Sunday, January 20, 2013

The Great Chux Weighing Experiment

For the complete background on this issue, please refer back to two recent posts: "Stats....200 Babies" and " Putting Yourself Out There".  Briefly, back in November, I was lucky to catch my 200th little babe.  Afterward, I put together some statistics from those births.  Some were expected and some were not.   One thing that surprised me was the rate of PPH.  (Again, for the full story please read the posts mentioned above.)  Since that time, I have been weighing every chux after every birth, and I just baby #210.  So, I thought that I would post an update:

Birth #201: EBL 200cc (my guess was 150)

Birth #202: EBL 100cc (my guess was 100)

Birth #203: EBL 500cc (my guess was 400), this Mama had no negative symptoms so I did not call it a PPH because it was not more than 500...

Birth #204: EBL 200cc (my guess was 250)

Birth #205: EBL 150cc (my guess was 150)

Birth #206: EBL 150cc (my guess was 200)

Birth #207: EBL 900cc (my guess was 850), this was a second time Mama who had a precipitous birth, she did have some symptoms and received two different anti-hemorrhagic medications.  She stabilized and finished her recovery at the birth center before going home.

Birth #208: EBL 2500cc (this is not a typo!), this primip Mama lost 1900cc at the birth center and was transfered to the hospital where she lost an additional 600cc.  She had a long-ish labor of over 15 hours, and a long-ish second stage of 3 hours and 15 minutes, third stage was 20 min.  She had SROM'd 18 hours prior to the birth, had been afebrile and the fluid was clear.  Baby was term and weighed 7# 15.5oz.  Initially, with the placenta she lost 700cc, received a dose of IM pitocin and stabilized.  Then at 1 hour and 45 minutes PP, over the course of 15 minutes she lost another 1200cc.  During that time, she received an IM dose of methergine, cytotc rectally, an IV was started and a foley catheter was placed.  She was very symptomatic and an ambulance was called for transport.  Upon arrival to the L&D unit, she had stabilized.  She was taken to the OR and a 600cc clot was removed from her uterus.  Then she completely turned the corner and had a good recovery...after receiving 2 units of blood.  An obvious cause for her PPH was not identified, there was no hidden laceration, the placenta and membranes were intact.  She is a healthy 25 year old who had had a completely benign prenatal course.

Birth #209: EBL 100cc (my guess was 150)

Birth #210: EBL 950cc (my guess was 900), this primip Mama had a precipitous labor with a hard second stage.  Her little one had double compound hands and she really had to work him out.  Baby was term and weighed 8# 10oz.  She had PROM'd about an hour before her labor started, she had been afebrile and the fluid was clear.  She received an IM dose of pitocin, then had some more bleeding and an IV was started with pitocin in the bag and she was straight cathed (she was unable to urinate in a bed pan or to walk to the BR).  She then stabilized and finished her recovery at the birth center before going home.  She is a healthy 25 year old who had had a completely benign prenatal course.

So, yuck...three big PPH's out of those 10 births!  Now, hopefully I won't have another one for a long, long time.  I have noticed that these things usually happen in clusters, so I am hoping for that.  In general, our Mama's have good diets, we recommend 65-75gms of protein per day and have the ladies do dietary recalls for us.  We recommend nutritive pregnancy herbs and regular exercise.

What I did learn from this experiment is that my EBL "guessing skills" are just ok, with a range of 50-100cc's off.  I found it to be much easier to estimate the loss when it was lower.  Thoughts?.....

Wednesday, January 9, 2013


Ask and you shall receive....

Kim is preparing to welcome her second child.  The room is full of love. Represented by friends and family members, the seams are bursting with it. Smiles are everywhere to be found.  Kim and her family had been at the birth center earlier in the day.  She was in early labor and had gone home to rest.  Now they were all back and eagerly awaiting the baby's debut.  Kim was in the pool, gracefully laboring.  Her husband was at the side of the pool, a strong reassuring force and source of support and comfort for Kim.  He was a true Papa Bear.  Kim began to push and soon she was crowning, then the head was born, pink and healthy.  But then, babe was held up, he seemed "caught", but not by his shoulders.  I calmly and firmly told Kim that she needed to get out of the pool.  The very next thing I knew, Kim literally rose up out of the water and over the side to the floor.  It happened so quickly that I was left behind, still crouching over the edge.  Hurriedly, I went to her and discovered the problem.  Babe had two tight loops of cord around his neck.  He was still pink, but wanted to be born.  The loops were so tight that they could not be uncoiled and I really did not want to clamp and cut them.  So, I asked for quiet in the room, which I instantly got and told Kim to focus.  We took a breathe together and I told her to push out her babe. With her push I guided the baby's head in toward her thigh and his body came out.  He was still wrapped up, so before she got off her hands and knees, I unwound him.  Soon the room was filled with the squeals of new life and joyous welcome.

How had Kim levitated out of the pool?  Her husband had literally, in one scoop, given me exactly what I asked for...Kim out of the pool!