Child Birth, Guest Posts

Postpartum Bleeding and Power Chords

June 25, 2017

By Bess Vanrenen

It was a Friday, six days after the birth of my first child, Marcel, and I was bleeding. Almost every nurse, doctor, and aid who had come into my hospital room told me that while postpartum bleeding was normal, I should tell them if I filled a pad in under an hour or passed a clot larger than an egg. After Marcel and I were discharged from the hospital, I kept a running list in my head of symptoms I should look out for in him and in me. We had already dealt with weight gain issues in him and had bought formula to supplement my breast milk, and six days later, I thought we were beyond the intensity of the postpartum period. Then I started bleeding. The kind of bleeding they tell you about. Though I hadn’t filled a pad in under an hour, it was a heavy flow. Pacing our tightly woven living room rug, I called the advice line at Kaiser, and the nurse who answered the phone ran the all-too-familiar questions by me. No, I hadn’t filled a pad in under an hour and no, I hadn’t passed a clot larger than an egg. So far, my situation was within the normal range.

An hour or two later, I sat on the toilet changing my pad yet again when I felt something substantial slip out of me. Fear coursed through my body, and I jumped up from the toilet. I knew what it was—a blood clot significantly larger than an egg—but I had to be sure. I could only manage a quick peek in the toilet. There, I saw what looked like a baseball-sized clot—impossibly large, red, and viscous. I called out to Jared, my husband, “We have to go to the emergency room. Now.”

My sometimes frustratingly underreacting husband began packing our things and within minutes we were in the car, the diaper bag in hand and Marcel strapped into his rear-facing car seat. I sat beside him in the back seat, and we made our way back to the hospital that we’d left only six days earlier.

I had just put a new pad on, but I could already feel it filling up—wet and sticky and dangerous underneath me. Beside me, Marcel looked so tiny in his oversized cap. In spite of my nerves, I tried to stay calm for him. It must have been the first time I tried to hide my fear for his sake, much like I would soon compromise my sense of security in order to protect him.

***

Only weeks before, I wasn’t sure I’d be able to do such a thing. I’d waited until my early thirties to have children, but that didn’t mean I was more prepared for it than a younger woman. During my pregnancy, I would lie in bed at night, one knee and my pregnant belly supported by a body pillow, and I would wonder what kind of mother I’d be. I took it for granted that I wouldn’t be a “natural” at mothering. I’d never babied anyone in my life, and as the youngest of three kids, I’d always half-expected other people to baby me. But after the contractions started right up until the hemorrhaging, I was surprised by my instinct to protect Marcel, even if I still didn’t feel like a natural.

***

In the car, I began to consider what would happen next, and what should happen next. We were headed to an emergency room, which by definition would be filled with very sick people, and my baby was barely a week old, vulnerable to any and every virus, from the common cold to Polio. How could I bring him into the ER?

But I was also terrified, thinking, maybe not even irrationally, that I might lose enough blood to die. It was probably the third or fourth time I literally thought I might die since the contractions had started. I didn’t want to go through it alone, but if my husband and son didn’t come with me into the ER, I would have to.

By the time we got to the hospital, I had made up my mind. As Jared parked the car, I told him what I’d decided. He turned his head over his shoulder to look at me in the back seat. I could see the sharp curve of his high cheekbones and his curlicue of a cowlick, which lack of sleep had made more pronounced. “Do you really need to do that?” he asked. As I explained my rationale, I was both surprised at and proud of myself from coming to what seemed like a natural conclusion—that Marcel shouldn’t come into the ER with me—but wouldn’t have been natural for me a week before. In the end, we agreed that they’d wait for me in the parking lot until we knew more about my condition.

Rows of plastic chairs faced the admittance area, where I checked in. I filled out the necessary paperwork and found a seat in the back of the room. The plastic chairs, bare walls, and scrubbed tile floors belied the tangible feeling of contagion in the room. Almost as soon as I sat down, the sound of a hacking cough reached me from a few seats over, validating my decision to keep Marcel away.

As I waited, I studied the other people in the room. Time had transformed my fear into a low hum barely audible underneath the loud buzz of irritability. Seated near me was a whole family: a grandma, aunt, mom, and several children. They were eating food that someone had packed for them, and somehow that made me angry. Did they think this was a picnic? Why were they so calm anyway? And why were there so many of them? Meanwhile my pad was wet and full, and I knew I’d be leaking soon if I wasn’t already.

