In October 2020, I was excited to learn I was having my first child. I had been a Labor & Delivery nurse for 8.5 years. I loved helping pregnant patients and supporting them through birth.
My pregnancy was considered high-risk simply because I was 35 years old and this was my first child. At an 18-week ultrasound scan, I was diagnosed with a complete placenta previa, which occurs when the placenta attaches low in the uterus and can cover the cervix and also cause bleeding.
When Birth Plans Change
I was devastated. I had always wanted to have an unmedicated, vaginal birth. I was now facing the reality that I would have to schedule a cesarean birth, and that affected me a lot. My birth plans had to change.
Every 2 weeks, I visited with specialists in maternal-fetal medicine for an ultrasound to reassess the cervical length and placenta’s position. At each visit, my cervical length would remain but there was no change in the placenta previa.
I was advised against vigorous activities and was asked to notify my pregnancy care provider if I started bleeding. The maternal-fetal specialists advised and scheduled me for a cesarean birth.
Being the Patient Where I Worked
At 29 weeks, I was admitted to the hospital where I worked on the labor & delivery unit. This was my third bleeding episode. The plan was for me to stay in the hospital until birth at 36 weeks.
I felt depressed being in the hospital as a patient. I was unable to sleep and it was hard seeing my co-workers knowing I couldn’t help them. After 2.5 weeks, I awoke in my hospital bed to a large amount of bleeding. My water had broke, which I was unaware of at that time. Within minutes, the room filled with labor nurses along with a doctor prepping me for an urgent cesarean.
I didn’t know how the early birth would affect my baby, Ethyn; I was only 32.3 weeks and felt scared, anxious, and nervous. I relied heavily on my faith. I knew everything was in God’s hands. I went into the operating room not knowing if my placenta would follow after my baby’s birth. My emotions were everywhere.
In the operating room, I gave birth to a beautiful, healthy, 4 lb, 12 oz. baby boy. My placenta soon followed, which resolved any concerns I had about continued bleeding or other complications.
Still, I stayed in recovery for more than three hours due to intermittent bleeding; also, my uterus was not firming up as it should. The nurses rubbed my uterus to help it begin to firm. A few times, my provider had to come in to check the bleeding. Many blood clots came out and the bleeding eventually slowed. It was only then I was able to leave the surgical area and go to the NICU, where I could spend time in the neonatal intensive care unit visiting my newborn, Ethyn.
Beginning Recovery
Once I got to a postpartum room, I felt good and anticipated pumping milk for my precious baby boy. A few of my co-workers, my mom, and my boyfriend came to visit. I began to notice the feeling of increased bleeding and felt a gushing sensation as I sat up in the bed.
I asked my nurse to check the pad I was resting on. She responded, “Oh, that is not a lot of blood. I really don’t want to hurt you by pressing hard.” I looked at her with confusion and told her in a serious way, “I work in labor and delivery, I know what a lot of bleeding is, and I am not concerned about pain. I am at high risk of hemorrhaging, please massage my fundus (the top of the uterus).”
My co-worker, who was in the room at the time, asked if she could check my bleeding and do a fundal massage. I agreed. When she pressed, multiple clots and gushes of blood came out. I immediately called my nurse in my room and asked her to notify the doctor.
Risking Hemorrhage
She was still hesitant to do so. She told me, “You have blood to be drawn at 3 p.m., so once I get those results, I will notify the doctor.” My co-worker instructed the nurse to weigh the pads catching the blood. The nurse threw the pads away and didn’t calculate how much blood was in the pads.
My coworker also noticed my blood pressure and heart rate. My blood pressure was dropping while my heart rate was increasing. My co-worker continued the massage and we noticed more clots with increased bleeding.
Another co-worker who was in the room at the time called my provider and she called out for additional nursing help. In just minutes, several labor nurses were in my room responding to a postpartum hemorrhage—I was bleeding out. My doctor had to manually push the clots from my uterus. What a painful experience!
