I wrote humorously in Connect the Dots about my getting scratched as I was opening a vial of methergine.
Let's take this apart.
We suspected mom's previous postpartum hemorrhage (PPH) had been from terrible mismanagement of her third stage. Mom had to have some goodly amounts of pitocin, methergine and then hemabate (a medication I didn't know when I received her records) to stem the tide.
Hemabate is a prostaglandin F2 alpha oxytocic that is used in abortions, but is now used more in postpartum hemorrhages than cytotec seems to be. I've been reading comparisons and while cytotec was once the darling of PPH control, now it seems to be hemabate.
That I hadn't heard of the medication until reading through this woman's chart, I felt, was an interesting window into either the newness of the use of the medication or the lack of experience with PPH I have had. I suspected probably the latter.
During the pregnancy, we talked on and off about the PPH the first time and how to make sure it didn't happen again... being as hands-off with the placenta as possible, making sure mom was well-nourished, nursing the baby right after birth, keeping things quiet and warm (a la Odent), etc.
Heading into labor, contractions were sporatic and incoordinate. Days of starts and stops that didn't seem to be from any mal-positioned baby kept my brow furrowed in confusion. I merely waited to see what would happen once labor kicked in good and hard.
Once I was called and then labor was going, not long before the decision was made to move into the hospital, I palpated mom's abdomen, much to her extreme discomfort. I begged her to let me feel just for a moment... as quickly as I could... her uterus was soft as butter on one side and while hard, not as hard as it "should" have been (could have been?) on the other side; labor does not progress with a uterus making these moves. I heard the nurse was doing the same thing in the hospital - speaking of the incoordinate contractions - they remained so for most of the labor, apparently.
So, earlier in the labor, when the apprentice and assistant arrived and I'd already set up, I'd saved the meds for the apprentice to draw up so she could practice. Sitting on the floor in front of me, my red med box held the methergine, pitocin, Vitamin K, homeopathics, etc. I watched as the pitocin was drawn up and then when I wanted the methergine drawn up in the other syringe with 10 units of pitocin, we had a mini-discussion that made me kind of cranky. (I know I already covered this, but please indulge me.)
I do have experience putting pit and meth in one syringe when a woman is hemorrhaging... why waste time with two pokes? Just throw it in one, for goodness sake. The assistant had not heard of this and she seemed to be challenging me a tad more than I had patience for (unusual for me, actually). My apprentice opened a methergine and tipped it upside down and as she pushed the needle in, the methergine spilled out onto her lap.
The discussion continued and I was increasingly frustrated. I explained my point, again, and said, "I'll do it," because I felt if she had ethical issues with putting the two together, I would just do it myself and not make her do something she had issues with.
I got out a new vial of methergine and flicked it to make sure the liquid was down to the bottom and flicked it right into my apprentice's face. What was up with that? She should have had goal posts up.
I took it back and tried to open it. And I couldn't get the damn vial to open! I tried with my fingers about 4 or 5 times. I never have a problem opening those things. The assistant or apprentice handed me a paper towel that I should have been using in the first place (I actually had gauze sitting right there for the job) and I started trying to open it again. It was so hard to open! Never had I struggled to open a vial so hard.
And then it finally snapped open.
And as it did, it dragged across my thumb, forefinger, middle finger, and hand under where my wedding ring knuckle is.
I looked down and saw the blood and glass and methergine spilled on the slices and looked at my friends and think I said something like, "This can't be good."
I started sopping up the blood with the paper towel and then started opening gauze that was sitting there and using that. The assistant suggested I go wash it out when I said how terrible it was burning. Was it the methergine?
I got up and took some gauze and went and scrubbed it good and hard with kiddie soap and gauze before drying it with new gauze and pressing more new gauze on it to try and make the bleeding stop on the back of my hand.
As I said in the other post, I made a giant production about my hand... FAR out of proportion to the reality of the injury. Some of it was for comedic relief, but some of it was just bizarre in retrospect. We have pictures of my hand wrapped in rolls of tape and gauze and it was decidedly hysterical talking about going to the plastic surgeon or getting a skin graft - sitting here now, it was odd odd odd that I talked so much about my damn hand.
My assistant and apprentice lovingly and laughingly asked about my physical well-being, pretending to chart it. I was "excused" from left-handed duties because of the heavy weight of the bandaged hand.
At first, the whole hand was mummified, but gradually, digits were unfolded and bandaided with purple "active" bandaids. Once the birth seemed imminent, I took the last thick white strap of plastic and gauze off and replaced it with a brilliant blue bandaid. I looked like a guitar player who'd played a hard set one night - nothing more.
So, in the interest of trying to justify my bizarre behavior - or maybe to highlight a spiritual message being sent to me to PAY ATTENTION - I offer this explanation for my hand being sliced open.
I believe my hand being sliced by methergine was no accident. I believe that it's continuous bleeding far beyond what it should have was no accident. I believe I was being told to watch out... to look ahead... that methergine and pitocin together ain't gonna cut it. Literally.
I believe that when I bandaged my hand, and then unwrapped and re-wrapped and unwrapped and re-wrapped it again, I believe I was almost smacking myself in the head with PAY ATTENTION PAY ATTENTION PAY ATTENTION - LOOK LOOK LOOK - LOOK AT THIS - IT ISN'T WORKING - IT ISN'T STOPPING - IT'S STILL BLEEDING - THE PAIN IS STILL THERE. I kept holding my hand UP and waving... holding it up for pictures... showing people... asking for sympathy (not my laboring mama) - it really was a very strange moment in time, this hand thing.
"Can't you see me yet? Don't you see? Don't you see that the medication didn't work? It broke! It cut! It fell! It spilled!"
Messages from where (?) telling me/us this birth wasn't safe at home. I hated getting to the place when we faced the hospital decision... mother and I crying, she so sad about her lost homebirth experience; I for her dreams, also lost.
When the birth happened, a CNM caught the baby and there was no uterine manipulation at all. No one pulled a placenta out. No one pulled on a cord. No one did anything to cause the repeat of what occured during this woman's first postpartum hemorrhage.
I was told by my apprentice that it seemed as if a faucet of blood had been turned on.
Pitocin, methergine and hemabate were once again used to stem the tide of blood coming from my client's vagina.
She was told she bled 1800 cc. Anything over 500 cc is considered a PPH. 250-500 cc is pretty normal for a birth.
It's doubtful any serious manipulations had been done during the first delivery to cause this sort of PPH. Some, perhaps, but repeats this similar can't be done without exact circumstances - and the only exact circumstance was delivery.
I don't carry hemabate. As far as I know, I am not permitted to. I will be checking on that Monday. It's a pretty hefty medication. Many midwives use cytotec for PPH in homebirths (rectally).
(Doctors will love this, I'm sure.) It terrifies me what would have happened if she'd have delivered at home. She very likely could have died. There is no doubt in my mind. I can't imagine that bimanual compression would stop that kind of bleeding, but I could be wrong. I would certainly do it! I think, "What if she'd been a primip?" I know there's risk in everything. But, it scares the holy shit out of me.
I told mom when I saw her the day she got out of the hospital that I was sorry she didn't get her homebirth, but that she could have had a lovely homebirth and then her husband might have been home with two girls and a funeral to pay for. Instead, she had a hospital birth and was lying in her bed with her daughters and her husband was cooking in the kitchen.
Not such a bad trade off in my book.
Isn't that so un-midwife of me to say?