A nurse called me back sooner than I expected. I realized my condition must have been bad enough to warrant that and felt an odd mix of pride and worry. The nurse led me past rows of sick patients only separated from each other by fabric panels, but I was given a small, private room. There, he gave me several new pads, told me the doctor would be in to see me soon, and then left me alone until the doctor, Camille, arrived to do the exam.

Camille was a red-haired South American woman with a light accent. About my age, she was professional and considerate. During the exam, she told me she could see placenta material hanging out of my cervix, which was the reason for the hemorrhaging. I pictured it like the string of a tampon but wiggly and pink. There was something so terrible about this revelation, like I was walking around with a limb hanging off. She said I would need an ultrasound to determine how much material remained in my uterus, and the results would tell us if it would need to be removed manually or surgically. My fear was still a low hum, alternately made more or less pronounced by learning more about my condition.

At some point, I called Jared, who was still waiting in the parking lot. I told him what was happening and to go home. He had to take care of Marcel, and a parking lot was no place to do that. This time he agreed quickly, and some small part of me deflated. I told him I’d call him soon with an update and hung up, alone again.

After that, I waited for what seemed like a very long time, enough to use the hospital-grade breast pump to pathetic results, call my mom, and commune with my complicated feelings, which ranged from fear to stoicism even to boredom. Eventually, another nurse came to wheel me to the ultrasound technician, who took scans and had me wheeled back to my room. The whole time, that wiggly string hung from my body.

When Camille returned, she told me there were enough membranes left in my uterus to require a dilation and curettage (D&C). Which meant surgery. That was something I hadn’t quite expected, even though I knew it was possible. “Surgery” was also a word I’d been dreading. Like many women, I had spent the past nine months imagining a C-section as the wrong ending to my pregnancy story. An ending I had managed to avoid through whatever twists of fate and acts of self-determination. And now it was happening anyway.

When Camille left, I called Jared with the news. It took him a few seconds longer than usual to respond and when he did, his voice was soft. But his concern was impotent: I still didn’t want Marcel in the ER. For his part, Jared assured me that Marcel was formula-fed and content. At least that.

By now, it was approaching 11 pm and I had been at the hospital for several hours. It was the end of my first week with a newborn, and I should have been exhausted. Instead I was full of survivor energy, the kind that gets you through the next obstacle and the next and the next until the hard stuff is behind you and you fade.

Another person appeared to wheel me into the surgical suite. We traveled through swinging doors into an eerily empty hallway where the only sound was the squeaking of the wheels on my hospital bed. Where were all those people from the ER?

The “survival energy” also made me feel more disconnected from my surroundings the more intense the situation became, so that while I was experiencing everything around me more acutely than normal, I wasn’t fully processing it. I heard the squeaking wheels, I saw the glare of lights against the white walls and floors, but none of it added up to a complete picture.

One stranger dropped me off with another, who led me into a smaller room, where I met the anesthesiologist. Of course I knew surgery meant anesthesia, but the reality of it didn’t hit me until the anesthesiologist peered over me, looking like a bobblehead from my position on the bed. After he introduced himself, he went over the risks of anesthesia. Minor risks: infection, confusion, anxiety. Major risks: heart attack, stroke, death. He gave me the option of spinal anesthesia, in which case I’d be awake for the surgery, or general anesthesia, in which case I’d be unconscious. A week before, I had opted to give birth without a spinal epidural, partially because it was supposed to be better for the baby and partially because I was terrified of anesthesia. And here I was, a week later, forced to go under. At the time, the irony didn’t escape me, but in retrospect it stuck me as a test, or maybe a challenge.

***

The day I went into labor, I handed the nurses my birth plan and noted their ambivalence. The birth plan said I wanted a natural childbirth—no pain medications, no epidural, if possible.

I had cried a little on the way to the hospital because the contractions, as small as they were, already rocked my body every time they came. I managed to get through triage and make it to my room without too much pain, but the contractions grew stronger quickly. To cope with the pain, I had music (I never thought for a second of turning it on), massage oil (the idea of scented oil made me queasy), a small tub (the water was tepid), a birth ball (leaning over it brought some relief), and a few positions committed to memory (these also provided a little relief). Because I’d asked to avoid medications and an epidural, the nurses didn’t seem to know what to do with me. They checked my stats and the baby’s every hour, and then they quietly disappeared. Soon, I began yelling to cope with the pain of the contractions, which felt like nothing I can describe, like nothing I’ve ever felt before, but something like being pulled apart, bone by bone, muscle by muscle. After one contraction, I asked a nurse who happened to be in the room, “Is this the transition phase?” She said, “You’ll know when you’ve reached transition.” Later, when my yells became screams and she was back in the room, she said, “Remember when I said you’d know when you reached transition?”

