Recovering from a Shocking Hemorrhage
Editor’s note: This article first appeared in Midwifery Today, Issue 132, Winter 2019.
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In spite of everyone’s best efforts,
Every once in a while
(Hopefully only very rarely)
There may be a catastrophic postpartum bleed.
We had an experience long ago that drove home how mamas truly need recovery help between the immediate stopping of bleeding and eating iron-rich foods for the next month. This story has a good ending and we learned from it, so no need to get triggered, okay?
Mama was having her first homebirth; she and all her relatives had only had induced and Pitocin-managed hospital births previously. After a very “normal” six-hour labor, on the heels of the baby came the torrent of red. It was the kind of heart-stopping, catastrophic flow that brought every response at our disposal, including bimanual compression and a 911 call—all within a few moments. The paramedics were swift, cheerful, young, and inexperienced. In spite of my objections, after they loaded mama onto the gurney for transport they routinely and quickly raised her to a sitting position. Mama did not have sufficient circulation at that moment to support blood getting all the way up to her raised head; her eyes rolled back, she had a bit of a seizure, and everyone got scared. Coming to in less than a minute, she nonetheless took several minutes to remember who she was, recognize her husband, and back down from a reflexive fight-or-flight combative survival response. And that’s what scared her the most.
The medical response and results were good and baby was quickly brought to the hospital to rejoin mama skin to skin. Everyone was tucked in for a 24-hour stay to get IV fluids and monitor the range of the inevitable drop in hemoglobin (Hgb).
And then … 10 hours later came a 4:00 am phone call. Dad was asking for help. ”My wife is afraid to go to sleep. She hasn’t been able to close her eyes since the birth. She’s anxious and afraid she won’t wake up. She keeps remembering the seizure and loss of consciousness; she
really thought she was going to die. She feels scared and transparent.
“Also, the hospital is just waiting to see how low her hemoglobin goes, to determine if she needs a transfusion. It’s already down near 6, and they say the next check in the morning will be lower still.… But we don’t want a transfusion; isn’t there anything we can do besides just waiting for things to get even worse?”
I brought along homeopathics, essential oils, flower remedies, liquid iron supplementation, and my hands and heart. This combination allowed mama and baby to peacefully fall asleep in less than 10 minutes, and we continued to use many of these remedies over her weeks of recovery. Her hemoglobin five hours later was 7 g/dl, something quizzically deemed “impossible” by the medical staff. Early nutritional and remedy-based intervention does make a significant difference in recovery!
A mother such as this one—once the immediate bleeding has been stopped and she is stabilizing—may have additional risk factors and challenges in her postpartum recovery that go well beyond low hemoglobin. These potential risks include a much-extended recovery period, days of severe headache, prolonged iron-deficiency anemia, a milk supply that is insufficient or never comes in, a weakened immune system, and postpartum depression. The more swiftly we can move this mother back from the physiological and energetic edge of the danger and fright she has experienced, the more stable she will be, the better she will feel, and the more swiftly she will recover.
However, before we hustle in with restorative help after the conclusion of such a frightening event, we must slow down to remember that this mother/baby unit is now especially vulnerable and highly sensitive. Even as we helpfully care for her, we must be extra gentle, extra kind, and speak and move quietly and more slowly. This may take some conscious intention—because babbling and bustling are common stress-discharge responses.
These mother/babies usually do best with a minimum of speech and movement around them for a time. They are easily jarred at every level, and being jarred distracts, or even diverts, from their immediate stabilization. Remember, mother/babies are a unit; the baby is also having feelings and experiences and laying down memory, just like mom. In one of my first births as an apprentice, every time the mother had another gush, the baby’s breathing also faltered. There are no secrets from the baby; they both need reassurance and matter-of-fact calming presences to reestablish equilibrium.
You can get an idea of how vulnerable such a mother is by observing the following:
- What is her “actual” measured or estimated blood loss? Adults generally have around eight pints of blood, which will normally expand by 20–24 weeks of pregnancy by about 50%, or to around 12 pints. Loss of 500 mLs (~1 pint/+2 cups) is generally considered a hemorrhage. Also, if her bleeding looks thin and watery by the time the blood loss is controlled, be extra concerned about reduction of clotting factors.
- How are her vital signs, both in numbers and behavior? How far from her normal is her blood pressure and pulse? Is she able to sip fluids through a straw without nausea? Is she asking to sit up and able to do so without wobble or wooziness, or is she instinctively remaining lying down with the smallest head cushion?
