Question about my birth experience...

[mesces]

I'm a registered nurse of six years. I worked one year of cardiac telemetry then 15 months of critical care, which was not for me, then I went back to telemetry. I have every intention of transferring to L&D in about 6 months because it is the reason I went to nursing school to begin with.

What do you think of my birth experience? I was preeclamptic with my firstborn, but did not end up on a mag drip and everything went smoothly. For the birth of my second child six months later I did not end up with symptoms of preeclampsia until one day before I was scheduled to be induced. My pressures were normal and my doc was even thinking about cancelling my induction (I was 38 weeks) and postponing it until a week later. Turns out I had 2+ protein in my urine and was starting to swell so he went ahead with the induction. During labor my pressure shot up to 180's/100's so I ended up on a Mag drip. I was hyperreflexive also. I didn't get my epidural until I was 9-10 cm dilated because I had to wait for the anesthesiologist (he was in with another pt giving an epidural). I did not feel excrutiuating pain until I was 7 cm dilated. The nurse told me that the magnesium actually disguises the pain. Is that true? Anyway, the night of the birth, after the mag drip was dc'd, I passed two huge clots. I showed the nurse and she said that happens sometimes and not to be worried. I asked if they should draw a CBC and she said they would just get it in the morning. I found out my H&H was 7 & 22 before the birth. Later that night I passed a clot that was at least 8-10cm. They still did not feel the need to call the doctor. The next day the lab did not draw my blood until 5pm because they were shortstaffed. I work at this hospital and I always end up drawing my pts' blood because of this. They let it ride until someone showed up at 5pm and my H&H was 5 and 16 at that point. Long story short (yeah right!) I ended up being transfused four units of PRBC's.

What do you think of this?

[babyktchr, BSN, RN]

The size clots you described would not have concerned me. Mag patients will bleed a bit more because of the relaxation of the uterus. Were you symptomatic with your H&H?? I would hope so if you were transfused 4 units.

[gr8rnpjt, RN]

For the birth of my second child six months later

I think that it is amazing how you could have a 38 week pregnancy 6 months after giving birth to your first child.

[Jo Dirt]

For the birth of my second child six months later

I think that it is amazing how you could have a 38 week pregnancy 6 months after giving birth to your first child.

Yea, that one got me, too. He, he.

[mesces]

For the birth of my second child six months later

I think that it is amazing how you could have a 38 week pregnancy 6 months after giving birth to your first child.

OK, obviously I typed that wrong. I meant to type 19 months later.

So, what if I wasn't symptomatic? Should they not have transfused with a crit that low? Is it normal for postpartum patients to be sent home with labs like that?

[Jolie, BSN]

You experienced a complicated pregnancy, delivered a healthy baby, and you both went home in good condition. I would consider that a success!

It sounds like you have reservations about the management of your anemia. Those would be best addressed to your OB/CNM. I am curious as to why your H/H was so low prior to delivery, but given that you were not symptommatic, I fully understand why your provider chose not to treat it at that time.

The clots that you describe would not have alarmed me either, in the absence of excessive active bleeding. You definitely had a significant drop in your H/H post delivery, but the delay in obtaining labs did not cause you any harm. So while the timing of your lab draw was not ideal, it really didn't impact on your care. Had your labs been drawn sooner, you would have received your transfusion sooner, but that would have been the only difference. I suspect that your doc ordered the transfusions based on the knowledge that you would soon be DC's home to care for a newborn infant, and would not have the strength or stamina to do so with an H/H as low as yours was. It is fortunate that you didn't have any symptoms during your hospital stay, but with a severe anemia you would have likely experienced extreme fatigue, hypotension, and possibe fainting if you had not been treated.

[Spidey's mom, ADN, BSN, RN]

You experienced a complicated pregnancy, delivered a healthy baby, and you both went home in good condition. I would consider that a success!

It sounds like you have reservations about the management of your anemia. Those would be best addressed to your OB/CNM. I am curious as to why your H/H was so low prior to delivery, but given that you were not symptommatic, I fully understand why your provider chose not to treat it at that time.

The clots that you describe would not have alarmed me either, in the absence of excessive active bleeding. You definitely had a significant drop in your H/H post delivery, but the delay in obtaining labs did not cause you any harm. So while the timing of your lab draw was not ideal, it really didn't impact on your care. Had your labs been drawn sooner, you would have received your transfusion sooner, but that would have been the only difference. I suspect that your doc ordered the transfusions based on the knowledge that you would soon be DC's home to care for a newborn infant, and would not have the strength or stamina to do so with an H/H as low as yours was. It is fortunate that you didn't have any symptoms during your hospital stay, but with a severe anemia you would have likely experienced extreme fatigue, hypotension, and possibe fainting if you had not been treated.

I agree.

In fact we had a pt who was anemic prior to delivery and even moreso after but the doc opted for more time in the hospital (1st baby-teenage mom) and iron supplements.

And the clots are within a normal range of clots I've seen.

steph

[sirI, MSN, APRN, NP]

To the OP, these are questions you should be posing to your OB provider and not the membership of allnurses.com. We cannot give you medical advice and/or offer advice about how your particular case was handled. Please contact your OB if you question anything that was done or not done.

[SmilingBluEyes]

For further clarification, please read the "Medical advice" sticky at the top of the forum, and do ask your doctor these questions. I wish you health and healing.