Physician, Heal Thyself

WARNING: Really long post involving a lot of vagina and uterus and (turn away Dad) chunks.

Six weeks ago I gave birth to our fourth child, our third son. It was a beautiful birth. The birth I wanted for him and for me, unmedicated, most of the labor at home, no needles or monitors. I treasure the memory of it and I didn't want what came after - the story of the next twenty-four hours to overshadow it.

Now, I want to tell it. I want to write it out for me because writing helps me process an event. I want to stop reliving it as I fall asleep, trying to remember lost details, asking Matt who drowsily tells me he doesn't know, he can't remember, it all happened so fast.

I also want to tell it for you. You lovely women, I think mostly women, who read this blog, many of you still in the middle of building your families, or with friends who are still having babies, or wives, or sisters. We need to be advocates for our own care. We need to own the idea that we can be more aware, more informed, than our health care providers. That's not a condemnation of the nurses, doctors, midwives, etc. that care for us. It's just a fact. They are human. I want them to be gods, Dr. McDreamy on TV, infallible, always there with the last minute save, but they aren't and no one is more aware of what is happening with your body than YOU.

Thirty minutes after Nate entered the world and Matt said it's a boy through his tears, when things were quiet and my euphoria was high, I started to have very painful contraction-like cramps. The nurse told me that with third and subsequent babies uterine cramping can be severe and I endured it for a while. I felt sick and dizzy. I gave the baby to Matt and reclined the bed. I tried to breathe through the contractions, but they were strong and painful and one on top of the other. Fluid gushed with each contraction and told the nurse I thought I was bleeding. She checked me, said it was more blood than they liked to see and that my midwife would check me again when she finished with another delivery.

Another hour passed. I have never felt so awful in my life. I didn't care where my baby was. The brand new baby that I wanted them to place directly on my chest, that I wanted to breastfeed immediately and keep beside me. I sobbed through the contractions. I begged for pain medication. I had just given birth, naturally, to a big baby boy and I was sobbing on a hospital bed for narcotics.

I knew something was wrong, but I never said: Something is wrong! Stop waiting for my midwife, I want to see whatever doctor is available right now! I thought the nurse would know how critical the situation was. I didn't want to be a baby. I didn't want to demand help only to be told that I chose an unmedicated birth and now I would just have to deal with the cramping.

In actuality, in that hour, I was bleeding to death on a hospital bed in the women's health wing of a world class birth center. By the time the midwife arrived, her face said it all, she had to pulverize my uterus, still without pain medication. Remembering those moments when she pressed with all her strength on my abdomen still brings tears to my eyes. She apologized throughout, telling me she had to do it while I writhed and sobbed "I know." I passed a blood clot that weighed two pounds.

I'd lost nearly half my blood volume, lying beside a nurse in a hospital. I have never felt so horrid in my life. It was so much more painful than giving birth that I am willing to call being split in half at the vagina "the easy part."

The nurse probably should have caught the problem, but that's not the point. The point is I knew there was a problem and I was afraid to speak up for fear of being wrong.

Forty-five minutes later, I started to feel ill again. This time, the reaction was instant, people came running from all directions. I writhed and screamed through a second round of uterus mashing, passed another big clot and, after my blood counts came back really low, won myself a front row bed to a blood transfusion and a really, really miserable night of mashing and drugs and needles.

I won't lie, I felt, still feel, a little cheated. Like fate pulled one over on me. I gave birth beautifully and idyllically and quietly, without medical intervention, to my baby and instead of enjoying a quiet night with my husband, cuddling our son and feeling elated and strong, I hardly saw my baby until the next morning and couldn't pick my head up off of the pillow.

The OB on call thoroughly checked the placenta a second time after the second hemorrhage. He told me that he thought it was all out, but if I had another bleed, they would do a D&C. I stabilized overnight with the blood transfusion and went home the next day.

I googled because that's what I do. I talked to other women who had experienced a severe hemorrhage. Feeling very informed, I told Matt before I left for my two week post partum check up, I'm going to ask them to do an ultrasound, just to make sure that there's nothing left in there. I can insist, right? Do you think it's okay to insist? He said it was. I went. It took two minutes with my midwife for me to feel silly, like I was overreacting, being a bit of a drama queen.

"I've been reading," I told her sheepishly, "I understand you can retain placenta after a bleed like that and it doesn't hurt to check. Maybe an ultrasound?" (So much for insisting.)

"No," she answered, "that's not necessary." (To be clear, I love her, she wasn't unkind or patronizing, she listened to me, she just truly didn't think it was necessary. The point is not that she was difficult or put me down, the point is the opposite, I am SO easily cowed by anyone that I think of as 'medically knowledgeable' that I sacrifice my own care.) "If you had retained placenta, you would have run a fever by now, there would be an infection."

That made sense, rationally and statistically I knew she was probably right. A little voice somewhere in my head said: but you had recurring appendicitis for four years and you never ran a fever, maybe you just don't run fevers very easily. I didn't listen. She is the trained one. What do I know?

I know myself, is the thing, and she doesn't, she only knows averages, probabilities.

I left. I didn't felt great over the next few weeks, but I lost a lot of blood, I had a four-week-old baby, I was tired. I thought the bleeding went on a little longer than usual, but I couldn't remember when it stopped with my others. I just lived my life, feeling a little off.

Monday, I had cramps all day. I thought, what the hell, surely I am not getting my period before I even stop bleeding from the birth. They were reminiscent of the cramping in that hospital bed. They started in my back and ran down my left leg in the same way, but so much less painful as to be laughable. I lived my day. Took the kids to the post office, went to a board meeting for preschool, went out for wine with my friends afterward.

