hemorrhage death after childbirth

Hi, this sounds absolutely horrible. Anyway, let me preface with the fact that I have no medical background outside of first aid training.

So, hypovolemic shock happens when somebody loses ~20% of their bodily fluids. Given the mother has just had a baby, she's actually already close to the line (sweating, defecating, amniotic fluid etc) which is why even fairly minor bleeds can be very dangerous postpartum. Placental delivery can lead to hemorrhage in a lot of ways, some easier to deal with than others. I don't know how experienced your mid-wife is, or how 'official' your medical system is. I have family who live in rural areas and ya, doctors do doctor things, but nurses do doctor things too, even if they're technically not supposed to because the doctor flat out doesn't have enough hands. Does your midwife feel comfortable putting in stitches? Has she ever seen a severe bleed before? Is this, like, her third delivery? I feel like you should address this, since some midwife reading your novel may read the grizzled war-vet of a mid-wife with hundreds of babies under her belt floundering at the bleed and call bull. If you don't want to pick a particular reason for the hemorrhage, don't, it'd be hard for anybody to identify some of the reasons short of an autopsy. They're going to be more focused on finding the source of the bleed and stopping it up.

Anyway, a hemorrhage can kill your MC mother really fast, especially if the people present don't get it under control. If they do, and she's in desperate need of a transfusion, they can keep her going for a long time on fluids. They're basically keeping enough liquid in the body to pump her blood around. Feeding her O2 helps as well to hyper oxygenate the blood cells she does have. So long as she doesn't do any jumping jacks they could keep her going for hours.

Also, you don't need to make her a rare blood type. Rural hospitals have notoriously hard times getting enough blood of almost any blood type. So long as she's not AB+ (universal receiver) she has a very solid chance of not having the right blood supply handy. Heck, more common blood types can be hard for hospitals to hold onto since they're also the most in demand.

Blood transfusions can happen in person, arm to arm as it were. There's a process to it, basically to stop backwash, but I haven't had to look into that in years and I can't remember it off hand.

Still, if the ultimate goal is:

Birth->yay baby!->Oh no, bleeding!->Whew, stopped the bleeding->crap, she's dying!->Ha ha! She's on O2 and salene, we got time-> check the blood fridge -> Hope? -> Blood fridge empty, feck -> Everybody around runs on gas, dying mom is diesel -> X_X -> sad

Then it's possible your midwife did everything right, stopped the bleeding, but complications, secondary tearing, heck, infection, could end her right when everybody thinks she's going to pull through. People are startlingly fragile and birth is a horrendously dangerous process.

Biggest thing is to keep an eye on your POV. If you're MC isn't a nurse or doctor, she may not even think the word hemorrhage, just see her mom bleeding like a broken faucet and freak right the eff out.

Hope this helps, sorry if it's really disjointed and hard to understand, I gave blood yesterday and really shouldn't be operating a keyboard with my own bloodloss still this fresh.

Tulip Mama <3

Hiya!

So I'm not a medical professional of any stripe, but I did work as counselor (and sometimes a labor & delivery coach and an extra pair of hands) with a group of midwives many years ago. This ended up requiring hundreds of hours of reading and study. So I've read and heard a lot.

It's my understanding that the most severe and dangerous type of postpartum bleeds are from an unresolved or incomplete detachment of the placenta.

Firstly, the midwife would almost certainly not try to get the placenta out after a normal birth. It comes out on its own with a new set of contractions sometime after the delivery. The new contractions clamp down on the vascular connections between the placenta and the uterus, essentially cutting of the blood supply, which triggers the placenta to "let go" and separate, then get passed.

One of the most dangerous shortcuts a delivery attendant can take is to try to hurry the placenta along by trying to get it out before the large temporary blood vessels that fed it have closed down enough after sufficient uterine contractions. The most any midwife or obstetrician will likely do is knead the woman's abdomen (sometimes quite forcefully) to encourage those vital contractions.

One of the things you'll see birth attendants do is inspect the placenta to see if there are any chunks missing. If there is even a small bit of left attached, the body may not get the hormonal message that the pregnancy is over, and just keep pumping blood to the open site. Very bad news.

In the case of noticing a missing piece, a doctor or midwife may try vigorous kneading from the outside, or if it seems too worrisome, they indeed do the emergency maneuver of reaching all the way into the uterus to manually dislodge any remaining placental tissue.