I clenched my teeth and tried not to climb up the bed as she manually removed multiple clots from my uterus. I received medications to help control the bleeding and two units of blood.
When Everything Crashed
Two hours later, I started to notice more bleeding and was told that I needed a dilation and curettage (D&C), which removes tissue from within the uterus. I agreed nervously. As I was transferred to the operating room and I remember crying and telling the anesthesia staff that I was scared to be put to sleep not knowing if I would wake up. I was reassured and comforted by personally knowing the staff caring for me. As I lay on the operating table waiting to fall asleep, I just told myself I would be ok and prayed.
When I woke up, I heard my nurse say, “Angie, you are in ICU (intensive care unit), you are still intubated (a tube in my throat to assist with breathing). You bled a lot and had to be transferred here.” Still confused about what happened, my nurse gave me a pen and paper to write.
My first question was, “How was Ethyn, my mom, and my boyfriend?” Next, I wrote that I needed to pump for Ethyn. My anxiety caused me to start breathing fast. Finally, an hour later, the respiratory therapist took the tube out of my throat. I could finally speak.
I still didn’t know the full extent of what had happened to me. My provider came to talk with me. In my mind, I knew they removed my uterus but I still didn’t fully grasp the idea. The doctor sat across from me. She proceeded to tell me all of what had happened.
Receiving Blood During Hemorrhage
Twenty-two units of blood were given to me to replace the more than four liters of blood that I had lost. During the D&C procedure, they placed a device inside to keep my uterus firm and remove clots. I wasn’t fully stable enough to breathe on my own, so I was given a breathing tube and transferred to the ICU.
I kept bleeding and my blood levels kept dropping; they did another procedure to help control the bleeding. This procedure was not successful either and ultimately, I needed an emergency hysterectomy—the removal of my uterus.
Losing My Fertility
After my uterus was removed, my bleeding slowed. I was emotional hearing everything that had happened to me. I felt overwhelming gratitude and yet grief and loss also consumed me. I thanked my doctor for saving my life but couldn’t help thinking that I would never be pregnant again. My fertility was gone. The thought of only having one biological child terrified me as this was my first pregnancy and I was just starting my family.
Later that evening, as I was able to get up, I walked around the ICU; a few team members looked at me in amazement. They were shocked that just 24 hours ago, I was laying in the bed, almost lifeless, with my body nearly drained of blood, and now I was walking the ICU halls. I was and am a walking miracle. I stayed an extra night in the ICU and was then transferred back to my original postpartum room.
Every day, I use my experience to advocate for other laboring patients. I recall how I was not listened to and ensure that I validate and reassure every patient I care for.
Finding Purpose in My Experience
Some say, “Be grateful you are alive,” or “At least you have a child,” but that doesn’t take away grieving my loss of fertility. There’s also little comfort for the many days and nights of crying and the post-traumatic stress syndrome (PTSD) I now have when I step into an operating room or have to be on the team of a patient hemorrhaging or receiving a hysterectomy.
Surely God had a purpose for my experience, although I will never know why I had to go through all of that. My faith in Jesus, along with therapy, and support from family and friends, has helped me cope.
Every day, I use my experience to advocate for other laboring patients. I recall how I was not listened to and ensure that I validate and reassure every patient I care for.
I teach new and experienced nurses how to correctly massage a fundus and not fear pressing firmly so they can know for sure if their patient has increased bleeding.
Educating patients directly on the importance of frequent fundal checks (to ensure your uterus continues to shrink back to its original size), especially high-risk patients is essential. I especially advocate for women of color because I experienced being ignored, and research says women of color are less likely to be taken seriously or listened to.
Although having my nurse listen to my concerns may not have prevented the postpartum hemorrhage or hysterectomy, her actions could have prompted earlier interventions that could have delayed or prevented my total blood loss and the interventions to control the bleeding.
My advice to all pregnant patients is to not be afraid to speak up and advocate for yourself if you experience a healthcare provider who is not listening to your concerns. Keep escalating the problem or concern until you receive the care you deserve!
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