- What is happening with her color? When blood loss is still occurring, her color may go from pale to white, to even yellow and then green. In my experience, green is very grave. When the situation is no longer worsening and blood loss has been stopped, her circulatory system can get traction as it works to acclimate and compensate. Mother’s color will return in reverse order: hopefully the rather ghastly green stage was brief and swiftly returns to the sallow yellow, and moves back toward pale. Things are usually going well when she has color in her cheeks and her lips return to her normal version of pink tone (depending on her usual skin tone/color). It may take an hour, or a few days, to get pink lips. Some mothers have a yellow cast for weeks.
- How is her vitality? What level of interest is she taking in her baby? She might have handed him off or have been clutching him tightly when things became serious … when does she ask for her baby back or open her eyes to return to curiosity and engagement with her baby? Is she talking to her baby or interacting with family members?
Immediately use as many of these components as you have and which the situation can tolerate and then decrease over the first days and weeks.
- Ferrum Phos 6X. The homeopathic tissue salt of iron. Homeopathic dosing is typically 3–4 pellets under the tongue, ideally in a clean mouth. Consider dosing every 10 minutes in the first hour, hourly in the first day, and 3x/day in the first weeks. The 6X combines a microdose of iron with the homeopathic frequency of iron, stimulating the body to increase its affinity and rebalancing of the mineral.
- Homeopathic Arnica. This is the #1 remedy for physical trauma, bleeding, overall bruised feeling, and state of shock with dazed appearance. This is a remedy that can be used first, and often, dosing as above.
- Homeopathic Phosphorous, especially if there was “bright red bleeding, after a difficult labor.” Acute conditions often do best with a higher dose, such as 200C, but if 12X or 30C is what is on hand, use it. Most mothers would benefit from a single dose in the immediate aftermath. Up to three doses may be used during the emergency, although if it hasn’t helped after two, I’ve usually moved on.
- Homeopathic Aconite, for a “sudden, shocking, frightful” experience, especially if it brought “fear of death.” Dosing is the same as above—keep this one in mind for baby post birth, also. Use on either of them if they have a “deer in headlights” look about them; it can be used anytime, including later in the postpartum period, as they work through fear or memories.
- Rescue Remedy or 5 Flower Remedy,
several drops in mouth or water, even topically on baby’s head or mother’s body. Administer also to any bystander/responder shaken up from the bleed. These flower remedies work on the emotional plane, are highly diluted just like homeopathics, and are safe for anyone, including a newborn. Use liberally and frequently.
- Homeopathic Bio-Plasma. Three or four pellets can be added to any fluid or administered directly by mouth, frequently in the first hour, several times daily in the first week or two. Bio-plasma is a blend of all 12 micro-mineral 6X tissue salt combos. It’s a must-have for any holistic birth bag, to help restore mineral imbalances in the body—it’s inexpensive, lasts indefinitely, needs no refrigeration, and is lightweight in your bag. Use anytime an electrolyte effect is needed, not only in cases of blood loss but also in extreme conditions of vomiting or diarrhea.
- Sweet warm liquids to be sipped, which will raise mother’s blood sugar, hydrate her body, and, in moderate amounts, seem to help her “get back in her body” after feeling woozy.
- One or two tablespoons blackstrap molasses stirred in a cup of hot water. This is hands-down the cheapest, most effective, and most easily available home remedy for absorbable iron. One tablespoon has about 3–4 mg of iron. Since prescription iron is synthetic and typically has only a 10% absorption rate, don’t be discouraged by the low concentration.
- Herbal infusions can be made routinely as part of birth setup. Per cup of simmering water, add 1–2 tablespoons each of shepherd’s purse (high in vitamin K), nettle (high in absorbable iron), fenugreek (comforting taste and for digestion), red raspberry (uterine toner and contains manganese, the bonding mineral), and a cinnamon stick (warming, bracing, and with anti-bleed qualities of its own). After a few minutes of simmering, leave covered and off the heat to steep.
- 1–2 tablespoons of liquid chlorophyll in a small glass of room-temperature water. Chlorophyll’s molecule is very similar to that of blood, with a center of magnesium instead of iron. Naturopaths have long taught that it’s easy for the body to switch out the magnesium for iron, supporting a faster blood restoration. This certainly has seemed true in practice.
- Note: We’ve learned to go slow on the volume of liquid orally. There’s only so much liquid that the postpartum stomach can absorb at once, and too much tends to make people feel “sloshy” and nauseous.
When needed, strain and liberally add honey (or sugar), which will raise blood sugar, feed the uterus to contract more vigorously, and restore the “sweetness of life.” Doulas could even educate their clients about bringing “honey sticks” to their hospital births.