At the little neighborhood place where we sat outside sipping our drinks, I felt a weird heavier discharge. I went to the bathroom. Somewhere in my mind, I feared a clot and renewed bleeding, drama, driving to the hospital.

Please no. I found, not a clot, but a ... chunk. Of tissue. In my underwear. A chunk of tissue that had clearly been in my uterus for the last six weeks. It was about the size of a fisher price person. You know? The little people that fit into the cars?

In case you aren't already there: IT WAS ABSOLUTELY DISGUSTING.

Of course, I did what any self-respecting girl with a fisher price person sized chunk of uterus in her panties would do. I saved it. Wrapped it up in an entire roll of toilet paper and stuck that puppy in my purse.

My midwife told me the next day that it was smart of me to do that. I wasn't feeling smart at the time. I was feeling pissed off. BECAUSE THEY TOLD ME THERE WAS NOTHING LEFT IN MY UTERUS and HELLO? Wait? What's this? Uterus chunks having a little party in my panties. Great. That chunk was SO going to the doctor with me the next day to be waved around with a flourish and a self-righteous expression.

You see? You see this? Chunk? Of something? FROM MY UTERUS! A chunk which recently and inconveniently exited my body through my vagina?

Anyway, there wasn't any blood or anything and I felt a little shaky but okay, so I went back out with my party purse and finished my drink. I love talking with these girls and I didn't want to miss it and there wasn't much to be done anyway until the morning when I planned a self-righteous waving of chunk event.

In the cold light of morning, my resolve wavered. Matt was horrified by my report of events.

"You kept it?"
"Yes I kept it, I want to know what it is. Will you...?"
"NO!! No. Nonononono. Keep your chunk in your purse, I don't want to see it."
"I need your help."
"Nooooo."
"Fine. I'm taking it with me to the appointment."
"Okay. Okay, just keep it in there."
"Do you think I shouldn't take it?"
"I don't know."
"You don't know? You don't know? A chunk of me fell out of me and YOU DON'T KNOW?"

I was unsure. Should I have kept it? Was that bizarre? MORE bizarre than having a weeble wooble chunk of tissue come out of your vagina? I called Elise and told her the whole thing. It took her a minute to get on board.
Elise: Wait? Last night?
Me: Yeah, at the bakery.
Elise: Last night with me? While I was sitting right beside you?
Me: Yes.

Obviously, my location when the chunk appeared was not the salient point of the story. The detail of concern was the appearance of the chunk itself. I could sense her shaking her head at me over the phone. Okay, I'm stoic about chunks, I'll give her that, if there had been blood, I would have hit the panic button, but there was only hardened flesh. Focus Elise.

Me: Do I take it to the doctor? I take it right? I show them? I know that's gross, but I take it?
Elise: HELL YES YOU TAKE IT.

Thank you, girlfriend. That's what I needed to hear. Matt you fail at chunk 101. Your chunk advice is useless.

I went in for my six week post partum check with my fisher price chunk of flesh still in my purse. My midwife took the chunk news in stride. I was shocked. I thought I might be featured in Midwives' Times or something. "Oh," she told me, "I've had women bring weirder things."

Really? Things that fell out of their uterus? I don't want to know. I handed the chunk over and she took it to the lab.

She returned a little while later and pronounced it tenacious.

Tenacious. Terriers are tenacious. Like I gave birth to a chiwawa in the restroom of a bakery. Aw, look at the tenacious little thing. Life is hysterical. I mean, come on, I can not make this shit up. A tenacious chunk of tissue fell out of my uterus, through my vagina and landed in my panties.

Serious. This is serious. Listen, I have a point. They did an ultrasound. Remember I asked about an ultrasound at my two week visit FOUR weeks prior to this. Guess what they found? Chunk's little friends still whooping it up in my fundus, which is a part of the uterus, in case you didn't know.

I had to have a D&C after all, yesterday, to make sure that my uterus was completely placenta free. That wasn't what I would call fun, more IVs, more drugs, a whole day out of commission between the surgery and the recovery, except that now, with my baby being six weeks old, I didn't have anyone to help at home.

Not fun, inconvenient and a little scary. I walked around for weeks at risk for infection and hemorrhage. I also lost a lot of blood unnecessarily because it took so long to catch the original hemorrhage. I know that the midwife, nurse and doctors had some role in all of this, but honestly, it was mostly bad luck with a healthy dose of FAILING TO SPEAK UP. Failing to be firm. Failing to be responsible for letting people around me know the level of my discomfort and concern.

It's really important to own our own health and be adamant about our own care, even with the best, most conscientious doctors, nurses, midwives, etc.

My favorite moment of the whole saga of my uterus post-Babynater might have been when the nurse came to collect me for the pre-op procedures yesterday. I sat beside Matt in the waiting room nursing Nate. She called out "Stacey." I waved my hand, negotiated the de-latch process and handed the baby to Matt. Mid-rearranging my shirt, I noticed that she looked absolutely dumbstruck. I followed her back to the pre-op examining rooms. She kept glancing at me and looking down.

Finally, she half-whispered, "how old is your baby."
"Six weeks," I told her. She looked at me like I had horns.
"And so, okay, so then, you're pregnant again already?"

AHAHAHAHAHA! No. You thought? AHA. That's a good one. Someone get Matt, he'll LOVE this, honey, she thought, ohmigod, I can't breathe, I might pass out, that is sooooo funny, baby, listen, she, that nurse, she thought we'd - oh shit, I can't even say it - she thought we'd had sex in the last six weeks. AHAHAHAHA. Isn't that? Oh, you guys kill me. Let me sit down a minute and wipe away these tears.

Matt didn't laugh.

"No," I said, "no, not unless it's the second coming."

She didn't laugh. It's a Catholic hospital, they have no sense of humor when it comes to Jesus.