Multiple moms are at a greater risk of suffering a postpartum hemorrhage. I wish I had known this prior to delivering my twins. The over-extension of the uterus can make it more difficult for the uterine muscles to contract properly after birth. Also, having multiple placentas detach from the wall of the uterus means multiple bleeding sites. In addition, C-sections are a risk factor in hemorrhage, and multiples are often delivered surgically.
Postpartum hemorrhage happens after approximately 1-5% of births, most often within the first 24 hours after birth. A hemorrhage that occurs after the first 24 hours after birth is called a late or secondary postpartum hemorrhage. Late postpartum hemorrhages are rare, but can happen anytime from 24 hours after birth to 12 weeks after birth.
I suffered both a primary (right after birth) and secondary (late) postpartum hemorrhage after the birth of my twins. Having had three previous single births without any abnormal bleeding issues, I was unfamiliar with the signs and symptoms.
During my first postpartum hemorrhage, which happened in the labor/recovery room after my vaginal twin birth, my nurse was uncomfortable with my blood loss and began weighing my pads. Once the blood volume lost was more than is typical, she involved the resident doctor who had assisted with the delivery of my twins. It did not feel like an emergency situation, rather one that required prompt treatment. I continued to talk with the medical staff and interact with my babies. I was given a bag of Pitocin through my IV, and my uterus was aggressively massaged to stimulate contractions. Breastfeeding my newborns also helped, as breastfeeding releases hormones that assist in uterine contractions post-birth. I was given a shot of a medication to cause contractions and yet another medication as rectal suppositories. While administering the rectal suppositories, the resident doctor joked, saying “I promise, this is the last time I will violate you today” and I couldn’t help but laugh. This combination of treatments slowed my bleeding down to a normal amount, and I was able to be moved to the mom / baby floor. I felt a bit woozy and extra emotional, but with iron pills, improved quickly.
My second postpartum hemorrhage occurred when my twins were 9 days old. I was home with one twin and the other was still in the NICU, sick with a rare birth defect. My husband had come down with a cold and had to stay out of the NICU, so, believing myself to be superwoman, I went twice to the NICU with my healthy newborn in tow, without help, doing more walking and lifting (barely one week postpartum) than was wise. My bleeding picked up a bit during those long days in the NICU, juggling a healthy baby and one attached to tubes and wires, but the increase in blood flow was not so much that I became alarmed. Perhaps I should have listened to my body more carefully.
After returning from the hospital the evening before my postpartum hemorrhage, I walked around the block with my teenage daughter. I was desperate for something normal, like enjoying the beautiful weather and walking the dog (my daughter held the leash.) I was exhausted, worried, and stressed to the max, so when I had some abdominal discomfort and diarrhea before bed, I thought nothing of it. Had I pressed on my lower abdomen, I would have noticed that my uterus had grown a bit larger, rather than smaller, than the day prior.
At 3 am our newborn woke to nurse. I fed her and went to the bathroom and noticed my bleeding had picked up more. I changed my pad and climbed back in bed. Feeling some unease, I asked my husband to call the triage nurse at the hospital. She told us that as long as I was not soaking a pad every hour I would be fine to just keep an eye on my bleeding. I got back under the covers, hoping for a bit more sleep, but began to feel small but frequent gushes of blood. I went back into the bathroom. In just five minutes time I had soaked a giant postpartum pad. My unease turned to a prickly fear. My husband quickly called a friend to come and got back on the phone with the triage nurse. She directed us to come straight to the ER. At this point I began to panic. The blood was coming fast, especially upon standing. Even sitting down, it had oozed up, soaking the front of my shorts. The hospital where I had delivered was 25 minutes away. I grabbed a towel and held it between my legs and informed my husband that we should go to the closest hospital. Our friend arrived to watch our children and we handed her the baby, pointed to formula samples, and ran out the door, blood dripping through the towel and down my legs.
The hospital nearest is very close – we were there in less than two minutes. My husband ran into the ER and came running out with nurses and a wheelchair. As he parked the car, I was wheeled into a room, placed on a gurney, stripped naked (my clothes were soaked in blood) and had large gauge IVs placed in both arms. I was shocked by the intensity of the reaction of the emergency room staff and the number of people suddenly rushing around me. Saline was forced into my veins quickly with pressure balloons. Blood was drawn. My blood pressure was checked frequently and my heart function was monitored with an EKG. I was covered in warm blankets while the ER doctor got on the phone with my OB. I was not aware that this hospital where I was being treated did not have an obstetrician on staff. Over the phone, my OB explained the treatment to the ER doctor – a shot of a medicine to induce contractions and uterine massage. I passed over 30 clots, some as large a softballs, became dizzy, and had to use a bedpan, as sitting up increased the bleeding. It was determined that I should be transferred to my delivering hospital, so an ambulance took me, and my husband followed behind.
I was wheeled into a second ER, where an OB resident vigorously massaged my uterus. This was painful, but it slowed my bleeding significantly. I was given pills to dissolve in my mouth, again, to induce contractions, but no food or water was allowed in case surgery would be required. More blood draws and waiting ensued. Eventually it was decided that I would not need surgery or a blood transfusion, but I should stay for the day and one night for observation.
I was released the next day and rested at home with a steady diet of high-iron foods. It really hit me that first night home – I realized how afraid I was of this happening again. During the next several days, my husband did ALL lifting and my walking was limited. I realized how important it was to be aware of what my body was telling me. I am grateful for the life-saving care I received.
All content on this Web site, including medical opinion and any other health-related information, is for informational purposes only and should not be considered to be a specific diagnosis or treatment plan for any individual situation. Use of this site and the information contained herein does not create a doctor-patient relationship. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.
Anne Schmidt is a stay at home mother of five, including three school age kids and fraternal twin girls born in May of 2016. A self-proclaimed book nerd and former school librarian, Anne currently spends her time mixing up her kids’ names, tripping over the dog, and trying to convince the laundry to wash itself.
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