth in the 1800s. Of course, it doesn't work perfectly every time because there is sin in the world, but overall, when you look at the number of baby humans on the planet, I think we can say there is a good design there. This is what first led me to questions whether what I was reading about uterine atony was completely true. Why would the uterus be the only muscle in the body that gets worn out with use that is at best infrequent? My kids are approximately 2 years apart. So using my uterus for 9 months and then resting it for a year is supposed to be wearing it out and leading to PPH? I use my heart every day and it doesn't tire. If I want to build my other muscles, I use them more, even to the point of muscle failure, not less. If God designed birth, He wouldn't have designed it so it would kill the mom when she has more people to depend on her, would He? I don't think so. And it doesn't make sense that the uterus would work in a completely opposite way from all the other muscles in our bodies. That just doesn't make sense to me.

I think women should have babies in the most medically appropriate environment. Low risk women should be free to have a baby at home. High risk women should have the level of medical care they need. When I had twins, I gave birth in a hospital operating room so that I could have an emergency c-section if necessary. That was medically appropriate. They had great care they needed. Ironically, guess what? The anesthesiologist showed up after I had delivered 2 babies and my placenta, everyone was cleaned up, and I was being wheeled back to my room. That made me think about how responsive a hospital is. 

Years later, I had to have my miscarried son induced. He had died a few weeks before but wasn't delivering. I had a Cytotec induction (google that for scary birth and hemorrhage stories) and shortly after he was born, the nurse and I heard a sound like a faucet on and water pouring on the floor. I sat up and the sound went away. We looked around but didn't see anything. I lay back down and the sound came back. Then the nurse lifted my bedsheet and we saw a huge puddle of blood on the floor. (One thing to remember about blood is that it always looks like a lot!) Doctors and nurses came in, my IV was opened to give me fluids, started manual manipulation of my uterus and swept for retained placenta (ow), and gave me pitocin to help my uterus clamp. This was about 3 am. I don't know how long it took them to control the hemorrhage, but it felt fast. I was kept on IVs but wasn't given anything to eat. At 8 am, I was told they had decided not to give me a blood transfusion, removed my IV and told me not to drive home. I did because there was no one to take me. What I reflect on here was how they managed the PPH: IV, pit, manual manipulation. When I had a home birth, my PPH was managed in the exact same way. Also, notice that the blood transfusion was discussed and rejected 5 hours after the PPH, not as it was happening or in the time frame it would take to drive from my house to an ER. These made me wonder if a hospital really *is* safer than home with a trained CNM who carries pit and IVs in her bag?

As I healed from that  I had a friend tell me her PPH story. As she lay on the table bleeding, she looked to the nurse and asked if she would be ok. The nurse sorrowfully looked her in the eye and said, "I can't tell you that this will turn out ok." But she was in a hospital! I had been told that was the place to be because then I wouldn't die! Except, I know and am ok with the fact that we will all die at some point. I just really hope it doesn't happen during birth. Paula's story again made me consider whether a hospital was the most medically appropriate place for me to be when I gave birth again.

Fast forward 11 months. After doing a risk assessment and deciding to home birth the next baby, I give birth in a tub in my breakfast nook.

You can see the blood in the water. 

My midwife and I had discussed the PPH treatments many, many, many times so I would be very comfortable with how it would be managed. And they managed it exactly like the one in the hospital. There was no extra technology in the hospital. The midwife had the exact same tools: pitocin, IV, manual manipulation and sweeping. The whole birth story including my PPH is here. What I didn't mention is that when they moved me to the bed very quickly after this picture so the treatment was done there.

The rest and good food and environment at home helped me recover and feel better than I had in previous pregnancies. This was the first time Bill really understood how to care for me post-partum, how to keep the kids away, how to let me just rest and nurse the baby and eat and drink. My recovery and all around experience was great. 

But with the next baby I wanted even better. I wanted to have a baby at home. I wanted to *not* hemorrhage. I started to research what causes PPH. Medical answer: having lots of babies and wearing out your uterus so it won't contract correctly. I started to try to find a way to prevent it. medical answer: you don't prevent it. The doctor just tugs out the placenta and gets pit into you and deals with the PPH. Hmmmm.....