My husband asked me, lightly, “Are you sure you don’t want an epidural?” Part of me did want an epidural, but I couldn’t answer him, and not just because I was ambivalent. Not only had I wanted a natural childbirth, but I was also afraid of anesthesia, afraid of someone thrusting a needle into my spine, afraid of what could go wrong. My fear of anesthesia is totally irrational, but the “what ifs” are almost as real to me as any logical outcome. If I drop this glass, it will break. If I get anesthetized, I won’t wake up… my legs will become paralyzed… it won’t work and I’ll feel the incision. But more than that, I couldn’t think long enough about anything to make a decision. And so I never received an epidural, and, after the doctor broke my bag of waters, I delivered a screaming, wiggly, six-and-a-half pound baby boy at 12:02 am, feeling every sensation of childbirth and every movement he made on his way into the world: a perfect little boy covered in fine dark fuzz with a full head of hair, who I reached toward as he reached toward me, and who I put to my breast as though it was as natural as breathing.

***

The night of my D&C, I handed the anesthesiologist my wedding band, which he put into a plastic baggie, and I imagined the headline that would publish if I died. New Mom Dies Six Days After Childbirth. Husband Left to Raise Newborn Alone. In the prep room, the anesthesiologist asked me what my favorite vacation spot was and before I could answer his inane question, I was asleep. The next thing I saw was the ceiling of the surgical suite, high and expansive. The room was bright with florescent lights and my throat was painfully raw. After the medical team checked my vital signs, they led me into the hallway, where my husband and son were waiting.

When I saw Marcel, it felt a little like giving birth again. I felt both weaker and stronger than when I’d seen him last. Weaker physically and emotionally for what I had just been through, but stronger, too, for knowing I could.

***

It was late January 2015, and the morning of my twenty-week ultrasound during which I’d find out the gender of my second child. It felt like Christmas.

In the tastefully bland basement of a medical complex, I found myself on an exam table with my feet in stirrups, a position I would find myself in many more times before the birth of my baby. I tried to gauge the ultrasound technician’s reaction as she moved the machine around on my stomach, capturing this or that image. Was my baby healthy? I wondered, all the while assuming the answer was yes. But I couldn’t read her expression, half masked by a blunt blond bob.

“Do you want to know the gender?” she asked.

“Yes,” my husband and I said in unison.

“It’s a boy,” she said with a smile. Two boys, brothers.

Before much else could set in, she asked me to go to the bathroom and return for a vaginal ultrasound. “I want to look at something more closely,” she said in an expressionless voice. Her whole attitude was so carefully controlled that her request didn’t strike me as abnormal. But minutes later, back in the stirrups, I wondered, What does she want to look at more closely? and so I found the nerve to ask, a cold blue fear creeping its way through my body.

In that same dispassionate manner, she answered my question. “You have placenta previa. Most cases of previa rise before the end of pregnancy. Your OB will want to take another ultrasound later to see if it’s moved.”

I had never heard of the condition before and had no idea what it meant for me and my pregnancy, but when I asked the tech for more information, she just told me my doctor would be in touch with me. And so we left the clinic with news of a new baby boy and an unexpected condition.

***

A nurse called me the next day while I was at work. I took the call in a stall of the women’s restroom. “Placenta previa is when the placenta implants too low,” she said. “Most cases rise on their own, but those that don’t require a C-section to prevent hemorrhaging.”

My voice came out high-pitched and wobbly as I defended myself against the risk factors. “Thirty-five isn’t that old,” I said, voice breaking. “I only smoked a little, back in college.” Kindly, definitively, she said, “It’s not your fault.”

When we got off the phone, I stared at the putty-colored bathroom stall, hearing but not hearing a woman come into the restroom and then leave again. The words “heavy bleeding” andC-section” ran through my mind. All I could think of was that Friday six days after Marcel was born.

But I would have to wait eight weeks to find out if the previa would rise or if I would have to have a C-section. And I would have to wait eighteen weeks hoping I’d even make it to the C-section, that I wouldn’t go into early labor and start hemorrhaging, putting the baby’s life and mine at risk.

***

I knew the birthdate of my second son weeks before he was born. I knew that because my previa didn’t rise. The C-section was scheduled for May 26, 2015.

The morning of May 26, my husband and I drove to the hospital. How strange to be heading to appointment to have a baby, I thought. With my bags packed and the perfunctory air of the drive, it felt more like a business trip. Still, fear was there under layers of normalcy. Fear of the spinal epidural. Fear of my stomach being cut open. Fear of the possibility of another bout of postpartum bleeding. Fear for my baby.

