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Midwife almost killed me... - Page 4

post #61 of 98
My sister hemorraged after a doctor reached in and pulled her placenta out. She said he was just impatient. How long is too long for it to be left in there? Why is there a big rush to get it out?
post #62 of 98
When I got to the hospital this time and had my baby, the OB that delivered me pulled the placenta out of me as well and I bled out.. My iron level went from normal to like 8.3.. I have major issues with this OB not only for that reason, I did file a complaint with the hospital.

They basically do it because they are in a hurry and don't really care about the mother and what she wants.
post #63 of 98
From what I understand it is safe to leave the placenta attached when there is little or no bleeding and women have left their placentas inside for up to 24 hours in some cases. Try THAT (allowing 24 hours for a placenta to deliver) at a hospital! or even with a very medicalized midwife, they wouldn't allow it. These are the questions you need to ask when interviewing midwives...how they handle 3rd stage difficulties and ask them to give examples.

This is what I don't understand, I don't know if anyone telling these stories about placenta mismanagement really can tell me what kind of hemmoraging was already happening causing their caregiver to take action?

Messing with the placenta with no bleeding or little bleeding would be bad management. Judging amount of bleeding is complicated stuff, not for novices....so I ask you who would I trust, me or my attendant on what constituted an uncomfortable amount of bleeding? Trust your attendant...it's practically a no brainer.

Once the bleeding gets past a certain point, the procedure for DEMS (direct entry homebirth midwives) is to ask the mom to stop bleeding. Then, depending on factors (placenta low or high, cord snapped or intact) If high and cord intact, you would have the mom hold her breath and push (try this at home, it is a much softer push than when you aren't holding your breath and it makes the push come from the top where the placenta would be located). While the mom holds her breath while she pushes, the midwife patiently and extremely gently pulls on the cord. At the same time, someone gently massages the mom's abdomen being sure not to push down on the fundus (the fundus is the top area, the top of the uterus, or baby pooch).

If the mom has already lost a pint, then the caregiver gets more agressive by wobbling the cord back and forth, still gently, visualizing it anchored from the top and peeling downward. Massaging from pubis to umbilicus. Mom holding breath while gently pushing. Using gentle traction on the cord.

You are supposed to be basically watching the mom hemmorage while patiently, gently and with perserverance trying to gently coax this placenta away. If this doesn't work, you don't pull harder, you try a different position like squatting.

I think the reason they peel low lying placentas with troublesome bleeding because maybe you can't get the same traction with the cord or benefit from holding breath and pushing (you can feel that holding breath and pushing would do nothing for low lying placentas if you hold your breath and push). You do not have the mom push in this case, cord traction is enough with peeling. You would only have the mom push while peeling placenta if the cord was snapped.

It is a tricky thing really to blame the midwife or doctor for hemmorrage. I'm thinking that no one is going to lose their licence over this. Without going into prenatal care, diet, exaustion, trauma in pregnancy, a lot of factors play into preventing hemmorrage that kind of puts the midwife whose peeling the placenta off some poorly nourished, exausted hemorraging mom at kind of a really unfair disadvantage when the time comes to judge whether or not she peeled it off slowly enough. Maybe if the mom had better nutrition, had less stress or exaustion she wouldn't bleed out when trying to get the placenta out...these are just my thoughts...really I do not know. I am not a midwife at all and have not a lot of experiences with these things. I'm just giving some feedback like was asked. I know the birth where I hemmorraged was my most stress filled least nourished pregnancy. I really think the stress in pregancy played a factor in my placental abnormality and hemmorage, and I would bet that it plays a factor in some other hemmorrages too. Since no one tugged or pulled at my placenta and I didn't have a midwife, I've had to look for answers for my hemmorage beyond just "the midwife or doctor almost killed me". I did however write a poem called "The placenta in my freezer almost killed me",though. But I don't hear anyone else here besides me getting really pissed off at their placentas. Mine was a real bitch, I tell ya. I hacked her up with a big knife and planted her under a thorny bush.
post #64 of 98
low lying placentas bleed more partly because the lower segment contracts differently and is already a close knit thing-- the biggest bleeding stopper in the upper part of the uterus is pressure on it's self(contraction)- the uterine muscles make their own pressure bandage and shut down most of the vessels- lower segment doesn't have the same thing going on- and I can say from experience that sometimes the uterus is still trying to expel whats in it so the cervix is open or atleast opening with contractions and the fundus pushing --
and even after the lower segment has to respond to any blood by letting it pass rather than close up around it-- I think that this is where your clotting factors really come in -- as a perimenopausal woman with a small non-pregnant uterus the hormonal flooding(read hemorrhage) at least for me is more controlled by my vitamin K levels than any uterine contracting -- my uterus can be in strong cramp mode and still be pouring blood --
there are many details with retained or partially retained or even hemorrhage- full bladder- no contractions , dehydrated mom , previous surgery-- I have no exact routines I recommend sometimes I would not want to frighten or alert mom/distract her away from her baby too much so I may not say stop bleeding- I might say does the baby want to suck? and mom may say this is hurting I want to move, ok lets do it you are bleeding a bit.. just depends...
post #65 of 98
Sorry for your difficult experience.