So I come back to my original thoughts. God designed birth to work and designed women to be able to have many babies. If this is the case, I do not believe that He would design the uterus to stop functioning in a dangerous way as a woman has more children. This mindset is wrong to me. Also, I truly believe women should be able to give birth in the most medically appropriate setting, not feel threatened or pressured by the overused "because you will die" argument or by insurance companies. If a PPH can be managed at home with the same tools as a hospital has, homebirth is a viable option. If a mom feels more secure in a hospital setting, I understand that too. I just don't think a hospital is necessarily the only answer. And doctors actively managing PPH is really only reacting to a situation. I truly believed in my gut there must be a way to try to prevent PPH. Also, the more I read, the medical advice for a doctor to tug out the placenta can actually lead to PPH because it can cause the placenta to tear and leave pieces in the uterus. There is actually a correct way to tug out the placenta and it takes finesse on the part of the provider. Tugging out an **attached** placenta (Which I've had done) can be dangerous. Tugging out an **unattached but undelivered placenta** allows the blood to flow out and the provider to assess whether a hemorrhage is happening. If one simply waits for the placenta to deliver, it can act like a plug, allowing blood to build up behind it but keeping the provider from being able to see the hemorrhage. Sweeping the uterus during a PPH is done to remove any pieces that might be there. My midwife had the completely opposite approach of allowing the cord to stop pulsing before cutting it and then allowing the placenta to deliver itself. My new midwife does the finessing the placenta out method. These thoughts led me to find what could help prevent PPH. 

The first and most important piece was faith. With faith and knowing that God would take care of our family whatever happened, Bill and I were able to go into this birth with very little stress. Also important to avoid PPH!

In the end I collected articles on a Pinterest board and started drinking smoothies with ingredients intended to help prevent PPH and made a plan with my midwife. It worked! With Lydia I did not have PPH. The smoothie recipe and story of Lydia's birth is here.

Here we are 3 years later. We are planning another homebirth in a new state with a new midwife. I'm rereading my articles, tweaking my diet and praying. And I feel at peace.

He's a preschooler

He wrote his own name.

End of year teacher work day

--print assignment books for next year
--watch LB overviews for high school, maybe language arts. Bring laptop and DVDs
--outline all writing assignments for 7th grade and when they fall
--watch Charlotte Mason narration tutorials from Alison.
--Grade end of Year assessments.
--Charlotte Mason book 7 in modern English?
--high school nature study at Weymouth
--summer read aloud list and book list for me
--create discussion questions for books the kids read
--outline prompts for analytic stage (incl 5th sci and religion)

#morningrun

You see yellow fog

slick, inexorable, insinuating;

I see God's fingertips. 

Everywhere I look, soft pools of pine pollen outline puddles in the road and puff as my feet run through the pinestraw. I made it out for a run before noon for once. My thoughts roamed.

Freedom of worship or freedom of religion. Return to fertility hormones. Pinecones, male and female He created them. Natural Law. Balance and false balance. The unexamined life. Pounding the pavement too hard. My knees. I wrote a poem. When will I die? How? Longleaf pines. "Infinite variety" as a trite phrase and a foundation shaking reality. Pink running shoes. Is it a haiku? Counting syllables. Fiddling with my stride. The necessity of nature study. Macbeth's Opinion. Reading Charlotte Mason for real. Michele Quigley. Elizabeth Foss. Pine pollen. First year pine cones. More of the poem. Could the ranger teach high school conifer study? Could we dissect pinecones? With what? Pine pollen in little polka dots on the lake surface.  

This school year I have not been pregnant. My baby is one and was breastfeeding all night until January. We are surviving, but survival mode looks very different from new baby before the new fiscal year, first freshmen in homeschool high school, #7 school aged kid learning to read. But something is lacking.

Of course I know my vices. I know where I am not excelling. These don't need reflection. What I don't know is how to combat my vices, how to overcome bad habits and begin to excel. I think about balance. Of course it is about balance. It is about balance and integrity and faith and getting up again and doing it every day. It's usually about balance. Then I thought of this picture:

It was meant to be funny, but today I think about it seriously. Because it isn't a picture about balance. It's a picture about false balance. The kids jumped so we could look balanced. Now I could take that in a million directions, but this is what I'm focusing on: "me time".

People love to ask a mom with "a lot" of kids, "How do you find 'me time'?" My response for years has been a thoughtful, "I don't think I believe in 'me time'." Because when I was a young mom with young kids, 'me time' made me resentful. It was expensive to hire a sitter or ask Bill to watch the kids for several hours so I could go be self indulgent. (And I pretty much think that if I am doing something for me, it's self indulgent.) And when I got back, I felt angry and fractious instead of renewed the way I was "supposed" to. I gave it up as a concept. I rejected the idea of 'me time'. My life was like this:

But I think I threw out the baby with the bathwater. I never considered that I was doing 'me time' wrong or that it might be different in different seasons of life. Lately I have struggled with my lack of memories. I can not remember chunks of my life. I don't feel this is a result of the sameness of every day, but a side effect of not taking the time to turn short term memories into long term ones. I have been pregnant/nursing/homeschooling/housewifing continuously for years and haven't created spaces for myself to be alone, to reflect on my experiences, to remember. I have been the river rushing forward, not the river leaving its mark on the landscape.

