I remember as a new graduate nurse I massaged a woman’s fundus and a clot the size of her head came out. It was literally like plump-plump in the bed. And I remember thinking “oh, I’m glad I got that out” and thought nothing of it 🙂 Luckily, my preceptor knew better. She told me “we will have to really watch her, we will need to get a stat H&H, watch her vital signs, give her medication if she continues to bleed, and notify the doctor.” She went over all the reasons that the patient may have had this huge blood clot. And then she told me that redheads bleed more than anyone, so I should always assume they would bleed after delivery and be prepared 🙂
Since postpartum hemorrhage is an issue for everyone, I feel like we all have to start doing something different. Are we adequately quantifying blood loss? Why is 95% of all cesarean deliveries that I’ve ever done had an EBL of 500? How can that all be irrigation (which is what I’ve sometimes been told by the doctor when I’ve asked)….I mean, I only brought in ONE 1,000ml bottle of fluid. Am I really adding up the amount of blood in my head when I’m changing her peripads? I mean, I’m super bad at math. Or am I catching it when it’s already too late…??
I don’t know. But in one of my classes I’ve been to here at the 2014 AWHONN Convention I was informed that blood transfusions have increased by 125%. That women around the world are dying every 4 minutes from a postpartum hemorrhage. We just can’t accept that. One thing I can tell everyone from every webinar I’ve ever seen and every class I’ve ever been to: if the patient’s blood pressure is 80/30, you’ve missed a lot of signs of hemorrhage on the way to get to that blood pressure. So here’s to educating ourselves and me making a better attempt to quantify blood loss.
A few resources for nurses:
- CMQCC OB Hemorrhage Toolkit
- AWHONN’s Obstetric Hemorrhage webinar. Ask your nurse manager to buy this for the unit! Tell her what you want: to figure out a way to prevent postpartum hemorrhages. Throw around words like ‘evidence-based practice’ and ‘Magnet status’ 🙂
I will add more to this list later. xx
Until my next delivery ❤