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Silent Hemorrhage

by Sister MorningStar

“But it didn’t hurt,” Beth told me straightforwardly as she cradled her sweet baby nuzzling in for a snack before nap at six weeks. I like to review births with mothers at various points during their postpartum, lying-in time. The 6-week or 40-day visit inevitably offers new perspectives. Beth had a herstory of excessive blood loss during childbirth. Knowing this, we designed a prenatal plan that included special herbs and diet to enrich her blood and strengthen her whole body system. We addressed dreams and fears and maternal family herstory. Despite our conscious team effort, it happened again.

Beth births like a quiet lion. She is protective of her newborn and it looks like a picture-perfect Hollywood birth film. Perfect until she opens up like a faucet and pours like the sky is falling. It took a 45-minute internal bimanual compression to give her body the time it needed to rebuild reserves and handle things on its own. She was nursing her baby while we engaged her with eye contact and questions to help her stay with us. Fortunately, the placenta birthed with the first gush.

I have always remembered her words to me. “But it didn’t hurt.”

Bleeding to death does not hurt. At least not from a uterine hemorrhage. I have never forgotten that. Pain is how we know to act on our own behalf. I wonder if that is why we hear the shuttering and tragic stories of mothers found dead and alone in huts or apartments from a delayed hemorrhage. I wonder. Were they just napping or nursing or dreaming of a better life when their life force just leaked away, carrying them with it, passively, painlessly? I wonder.

The prenatal plan we designed was successful in preventing repeat hemorrhage in other mothers. Why did it not work for Beth? I wondered. I kept listening.

“When I am bleeding like that, it is the only time Brian cares about me.” The tears swelled up in her eyes and the baby nuzzled in closer. So did I. I put my arm around Beth and got her another drink from the little table of snacks by her bed. Beth talked and cried and talked some more. “I like the look in his face and the sound of his voice that is really worried. I feel like he cares what happens to me.”

I had no remedy for that in my little midwifery bag. This is the work of the soul and intimate relationships, and maybe past lives, for all I know. The will to live is a powerful ingredient in overcoming obstacles like hemorrhage. Beth had one more birth. There was not one drop of extra blood as she birthed her placenta and swooped up her baby. She had done all the same precautionary and preparatory actions prenatally. She had hired the same midwives. She had birthed at home. She had changed two things: She labored alone in her bathroom and she chose a new partner. She named her little darling Dharma, rewrote herstory, and walked into a new life of personal power.

I wish there were a formula to avoid, respond, and repair the depletion caused by hemorrhage in childbirth. There is not. We are not robots. We are unique physical and spiritual expressions of a long line of experience. A hemorrhage can be a silent killer. I teach my students, “It isn’t how much blood a womyn loses; it is how she tolerates the loss.” That was the wisest education I learned regarding blood loss in childbirth.

I have seen robust wimyn dump four cups of blood, swing their legs over the bed, tie their shoelaces, and be on about their day—not wanting to alert the other children in the house. I have seen other robust wimyn lose little more than a cup and need help to stand and walk to the bathroom. I have seen sorely malnourished, anemic mothers offer up barely two tablespoons of blood, as if their body knew there was not a drop to spare. I have seen wimyn of all shapes, sizes, colors, ages, and parity surprise me when it comes to how their body manages blood loss. Only one fact remains constant: no two wimyn are alike and no one womyn births the same every time.

Each pregnancy deserves the close and devoted attention of someone who cares. The village midwife was that, and she is disappearing around the world. Her attention to the individual narrative has been lost to professionals who often know more about hemorrhage than they do about the mother they are serving. It matters if we want to help resolve excessive blood loss without endangering her reproductive future with compromising drug therapies. We need to know how to prepare, assess, respond, and recover. We need hand and heart skills to make that possible. We need the village midwife with her experience and wisdom.