I'm so thankful that you are okay and your baby is too.
I liked what one poster said about every birth being perfect in its own way. May you continue ot process this experience and find peace with it.

I'd like to encourage you to talk to your midwife about the experience. Share what you liked and what was helpful...and what you didn't like, what scared you, and what you think was done wrong. You could write her a letter.
Try to come from a place of helping since she may very well attend the births of others.

What did your original midwife say? Not the one who attended the birth but the one who was already at another birth. Seems like she was your main midwife. Did she contact you to see how you were doing?
post #66 of 98
What an unfortunate thing to happen to you! So scary, too.

However, I don't think your experience has anything to do with your midwife being a direct-entry midwife with 2 years' experience. I am a student midwife and it is pretty common knowledge that you would never, EVER, manually remove a woman's placenta after ONLY 30 MINUTES. That is so ridiculous I don't even know what to think about it. What sort of training do direct-entry midwives have in the USA?

As far as "just in case" saline/Heparin locks, it's this "just in case" attitude that has led to the vast medicalization of childbirth in our culture. You can put in an IV pretty quickly if a mom is bleeding.
post #67 of 98
Quote:
Originally Posted by blissful_maia View Post
I am a student midwife and it is pretty common knowledge that you would never, EVER, manually remove a woman's placenta after ONLY 30 MINUTES. That is so ridiculous I don't even know what to think about it. What sort of training do direct-entry midwives have in the USA?
Not even in a case of hemmorrage? So what are you going to do, let her bleed to death? I've seen women been given shots of pitocin when they hemmoraged before the placenta is delivered. But that was with Licenced DEM's around here lay midwives don't carry pitocin, so I am kind of wondering besides using shephards purse or angelica what you are gonna do when your mom is hemmorraging before the delivery of the placenta? In some earlier posts I copied my notes on here from midwifery school. It said in the case of excessive bleeding and low lying placenta to peel it...no matter what the time frame.

It said for excessive bleeding to gently pull on the cord while the mom held her breath and pushed. It talked about wobbling the cord back and forth while massaging the uterus from pubis to umbilicus (not pushing on the fundus).

I'm curious too, what midwives do in these cases.
post #68 of 98
Quote:
Originally Posted by Bestbirths View Post
Not even in a case of hemmorrage? So what are you going to do, let her bleed to death? I've seen women been given shots of pitocin when they hemmoraged before the placenta is delivered. But that was with Licenced DEM's around here lay midwives don't carry pitocin, so I am kind of wondering besides using shephards purse or angelica what you are gonna do when your mom is hemmorraging before the delivery of the placenta?
Sorry, I should have been clearer. I did not mean in the case of a hemorrhage. I was replying directly about the OP's birth, in which case there was no indication to manually remove the placenta. Also, I can carry pitocin, which is what I would give if a mom was hemorrhaging before the delivery of the placenta. Then I would try compressions, etc. I wouldn't move right into sticking my hand in her uterus!
post #69 of 98
What I wonder about the OP's birth is that she doesn't mention hemmorage, but could it be possible that she was focused on the baby and didn't notice that she was hemmorraging and the midwife didn't tell her that she was? OP, did you talk to your midwife after the birth and find out what was really going on that would cause her to feel like this was the thing to do? This can be really healing to do. It's a way of putting more details about the birth together. In some states it is illegal for a midwife to carry pitocin. In some states Direct Entry Midwifery isn't legalized. It would be hard to get pitocin in these states.
post #70 of 98
blissful_maia wrote>> "What an unfortunate thing to happen to you! So scary, too.

However, I don't think your experience has anything to do with your midwife being a direct-entry midwife with 2 years' experience. I am a student midwife and it is pretty common knowledge that you would never, EVER, manually remove a woman's placenta after ONLY 30 MINUTES. That is so ridiculous I don't even know what to think about it. What sort of training do direct-entry midwives have in the USA?"


