Postpartum, everything was going too well.
My uterus decided it was time to shake things up and turned against me, which is frankly just rude given how much uterus love I put out into the world on the reg.
Some bleeding is expected postpartum, and my level of bleeding had been normal. The night of my twelfth day postpartum, as I was finishing my last feeding for Baby Girl 2 before going to bed, I felt a gush of blood. Once I had her settled in the bassinet, I headed to the bathroom expecting to see a little blood on my pad. Instead, my pad and underwear were soaked through. I was soon panicking as blood poured out of me into the toilet. I kept thinking it had to stop soon, but each time I stood up, I soaked a pad within seconds. I couldn't leave the toilet without blood falling to the floor. I was SCARED. My OB/Gyn physician brain was running rapid speed thinking of the bad things that could be wrong and go wrong. But my mind was also in mom mode thinking about the difficulties that would be involved with going to the emergency room in the middle of the night with a toddler and a newborn (with that one having to breastfeed) at home. The bleeding ultimately did let up after what felt like an eternity. I decided to monitor it the rest of the night and go to my office for an appointment in the morning.
I tried to be optimistic as I entered the office for my appointment. Maybe this was just a fluke occurrence. Maybe everything was fine. My main suspicion was confirmed as soon as the ultrasound probe was placed, however; I had retained products of conception - lingering tissue from the pregnancy that needed to come out - and not exactly a tiny amount of it. I wanted so much to believe it wouldn't be there, especially as it was unusual for this not to have caused 1. any excessive bleeding sooner or 2. problems with my breast milk supply (on the contrary, breastfeeding was going exceedingly better than it did my first time around), but I couldn't argue with what I could quite obviously see.
Still in mom mode, I originally considered medical management rather than surgical even though I knew that that wouldn't be the most successful choice with what the ultrasound suggested in terms of tissue size and blood flow. I didn't want a surgical procedure. I didn't want to worry about what could happen in the operating room. I didn't want to interrupt bonding and breastfeeding with my newborn. I realized, though, that in this moment I needed to do what was best for me so I could continue to be my best for my daughters. I took the opportunity to go to the operating room within the hour, keeping in mind that a dilation and curettage procedure is generally quick and that I would be home soon after.
I woke up to unexpected news. There had been a lot more bleeding than is typical for such a procedure - nearly a liter (for reference, the average human blood volume is 5-6 liters). I received multiple medications to help reduce bleeding and a silicone "balloon" was placed in the uterus for tamponade. I would need to stay in the hospital at least for the night as the balloon would stay in for hours and we needed to watch my bleeding, overall status, and vital signs.
Thankfully my husband and newborn could stay with me, so I didn't have to be alone, and breastfeeding was only put on pause during the procedure and immediate recovery. Fortuitously I had previously hand expressed some milk and stored it in the freezer at home, and my husband was able to feed some of that to my daughter during that time. My parents came up to watch our toddler at our house overnight. The balloon was removed around midnight and my bleeding was light thereafter. I felt good, my vital signs were normal, and my blood counts were appropriate. I was able to go home the day after the procedure.
I say somewhat jokingly, "Well I didn't die," as a coping mechanism. The truth is that that was a very real possibility. Hemorrhage is the leading cause of pregnancy-associated death worldwide. Had I not gone in for evaluation at all or chosen medical management, I very well could have had another horrific bleeding episode at home, potentially one that didn't stop and potentially without the chance to make it to a hospital in time. Even as an OB/Gyn physician who very well knows the possible consequences of postpartum hemorrhage, those were routes I almost chose. I could have deprived my girls of a mother by not prioritizing myself when needed. That is a real circumstance for families all around the world every day - due to stubbornness, putting others' needs first, unawareness of normal and abnormal postpartum symptoms, difficulty accessing medical care, healthcare professionals brushing off patient concerns, lack of appropriate resources, and on and on. And that's not just the story for postpartum hemorrhage - it's true for essentially every complication of pregnancy and the postpartum period. People don't get the care they need because this idea is perpetuated that pregnancy, childbirth, and the rest are benign states full of only bliss and happiness, and birthing people, their support systems, society, and healthcare professionals don't always acknowledge the real dangers involved.
This experience was emotional and traumatic. But I am lucky - lucky to have a spouse who supported me in each step of this, parents who dropped everything to come help, co-workers who lent a hand, a skilled and knowledgeable physician (and friend) who cared for me and knew exactly what to do, access to medical care, and the personal understanding that I needed to be evaluated for a problem in the first place. Luckiest of all, I am here to be Mama for two wonderfully perfect daughters that I'm hugging so tightly now.
Everyone deserves such luck.