Karli was pregnant with her fourth child. Karli had a herstory of fourth-stage delayed hemorrhage. The first had been handled with Pitocin. The second with herbs and Pitocin. The third with herbs and placenta. Each time, when she stood up, she went down. All had been followed by a long and depressingly weak postpartum recovery that affected milk supply. Karli knew she could birth triumphantly. She wanted to have a birth without a hemorrhage and all the extra tedious care that it requires. She changed midwives and focused on two things: 1) Prenatal care that included quarts of red raspberry and blackberry leaves; sprouts; pregnancy blend herbs; increased greens; extra calories for the extra workload; dreamwork; village prenatals; daily time alone in nature; and keeping her birth plan a secret. 2) Complete privacy, with plans to eat some of her placenta prophylactically, rather than waiting for it to be made into a smoothie. She did not stand the first day. Her midwife stayed the night and next day keeping vigil without disturbing her. It worked. No delayed hemorrhage. No need for lifesaving herbs or actions. No long recovery. What worked? All of it.

Carol had had a placenta accreta with her first homebirth, necessitating an emergency transport, scary blood loss, and surgical delivery of her placenta. Her second baby was stillborn in the late second trimester. She had been given a cesarean because her baby was breech and it was against hospital policy to do vaginal breech birth. She argued between premature contractions, as she was being wheeled to the surgical theatre. When she awakened from the general anesthesia, she was told she had had another accreta and surgical removal of her placenta. She held her lifeless baby in her arms, crying for many, many reasons. She was told her body would never do this right, that she should not have more children, and that absolutely she should never consider another homebirth. Carol’s fury was palpable. With her closest family in a circle around her, we buried that holy child on her land after he was returned from autopsy. Her desire and determination for homebirth was uncompromising. I researched sources from around the world and alternative therapies. Along with the prenatal regimen for avoiding excessive blood loss, we added homeopathic hydrastis. And prayer. The kind that is non-ceasing. Carol lived in a little trailer far from a paved road. I felt we needed a miracle. Carol felt she needed to birth her placenta. It was a waterbirth. The baby was born pink and lively. What happened next? Believe it or not, she birthed her placenta whole, healthy, and with no more blood than an herbivore deer in the forest. What happened after that? Carol asked for the phone. She called the hospital where her dead baby had been delivered by knife, the place where she had received a curse on her reproductive future. She said things that frighten fish and bring the dead to life.

Because of Carol’s bravery and insistence that I learn more and be more as a village midwife, I have been able to share this information with others. One mother in Russia, with a herstory of three placenta accretas, told me in tears, “Sister, I want to birth my placenta and not die. I want to birth at home.” I met her midwife. We talked for hours. We reviewed the preparatory plan and response plan. I shared what homeopathic hydrastis had done for Carol. The next year I returned to Russia. This same mother came running toward me. In one arm she cradled her homebirthed baby and in her bag—her placenta on ice. She wanted to show me her miracles. Both of them.

There are wonderful resources as well as full books on hemorrhage in childbirth, which tell us how to follow the flowchart to success. It is often very valuable information and every trick is worth remembering. But a birthing mother is a unique creature on this planet. She has a narrative unlike any other womyn. Many of her shadow issues or dark fears, demons, and desires may not be known to her until birth unravels and unveils them in a way like no other moment in her life. It is called the mini death by many village midwives. The womyn you were is no more. You walk through the portal door of then and there to here and now. That journey turns you inside out and spins you like a cosmic Milky Way. The river is flowing and carries a womyn to a distant shore. She is beyond fortunate if there is someone, even an ancestor, who is willing to get in that river and not just walk along the safe and sterile shore.

From nearly every continent and culture I have heard wimyn exclaim at birth, “I am going to die!” or “I thought I was going to die!” It’s a leap. What a privilege to witness that leap and see them land, like a big cat, on all fours and roar with their new self-claimed power. The power of a womyn.

That is the power that protects the new life they brought forth.

An unattended hemorrhage can be the end rather than the bright beginning of motherhood.

I was in Russia in 2015 or so, sleeping in a heavenly loft above a powerful woman from the United Kingdom whom I knew only by reputation. Her voice rocked me to sleep at night and called me to attention in the morning as she would open her computer, scowl, and curse the machine that brought her hundreds of emails from “blathering idiots!” She would, one by one, answer or dismiss them with no internal monologue that I could detect. This amazingly brilliant womyn is Beverley Beech—a birth activist and central figure for AIMS in the UK for decades.

I admired her openly and enjoyed our depth of dialogues. I was grateful when she came to several of my controversial sessions on home VBAC and other such topics at the Midwifer