A Complicated Story

Last night was busy.
We had 2 back to back births with complications. One mom wouldn't stop bleeding, and the other on had Pollyhydramniose, a condition where there is too much amniotic fluid in the uterus. In school we learned about the way a midwife should deal with complicated and uncomplicated birth: If the birth is normal, the best thing the midwife can do is be unobtrusive as possible, and let the mom do what she needs to do. However, if there is any complication the midwife needs to act quickly and make whatever intervention that is necessary.
  I saw a really good example of that last night.
 A couple of things can cause a hemorrhage after birth, but most hemorrhages occur when for various reasons, the uterus is unable to contract and cut of blood flow from the place where the placenta has detached. When the placenta detaches, hundreds of blood vessels from the lining of the uterus are left open, and the mother bleeds through the open sight with each heart beat. Normally, the uterus starts to contract just fine, and the muscles in the uterus around the open vessels constrict, naturally ligating them, and bleeding is minimal.
 However, If something, for example a large clot, is keeping the uterus from involuting after birth, the mother will continue to hemorrhage, more blood will fill the uterus, making it even harder for it to contract, leading to a vicious cycle of bleeding that can eventually cost the mother her life, unless the clot is removed, allowing the uterus to contract normally.
Last night's complications are just another good example of why it is so important to have a skilled attendant at a birth. Happily, 50% of all births are perfectly normal, requiring no assistance whatsoever. In cases like these, the midwife's job is to sit very quietly in the corner, provide encouragement when appropriate, make a hot drink for the mom when the labor is over, and clean up the mess. But that other 50% of the time is when the midwife needs to quickly recognize the problem, take whatever action necessary, (including transporting the mother and baby to a hospital where they can receive further care if that is an option)  and monitor the mother and baby to ensure that they are stable before going home for the night. In that other 50% of births, that we pray never happen on our watch, are when difference between having a skilled birth attendant and not, can be the difference between someone living and someone dying.
Thanks to God, the author of all events, for the two good endings we had last night and kudos to Rose, Vicki, Imelda and Cecille, for giving their time, minds and hands when they were most needed.