The surgical prep room was even like a motel you might stay in on a business trip, except nurses, doctors, and anesthesiologists were in constant rotation. The nurse anesthetist seemed both empathetic and professional as she explained the risks of a spinal epidural. The risks alarmed me as much as they had the night of my D&C, but this time, I’d had months to mentally prepare for anesthesia and surgery. Anyway, the C-section was inevitable, and so I was resigned to it and only felt afraid in the deepest parts of me. As I talked with her, I tried to walk the line between being communicative about my fears and being self-dependent, subconsciously wanting to be an adult and a “good” patient.

Right on schedule, they wheeled me into a florescent-lit room, a shock of white and blue. It was surprisingly cold. From my position on the hospital bed, I saw the specialist, his surgical assistant, several nurses, and the nurse anesthetist. I had the strange sensation that I should be standing upright with everyone else, not lying flat on the hospital bed. But of course I knew I was about to undergo surgery, and moments later, I was sitting on the edge of the hospital bed, leaning over for the shot I’d dreaded for so long. As I waited for the needle to prick my back, I was aware of my fear from a strange sort of distance, as though wad of cotton separated me from it. In a movie, this is the moment the power chord–ladened rock song would play. Will the heroine face her fears? Does she have the strength? In a way, it’s not accurate to compare this moment to the climax in a movie because I had no choice. The C-section had to happen. The baby had to be born. But narrative structure is an artificial means to portray the very true challenges we face—and for me this was one of those challenges.

Soon, the shot had been administered and I was hooked up to an IV, watching from a reclined position as the surgery began. Because of the fabric shield, I could only see the top half of the doctors. I sensed rather than felt the first incision. That’s when I cried. All the fear and regret I’d tried to repress came bubbling up. The room stopped for a moment until I squeezed my eyes shut, pushed back the tears, and reassured everyone that I was fine.

Several people had warned me about the strange feeling that comes when the doctors push the baby out during a C-section. Even though you’re numb, you can still feel a hard shove against your abdomen that almost takes your breath away. I expected it and it still made me gasp.

And then my baby, who in a few hours would be named Sebastian, was delivered. It all happened so fast. But here he was, in the room with me, and safe. After letting me have a quick look, the nurses shepherded him over to the weight station to check his vital stats and clean him. When they announced his weight, 6 lbs, 11 oz, another wave of relief washed over me. A healthy baby boy. Soon my husband brought him back to me and held him up so I could see him better. Sebastian was an angry little thing with a pointy crown, round cheeks, and a red face, and I thought he was perfect.

But then I heard whisperings among the surgeons. Another wave of fear went through me, and I asked what was going on. They told me they needed to do another D&C because my placenta was “stubborn” and “fragmented.” Again, my mind raced back to the complications after Marcel’s birth. Half of my attention was on my baby and the other half on the doctors as they talked quietly to each other and stared with laser-like focus at my abdomen. But soon geniality replaced their intense concentration and it was over and they were stitching me back up.

***

Sebastian and I are home from the hospital. I thought I knew what to expect from a newborn baby boy, but Sebastian is different from Marcel. Of course he is, only I had to meet him to figure that out. For one thing, he sleeps more. He’s sleeping now, in his brand new tufted and skirted bassinet. I should be sleeping, too. But my body and mind are only now beginning to uncoil after the C-section and the first sleepless nights with him. Recollections come, only they are so clear, it’s almost like I’m reliving them: The postpartum bleeding and D&C with Marcel. Learning that I had placenta previa with Sebastian. The medical centers and specialists’ offices. The spinal epidural and C-section under fluorescent lights. The things I feared for so long being the exact ones I was forced to face. It strikes me now how similar the two pregnancy and birth experiences are. Different, but similar in odd ways.

I hear Sebastian’s breathing change and wonder if he’ll wake soon, but I don’t even mourn the sleep I’m not getting because it feels like I’m onto something. Those experiences, as miserable as they were, showed me that I could be a parent to my sons. Through them, I found that I could be braver and more self-sacrificing than I ever thought I could, all to protect these vulnerable creatures entrusted to my care.

A writer, editor, and (mostly armchair) traveler, Bess Vanrenen lives in Denver with her family. She has an MA degree in English from the University of Colorado at Boulder and an MFA degree in Creative Writing from Antioch University Los Angeles. Her personal essays are published in a variety of print and digital publications, including Role Reboot. Her short story “Missed Connection” won a Stories on Stage contest and was performed live, and her short story “Unexpected Gifts” is forthcoming from The Sand Hill Review.

 

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