- Food-based liquid iron such as Floradix or Gia brands. When compared to synthetic/Rx iron, liquid iron from food sources or delivered with iron-rich herbs has a greater absorption rate, stimulates less nausea, and almost never brings constipation. Give 1–2 tablespoons by mouth or in fluids, even hourly, for a few doses in the beginning.
- Placenta as medicine. Placenta is a valuable asset during and after a hemorrhage for its hormonal effects on uterine tone and blood loss. A small chunk may be used immediately, raw in a fruit smoothie or placed between mom’s gum and cheek. Placenta may be encapsulated, tinctured, or frozen in small pieces for postpartum use. There is little research at this time, but lots of anecdotal stories of benefits, with a few concerns. This is a good place to do your own research, with an open mind; the mother is likely to have her own strong preference.
- Have someone quietly hold the soles of her feet with the palms of their hands. Mothers nearly always visibly perk up and invariably remark on how much better they feel after this grounding work: “Don’t let go!” This is a great job for a new apprentice, a determined grandma, or a doula in a hospital setting. They may expand the positive effects by visualizing their own feet extending like roots of a tree deep into the earth, breathing deeply and evenly, and silently praying, if this is their way.
- Visualization. Give guided suggestions focusing on “What color is your uterus right now?” And then, “What color is it when your uterus is firm and safe, and you have just the right amount of healthy blood in your body?” Then quietly coach her to imagine shifting from the first color to the second color; there is no right answer. The answer is hers. One time in the ambulance, a mom had another big gush and again became ashen and faint. While the EMT raced to establish the IV, we resumed uterine compression and visualization out loud. In less than 90 seconds, color began to so obviously rush to her cheeks and lips that the EMT remarked, “Wow, the IV isn’t even in yet!”
- Cranial-sacral contact. Even without training, calm hands that simultaneously make gentle contact with the base of her neck and base of her spine will be grounding.
- Judicious use of high quality essential oils can support her in becoming more stable; resist the urge to over-scent the mother/baby or room. Research has shown that frankincense crosses the blood-brain barrier and oxygenates the brain, in addition to its sacred role of supporting transitions like birth into life. A single drop may be applied to the soles of mom’s feet, or the base of her skull or spine. My other favorite for stabilizing mothers is the original Valor blend from Young Living Oils; it seems to strengthen their energetic backbone and bring back the brightness to their eyes.
In the first minutes and hours, you’ll know you’re on the road to success when her color returns, her voice strengthens, and she regains her ability to carry on a bit of a conversation.
DOS and DON’TS after a Serious Bleed
- DO keep this mother and baby together as much as possible, with soft voices and gentle handling.
- DON’T offer ice-cold liquids or foods. She very much needs the warming qualities within, a philosophy of healing also promoted by Chinese medicine. Placenta smoothies are cold, and that’s a drawback.
- DON’T insist on dialogue, at least not beyond making sure she is conscious and present.
- DO consider an enema if you do not have access to IV fluid replacement. The role of the lower intestine is to absorb. An inexpensive Fleet enema can be used to hydrate. This is the favorite hydration solution of a colleague, who has served her local rural Amish community for over 2600 births, where solving problems at home is strongly needed. Warm the fluid (never in a microwave), lay mom on her left side, use lube to gently insert the tip past the sphincter (K-Y jelly, coconut oil, or something similar will work), and very slowly release fluid into her rectum. Think the pace of a dripping IV, not the pace of drinking a glass of water. Also, don’t hesitate to amplify the positive effect by adding some of the remedies to this fluid—at the very least, dissolve some Bioplasma, blackstrap molasses, or chlorophyll in it. Once the original fluid is gone, the container may be reused with raspberry/nettle herbal infusion or molasses tea as the fluid base.
- DON’T ask her to walk to the bathroom to prove that she’s stable enough for you to go home. While she must urinate before you leave, she can pee on her hands and knees over a bowl on the bed, be moved to the bathroom using a rolling office chair like a wheelchair, or crawl on her hands and knees to the bathroom. “No one falls off the floor.” One mom had a hospice potty chair that we set on a tarp next to her bed, which was super handy.
- DO ask her to stay in bed until the next time you see her (which will be within 12–24 hours, depending on the severity of the bleed). Also, someone must accompany her to the restroom every time for the next 24 hours, and maybe up to 72 hours, depending on what you find on return visits. Yes, even if she “feels bad” for waking family. As one of my early mentors used to quip, “You may not be able to keep her from fainting, but you can keep her from having a closed head injury.”
