Sometimes women bleed after having a baby, I was told in my orientation sessions. Some blood loss is normal, they said, but may require quick action and medication. Sometimes it’s predictable, like with fast or long labours when the uterus gets overworked. At its worst, it can be like someone forgetting to turn off the garden hose. They were right.
It was the end of a 12-hour night shift. Although I had more than five years experience as a nurse, I had only worked in labour and delivery for a year, just long enough to know I had a lot to learn.
I crept back into the quiet, dark delivery room after my break. My patient’s epidural was effective and she was sleeping through her contractions while her husband napped in the corner. I realised that the induced contractions on the monitor were coming too fast. This can either cause stress for the baby or tire out a uterus. In this case, the baby was fine but mum’s uterus was getting tired.
The baby’s heart rate looked good on the monitor and things progressed quickly. The family doctor, who rarely did deliveries any more, flew in just in time to catch the baby. One more minute and I would have delivered her.
Then the steady pour began. Big baby, third baby, fast labour, too many contractions – a lethal combination. Like a runner at the end of a sprint, the mother’s uterus just gave up.
The room filled with doctors. I was part of the resuscitation team. We started IVs, hung blood, gave medication. A senior nurse came in to assist. My natural inclination was to turn it over to her experienced hand, but she said: “You’ve got this, I’m here if you need me.”
I have never felt so empowered. All my worries that I would freeze under stress were eradicated. The adrenalin was like a camera focusing a lens. I knew what to do, and how to do it.
I watched as the colour drained from the patient’s face and she began to lose consciousness. When I readied her for the operating room, I realised if she died, the last thing she would have seen was my face as I took her healthy baby out of her arms to be fed by another nurse.
After documenting everything in a record to show we had done what we could, I stopped in the car park to dry heave. The superwoman feeling was gone, exhaustion and shock in its place.
Then the dread set in. I realised I could do this, but did I want to? I was scared that the next time my patient might not live. I knew all nurses have the potential to lose a patient but in that moment, it became real to me. I could be the difference between life and death.
I had a scheduled week off and the further away from the situation I got, the more I didn’t think I could return. I spent the days at home with my family and began to doubt my abilities. I had called to find out that, although the patient had lost her uterus, we had saved her life.
In the end, practicality won out. If I didn’t go back what would I do? I have children to feed and a mortgage to pay. I didn’t see an alternative but to face my fear head on.
My heart rate increased when I received my next assignment. My patient was having her fourth baby; it was big and she had a history of bleeding heavily after delivery. All the things that put her at risk of bleeding again. Checking the board, I realised the same obstetrician was also on duty. The patient had a challenging delivery and in the end she did bleed, but I was ready for it. I massaged her uterus and gave the drugs I had the week before. This time, they worked and the bleeding stopped. Somehow, the universe knew this repeat haemorrhage was exactly what I needed.
I chose to believe the voices in my head saying I couldn’t handle this job were wrong. The second haemorrhage wasn’t as bad as the first, but the feeling of panic was gone. Despite hoping mums don’t haemorrhage, I realised that it is a privilege to be a nurse with the skills, the medication, and the team to treat them if they do.
Postpartum haemorrhage is the leading cause of maternal death worldwide. I didn’t have to watch in desperation as my patients bled to death like so many nurses and midwives do. I live in a country where I have the privilege of being part of a team that has the resources to fight back.
Without doing what I do, in a different place or time, these patients wouldn’t survive. Here, in Canada, I have the chance to save them.
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