(There are certain conditions discovered either before delivery or shortly after that require more intervention to detach a placenta, but those are serious and are not likely to be attempted outside a surgical, or surgical-adjacent, situation.)

So even if the placenta comes out whole, what can happen is that one or more of the large vessels that have released the placenta fail to clot or start to leak. So the flow can be a steady trickle to a rushing cascade. And, of course, that's the key to how long it will take to be fatal.

It can be quite a number of days, even more than a week. Or you can bleed out in a matter of minutes.

The countermeasures against a uterine bleed are IV administration of Pitocin, manual pressure from the outside, transvaginal palpation for missed pieces of placenta for emergency extraction (sometimes surgical), and emergency hysterectomy.

There's not really anything to sew in a uterine hemorrhage. Or more precisely, too much to sew and no way to get at it. If the attendant can't get the bleeding to stop, the life-saving measure is often to remove the entire uterus.

A cervical tear can bleed quite terribly, possibly even fatally, and that can be sewn up. I had a good friend who ended up having that done without anesthesia. Frickin' yikes. But there's a lot more intervention that can be tried with a cervical tear.

If your character needs to bleed out quickly, a placenta that doesn't detach completely with involvement of the larger blood vessels could realistically send her into shock and then cardiac arrest in a short amount of time.

And, I think, particularly these days, no sane hospital would be up for the 'just grab a stranger off the street and start transfusing their blood into the patient'. You don't know what diseases he may have, what might be in his blood, etc.
In his youth my dad was a blood donor (universal donor) and (small town) he was called in a couple of times for emergency donations, but he was on file, checked regularly, and not some random stranger dude.

I am a medical professional.

That's all pretty elaborate but you can do anything you want. She could bleed out in less than an hour or you can have her bleed more slowly so as to fit it to the story you want to write.

One problem is a retained piece of the placenta rather than the whole placenta. When the placenta is delivered one always has to inspect it to see that it's complete. A retained piece requires a D&C. You can have that piece be small so it's not noticed right away and they don't know why the bleeding isn't stopping, or larger to keep the bleeding from stopping despite their knowing what is wrong.

Another possibility is lack of nursing care to check on and massage the uterus so that by the time someone notices, there has been significant blood loss. Though I hate to see the nurses blamed for anything.

frimble3 said:

And, I think, particularly these days, no sane hospital would be up for the 'just grab a stranger off the street and start transfusing their blood into the patient'. You don't know what diseases he may have, what might be in his blood, etc.
In his youth my dad was a blood donor (universal donor) and (small town) he was called in a couple of times for emergency donations, but he was on file, checked regularly, and not some random stranger dude.

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I agree asking people in the street isn't likely. I agree a list of nearby donors makes more sense.

But there might be a system for donated blood in a rural area if they have very limited access to a donor blood supply. Maybe asking for a volunteer within the hospital for example.

They would have to have the ability to type and cross any donated blood. Usually that's done at the blood bank in a big city but it could be done through the pharmacy in a small hospital. I run rapid HIV tests in my office, they take 30 minutes. I don't know the year this is occurring but they have a new test for hep C that is the same. There's a rapid hep B test but I don't think it's approved in the US yet.

The other things like Zika and West Nile are rare enough in the blood supply you could forego testing for it in a life threatening situation.

If there is a reason in the story for finding a volunteer donor on the spot, a writer could make the scenario work. If there isn't a reason the donor be random, look for other possibilities like in-house volunteers to avoid getting into a less than credible scenario.

I know you said you had what you need but just as an addendum to 1971, pre-HIV, there as no test for hep C until 1993 either. And until the blood banks in the US learned their lesson with HIV, blood was not discarded for past hep B infection.

Hep B core Antibody = past infection
Hep B surface antigen = current, active infection
Hep B surface antibody without core antibody = vaccine acquired immunity

We have used hep B core antibody as a risk factor and a reason not to use the blood for transfusion. Had that been done before we had an HIV test a lot of people would not have gotten HIV from blood transfusions. Of course the first HIV case I saw in a US hospital was in 1978 and it wasn't recognized until the early 80s. We didn't know what the patient had in 1978. We found out later.

It was a different world in 1971 as far as blood transfusions went. I don't think it was much different in Europe.