Recovering from a Shocking Hemorrhage, Part 3/4
Important, read first: This article was written to teach homebirth midwives and other birth professionals about effective naturopathic responses to excessive blood loss in childbirth. If that’s not you, this frank discussion may be alarming. It’s not gory or anything, but I would normally protect pregnant clients from doing a deep dive (and getting the mental imprint) on such a topic, unless they had a past event and needed this info. But I’m old-fashioned that way. On the other hand, since women who’ve hemorrhaged in hospital births are often sent home with very little guidance and a prescription for constipating iron, this info is desperately needed out in the world!
Full article first appeared in Midwifery Today, Issue 132, Winter 2019.
DOS and DON’TS immediately after a Serious Bleed
DO keep this mother and baby together as much as possible, with soft voices and gentle handling. Do keep a watcher with mama, for a while or some time, as she may need help with baby in positioning, latching, holding close etc.
DON’T offer ice-cold liquids or foods. She very much needs the warming qualities within, a philosophy of healing also promoted by Chinese medicine. Placenta smoothies are cold, and that’s a drawback.
DON’T insist on dialogue, at least not beyond making sure she is conscious and present.
DO consider an enema if you do not have access to IV fluid replacement. The role of the lower intestine is to absorb. An inexpensive Fleet enema can be used to hydrate. This is the favorite hydration solution of a colleague, who has well-served her local rural Amish community for over 2600 births, where solving problems at home is strongly needed. Warm the fluid (never in a microwave), lay mom on her left side, use lube to gently insert the tip past the sphincter (K-Y jelly, coconut oil, or even butter), and very slowly release fluid into her rectum. Think the pace of a dripping IV, not the pace of drinking a glass of water. Also, don’t hesitate to amplify the positive effect by adding some of the remedies to this fluid—at the very least, in it dissolve some Bioplasma, blackstrap molasses, or chlorophyll. Once the original fluid is gone, the container may be reused with raspberry/nettle herbal infusion or molasses tea as the fluid base.
DON’T ask her to walk to the bathroom to prove that she’s stable enough for you to go home. While she must urinate before you leave, she can pee on her hands and knees over a bowl on the bed (line it with a chux pad), be moved to the bathroom using a rolling office chair like a wheelchair, or crawl on her hands and knees to the bathroom. “No one falls off the floor.” One mom had a hospice potty chair that we set on a tarp next to her bed, which was super handy.
DO ask her to stay in bed until the next time you see her (which will be within 12–24 hours, depending on the severity of the bleed). Also, someone must accompany her to the restroom every time for the next 24 hours, and maybe up to 72 hours, depending on what you find on return visits. Yes, even if she “feels bad” for waking family. As one of my early mentors used to quip, “You may not be able to keep her from fainting, but you can keep her from having a closed head injury.”
DO prepare her and her family for her normal postpartum recovery period, which ideally will include something like “a week in bed, a week on the bed, and a week near the bed.” If she has a large family, intense life circumstances, or serious financial issues that will make this downtime especially challenging, talk to the mom and family the next day about this recovery. The described ideal might not even come close to the amount of support she needs in recovery. It is not appropriate, and maybe not even safe, for this recovering mother to be left alone (probably for at least several days), or with other children (probably for at least 1–2 weeks). She may need twice or even much more than the expected time to get back on her feet.
DO explain to families that protecting an adequate recovery period is not only much safer and better for mom and baby overall, it will also be much cheaper in the long run. In these cases, a mom who takes the necessary time to recover will, in the long run, need less intensive supplementation, family support, and child care. Compare this to a mom who assumes too much responsibility too soon, and therefore is at higher risk for extended postpartum bleeding, relapse, depression, suppressed immune system, and dragging around feeling crappy for months.
DO suggest continuing with intensive supplementation until her hemoglobin is normalized, and maybe beyond. Ideally this includes food-based iron, ionic minerals, prenatal vitamins, methyl folate (B9 is needed to form red blood cells) and vitamin C—at least 200 mg for every 30 mg of iron. Vitamin C increases the body’s absorption of iron. In addition, avoiding iron blockers, such as coffee, tea, and cola, is helpful. Alternatively, she needs to fall in love with daily blackstrap molasses.
DO suggest minimizing fish oil supplementation late in the third trimester and in the first week of postpartum. Fish oils are known to make blood more slippery, which is decidedly not helpful to a birthing mother. My hemorrhage rate, which was considered average, dropped dramatically after I heard Gail Hart pinpoint this risk at a Midwifery Today conference.
DO let her family know what normal looks like with iron-deficiency anemia, or low iron in the blood. It’s common to feel weak, get tired more easily, be out of breath, feel dizzy, have trouble focusing, get headaches, feel grumpy and/or look quite pale. They should take steps to protect mom and baby while she recovers; for instance, she should avoid stairs until symptoms improve, and someone else should carry the baby down the stairs for her.
DO research specific homeopathics if there are extenuating circumstances, such as
Bellis—“Arnica for the abdomen.” For uterine soreness after manual or surgical placenta removal, or vigorous or extended uterine massage.
Carbo Veg—Passive hemorrhage, icy cold, deathly pale; known among homeopaths as a “corpse reviver.”
Staphasagaria— Often indicated if there is surgery or cutting, or feelings of abuse from a medical experience.