it is pretty much standard of care in medical/hospital based births here to pull on the cord/traction- give a shot of pit and expidite the delivery of the placenta -may placentas are delivered within 5 minutes of the birth- and I have noticed that most do come within the first 15 minutes (without active management- all on their own) -- many direct entry midwives have similar training- many of the ideas about getting the placenta out ASAP started with the Bristol Study done in the 80's recommending active management and over the years there continues to be support for that style of management -- I know of licensed midwives who have been penalized in this country who do not transfer care or get a placenta out quickly-
as for education there is a variety of ways a direct-entry mw will come by training schools (like MEAC accredited schools) and they teach to particular standards- and I'll bet you dollars to doughnuts many who have been in schools have been taught about the "evidence" of getting a placenta out quickly- there is self-study/informal training along with apprenticeship(this is a catch as catch can approach) also formal/guided self-study more like a distance school Ancient Arts Midwifery Institute-
we don't have licensure in every state and each state has different laws /rules and regs regarding midwifery- not every licensed midwife can easily carry pit or methergin - an unlicensed one may carry these drugs but puts herself in danger to use them -and there are clients and midwives who also have a preference to not use these or any drugs...
I don't know what kind of training the midwife had except that the tugging on the cord is probably a more common method in this country than not - if you do have a placenta in place and uncontrollable bleeding then manual removal is probably the wisest option- before the woman bleeds too much
post #71 of 98
Quote:
Originally Posted by Bestbirths View Post
What I wonder about the OP's birth is that she doesn't mention hemmorage, but could it be possible that she was focused on the baby and didn't notice that she was hemmorraging and the midwife didn't tell her that she was?
This is a very good point, I never considered this possibility though it does often happen.
post #72 of 98
Quote:
Originally Posted by mwherbs View Post
I don't know what kind of training the midwife had except that the tugging on the cord is probably a more common method in this country than not.
Well, I knew it was standard practice for OBs/doctors, but I didn't know it was so for midwives. I guess here in Canada midwives seem to lean towards expectant/physiologic management unless there is an indication otherwise.
post #73 of 98
what is a 'hep lock?'

fwiw, I nearly bled out and I was in a hospital with a 'doctor.'

I have no idea what happened with my placenta because I was in the middle of an out of body experience and was viewing my baby rather than myself. weird, I know.
post #74 of 98
Quote:
Originally Posted by bigeyes View Post
I have no idea what happened with my placenta because I was in the middle of an out of body experience and was viewing my baby rather than myself. weird, I know.
I don't think it is weird at all, I get kind of all out of body, shocky, concerned with my baby too. Dh is the one who noticed I was hemmorraging, I was oblivious. Dh had to mention it several times before I "got it" that there was a problem. Especially since it was a trickle over an hour and a half. Then, once I realized, I was like crap, we'd better go to the hospital. But when I got up to go, I bit the dust, passed out and two people had to carry me down a flight of stairs to the car. Sigh.

Quote:
many of the ideas about getting the placenta out ASAP started with the Bristol Study done in the 80's recommending active management and over the years there continues to be support for that style of management --
I went to Apprentice Academics (Ancient Art Midwifery Institute) and they taught us that the Bristol Study in the 80's was flawed. The information I printed out on how they instructed us to handle hemmorage was from Apprentice Academics.
post #75 of 98
Quote:
Originally Posted by Bestbirths View Post
I don't think it is weird at all, I get kind of all out of body, shocky, concerned with my baby too. Dh is the one who noticed I was hemmorraging, I was oblivious. Dh had to mention it several times before I "got it" that there was a problem. Especially since it was a trickle over an hour and a half. Then, once I realized, I was like crap, we'd better go to the hospital. But when I got up to go, I bit the dust, passed out and two people had to carry me down a flight of stairs to the car. Sigh.
You'd be surprised how many people have tried to convince me I didn't experience it at all. I remember asking them to let me see him, and nobody would answer me, so I just sort of floated over there myself. Later my mom told me nobody heard me because they all thought I was dead.

It's scary how many so called birthing experts are out of touch with their patients. I don't think my doc was even in the room for more than the last few minutes before I passed out.
post #76 of 98
Quote:
Originally Posted by bigeyes View Post
what is a 'hep lock?'
It's basically something you can put in a vein so that you can very quickly insert an IV in an emergency. All you have to do is plug in the tube instead of doing the whole IV procedure. HTH.
post #77 of 98
Quote:
Originally Posted by blissful_maia View Post
It's basically something you can put in a vein so that you can very quickly insert an IV in an emergency. All you have to do is plug in the tube instead of doing the whole IV procedure. HTH.
ok. am I correct in assuming that means like a unit of blood, or is it for medication/anesthetic?
post #78 of 98
I'm so sorry that you did not have the homebirth you hoped for.....and also dealt with the inexperience and mistakes of 2 midwives. :

I'm glad you are BF & bonding with your little one.
post #79 of 98
Really, a heplock won't help with a hemmorrage at a homebirth. A shot of pitocin might, or some herbs, or a midwife who can peel a placenta. If the placenta isn't out and there is a hemmorrage, it needs to come out. I can't remember if it is shepard's purse or angelica, one of those is used to stop hemmorrage and one is used to bring the placenta. That's what I would have on hand for homebirths (or with these hospital nightmare stories-put a couple dropperfuls in some "tea" right at the hospital).
post #80 of 98
Quote:
Originally Posted by bigeyes View Post
ok. am I correct in assuming that means like a unit of blood, or is it for medication/anesthetic?
You could use it for anything, really, it's basically just a portal into your vein... an IV without the tubes/bags attached.
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