- DO prepare her and her family for her normal postpartum recovery period, which ideally will include something like “a week in bed, a week on the bed, and a week near the bed.” If she has a large family, life circumstances, or serious financial issues that will make this downtime especially challenging, talk to the mom and family the next day about this recovery. The described ideal might not even come close to the amount of support she needs in recovery. It is not appropriate, and maybe not even safe, for this recovering mother to be left alone (probably for at least several days), or with other children (probably for at least 1–2 weeks). She may need twice or even much more than the expected time to get back on her feet.
- DO explain to families that protecting an adequate recovery period is not only much safer and better for mom and baby overall, it will also be much cheaper in the long run. In this case, a mom who takes the necessary time to recover will, in the long run, need less intensive supplementation, family support, and child care. Compare this to a mom who assumes too much responsibility too soon, and therefore is at higher risk for extended postpartum bleeding, relapse, depression, suppressed immune system, and dragging around feeling crappy for months.
- DO suggest continuing with intensive supplementation until her hemoglobin is normalized, and maybe beyond. Ideally this includes food-based iron, ionic minerals, prenatal vitamins, methylfolate (B9 is needed to form red blood cells) and vitamin C—at least 200 mg for every 30 mg of iron. Vitamin C increases the body’s absorption of iron. In addition, avoiding iron blockers, such as coffee, tea, and cola, is helpful. Alternatively, she needs to fall in love with daily blackstrap molasses.
- DO suggest minimizing fish oil supplementation late in the third trimester and in the first week postpartum. Fish oils are known to make blood more slippery, which is decidedly not helpful to a birthing mother. My hemorrhage rate, which was considered average, dropped dramatically after I heard Gail Hart pinpoint this risk at a Midwifery Today conference.
- DO let family know what normal looks like with iron-deficiency anemia, or low iron in the blood. It’s common to feel weak, get tired more easily, be out of breath, feel dizzy, have trouble focusing, get headaches, feel grumpy and/or look quite pale. They should take steps to protect mom and baby while she recovers; for instance, she should avoid stairs until symptoms improve, and someone else should carry the baby down the stairs for her.
- DO research specific homeopathics if there are extenuating circumstances, such as
- Bellis—“Arnica for the abdomen.” For uterine soreness after manual or surgical placenta removal, or vigorous or extended uterine massage.
- Carbo Veg—Passive hemorrhage, icy cold, deathly pale; known among homeopaths as a “corpse reviver.”
- Staphasagaria—often indicated if there is surgery or cutting, or feelings of abuse from a medical experience.
Here’s how the numbers actually went for Zoey*, who was supported with this protocol during and after bleeding that began suddenly post-placenta, after an otherwise smooth and relatively swift homebirth:
- At 30 weeks, Hgb 12.2 g/dl.
- At hospital one hour post-birth, Hgb 11.6 g/dl, with measured blood loss (home/transport/hospital combined) that totaled 11.5 cups. This is approximately half her blood volume.
- Remedies were brought to the hospital by two hours post-birth and she took them about every 10 minutes/hour, along with nibbling fresh cherries
and eating lightly. She also received a total of two liters of IV fluids.
- At discharge, approximately 10 hours post birth, Hgb 9.2 g/dl.
- Three days postpartum, Hgb 6.8 g/dl, the lowest measured point.
- Two and a half weeks postpartum, Hgb 10 g/dl.
- Five weeks pp, 12 g/dl.
Other details of postpartum—She was careful to get ample fluids orally, in addition to continuing most of this protocol throughout her recovery. Her family and friends rallied to protect and provide for her over three weeks of resting and caring for her newborn, but not household or other children. She was mildly dizzy for the first few days if she sat too much and had a ferocious headache for over a week despite a wide range of approaches. At seven weeks she reported a high level of satisfaction with her birth and recovery, no emotional trauma from the experience, and an excessive milk supply.
To compare, the Red Cross requires women to wait at least eight weeks between blood donations of a half-liter (about two cups) of blood so their hemoglobin has sufficient time to return to at least 12 g/dl. Zoey essentially returned to her beginning hemoglobin within five weeks by using multiple iron-rich supplementation sources, even after more than five times that amount of blood loss.
And Then Later
Nutrition. Food-based support to help mama restore her healthy blood volume is usually the most sustainable and helpful. What are her family’s or her culture’s preferred high-iron solutions? I’ve seen grandma’s fried liver and onions, local plants, nettle soup, and magical dishes from other parts of the world do wonders. Bringing in traditions or family favorites lets everyone feel helpful and recover from their worry together. In the US, high iron foods include:
- Dark leafy greens like spinach, Swiss chard, romaine, kale, collard greens, and wheatgrass juice. Steamed or roasted greens will nourish her more right now than cold salads, which need a lot of “heat or fire” to break down—hard for a blood-deficient mom to summon. Avoid parsley and sage, which are used to reduce milk supply.