Briefly, I came up with these places where I messed up and should have created those spaces. I should not have allowed kids in the bathroom with me. Not to shower, not while I toileted, not when I was in a state of undress, not even talked to them from the other side of the door. I should have created a prayer time and space at home that they could not intrude in. I should have created a nursing refuge that I used once a day where I only nursed and enjoyed the baby without interruption. I should never have given up quiet time but instead turned it into uninterrupted computer time. I should have created a grading period in the school day. I should have built in teacher workdays every quarter and more. And I should have gone on a walk alone every day.

With those areas of space (perhaps this is what Elizabeth Foss wrote about when she wrote on "wide margins"? I never read what she had to say on that), I would have had opportunities to reflect on the meaning of my life experiences. I could have not only seen the world around me but observed it as I did today. I could have had the safety and peace to think for a while, to see where my thoughts would lead me and enjoy them, to work through intellectual struggles.

My run today have me that space. When I say run, I mean 20 minutes of walking and 2 5-minute wheeze and huff my way down the road. I don't have an answer for what I need to do next. I just needed to take the time to put down what I had come up with so far. To appreciate what today's morning run gave me.

Easter Sunday

With Easter on its way, I assured him that we do not serve our version of hot-cross buns even one day after Easter Sunday. We do sell them before Good Friday, but only for two weeks. The joy of eating with the seasons – fresh produce, religious or otherwise – is that it varies our diet subtly, yet profoundly. Seasonality teaches us patience and restraint during the lean months and educates our palates about what proper fruit tastes like during times of harvest.  -- Claire Ptak

Since the boys will be serving the 7am Easter Mass as usual, we need a quick but celebretory breakfast. I've decided to serve whole milk Brown Cow yogurt and make hot cross scones that I found on the blog post above, to be eaten at 5:30 am.

*****
I lied. I made the usual scone recipe but with Zante currants and hot cross bun spices. I'm sure they'll be great and won't require me to make mascarpone cheese. :)

What's the difference between Duke and hell?

Yesterday afternoon I took several of the kids to a local Oratory with one of our favoritest priests. Dominic especially loves Msgr. Ingham, and although Msgr. can sometimes be a bit reserved, he loves Dominic too.

Later in the evening I took all the kids to our parish mission, and Dominic began to cry because he hadn't hugged Msgr. goodbye. Tearfully, he looked at me and asked, "Are we going to the purgatory?"

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The parish mission started with exposition of the Blessed Sacrament which is my favorite devotion. I go weekly, and Dominic first crawled in the Adoration chapel so last night's exposition was nothing new for him.

After the Eucharist was placed in the monstrance, he looked and me and asked, "Jesus can see me?"

"Yes," I assured him. "Jesus is right there and He can see you."

"Yesss..." Dominic nodded to himself. Then he looked at me and asked, "Will He wink?"

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In hell, people want to go to purgatory.

Hand Me Down Closet

This is a project in progress. I couldn't find any images of what I was trying to achieve, so I gleaned some ideas and came up with this system. For the past 11 years/7 houses we have had the clothes stored in bins separated by size and gender. At a certain point, it became too difficult to put things away or climb through the attic to access the tubs. We knew we needed a new, faster and easier-to-keep-organized model.

When we decided that our master bedroom and bathroom and closet were ridiculously large for 2 people, we put 4 kids in the bedroom, divided the bathroom into a dressing room and a full bath, and turned the walk-in closet into a clothes and shoe store.

The clothes are divided based on how I shop:

Tape labels on the hangers seem like
the best method for making it easy to read
and knowing where to put things away. I am
thinking about a way to label all the clothes
this way. I tried dividers but don't like them as well.
This is to the right of the door as you enter. All the
boys' clothes fit on this long wall. The girls'
play clothes will all fit on the top rack on the
shorter side with church dresses on the back wall.

BOYS
Church shirts
Church pants
Shirts
Pants and shorts
PJs
Scout uniforms and Swim

GIRLS
Church dresses
Tops
Bottoms
PJs

This is the back wall as you turn left. There are more shelves back there too.
Everyone's coats that aren't in use are stored in the back of the closet.
I arranged them all by size since 6 months of storage and growth means
that by the time we pull them out again, they may fit the next child down the line.
Dress blues, my funeral dress, tablecloths are in the very back. 

Interestingly, I have always found having our church clothes arranged in separate bins by type (pant, shirts, girl stuff) to be the method that have saved the day most often. When you almost out of time to pull together a nice outfit, I guess you just can't pretend that sloppy street clothes are play clothes. I mean, maybe *you* think you can, but I assure you, you are not fooling anyone. ;)

We don't save many shoes and I want to put the baby (up to 1 year) and maternity clothes in bins since we have shelves, but I have to climb through the attic to get them. I'm about 1/2 done with organizing and labeling by size.