- Dried dark fruit such as raisins, currents, black mission figs, or prunes.
- Blackstrap molasses daily; this is a great time for cheering her up with gingerbread and real whipped cream, too.
- Dried beans and legumes.
- Eggs, red meat, and organ meats (if she eats them).
- Sea vegetables.
- Herbal sources such as nettle, dandelion, yellow dock, kelp, alfalfa, watercress, and fennel.
- Bone broths and/or herbal infusions will help restore mineral balance.
Check under the lower eyelid. The mucous membrane, revealed when the lower eyelid is pulled down, reflects the oxygen-carrying capacity of the blood in real time; anemia makes it paler. Familiarize yourself with this surprisingly accurate visual by checking your own and those of your clients, especially at their low points and when their Hgb is known through lab work.
Attend to the baby. Tell the baby what happened. “We’re really sorry that mommy had to leave so quickly to get help. She loves you very much. It was not your fault. You are together now and both of you are safe and sound.” What future perception do you want them to have? Addressing the baby’s narrative now will help diffuse the potential of being held back in life by that newborn experience such as, “If I make a move, someone I love leaves.” Coach the parents to address the baby with positive language; “If I were the baby, what would I need to hear?”
Attend to the family. Did the wide-eyed children see an ambulance take their mommy away? Did a family member later wash out birth bedding, experiencing a tangible shock of the red blood lost? Sometimes just calm listening is needed; sometimes down the road they also may need a bit of tenderness, rescue remedy, or hug. Helping family trauma heal also helps shift the family story about this birth, freeing motherbaby from a forever link to emergency triggers.
A birth professional using a comprehensive naturopathic approach to assist her client after a serious bleed can make a profound improvement in the client’s experience and memory of that postpartum experience. Doulas are also well positioned to offer holistic approaches as a healing ballast for their medically birthing clients, who are commonly discharged shaken and scared, with a prescription for iron and instructions to “resume normal activity.” Applying these naturopathic approaches when a serious bleed occurs expands your care in safe, effective, and cost-effective ways that are also medically compatible and empowering to all.
Now, dear ones, take a deep breath! Most of us have witnessed a bleed that scared us. We, too, must breathe deeply and release our highly-charged emotions around these events. And we can. Using these remedies will create a healing bridge back to normality and health for us to witness and absorb as well.
*Info shared with permission, pseudonym used to protect privacy.
- Association of Ontario Midwives. 2016. “Life after Postpartum Hemorrhage: Recovering from the Unexpected.” Accessed August 25, 2019. ontariomidwives.ca/sites/default/files/CPG%20client%20resources/Life-after-PPH-English.pdf.
- ———. “PPH CPG Work Group.” 2016. Accessed August 20, 2019. ontariomidwives.ca/sites/default/files/CPG%20full%20guidelines/CPG-Postpartum-hemorrhage-PUB.pdf.
- Brennan, Patty. 2018. Homeopathy for the Birth Bag, 5th ed. Ann Arbor, MI: Dream Street Press.
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- “The Donation Process.” 2019. NHS Blood and Transport. Accessed September 1, 2019. blood.co.uk/the-donation-process/after-your-donation/how-your-body-replaces-blood.
- Gesicki, CR. 2018. “Postpartum Nutrition from a Traditional Chinese Medicine Perspective.” Accessed September 10, 2019. birthfit.com/blog/2018/04/24/postpartum-nutrition-from-a-traditional-chinese-medicine-perspective.
- Higley, Connie and Alan. 2018. Reference Guide for Essential Oils. Spanish Fork, UT: Abundant Health.
- Kruzel, ND, Thomas. 1992. The Homeopathic Emergency Guide: A quick reference handbook to effective homeopathic care. Berkeley, CA: North Atlantic Books.
- National Institutes of Health. 2015. “Study shows iron supplementation after blood donation shortens hemoglobin recovery time.” Accessed August 25, 2019. nih.gov/news-events/news-releases/study-shows-iron-supplementation-after-blood-donation-shortens-hemoglobin-recovery-time.
- Strange, K. “Simple Tools for Mothers.” Accessed August 18, 2019. static1.squarespace.com/static/57766acbff7c5070b30f351b/t/5ad5736470a6ad9f6119a096/1523938148634/Simple+Tools+for+Mothers+%282%29.pdf.