#227 | Tips For Preventing Postpartum Hemorrhage with @AlmostHolisticAllie

There's four causes of postpartum hemorrhage, right? It's tone, tissue thrombin, or blood clotting ability, and trauma like lacerations, you can bleed from that.

I was obsessed with having my babies at home. And I knew I didn't want to have them in the hospital. And so I just decided we're going to do this. And we're going to do all the research on preventing hemorrhage. So that's what we did. And I actually was able to prevent hemorrhage, I did not hemorrhage with my third baby. And my sister who had hemorrhage with her first two at home as well prevented hemorrhage six months after I had my third, she had her third and she also prevented hemorrhage, the same protocol that I took. And so it's, you know, we kind of have it under our belts now, like, Okay, well, we're good for birthing at home, we know what we're doing, and only two or three times.

I'm Cynthia Overgard, owner of HypnoBirthing of Connecticut, childbirth advocate and postpartum support specialist. And I'm Trisha Ludwig, certified nurse midwife and international board certified lactation consultant. And this is the Down To Birth Podcast. Childbirth is something we're made to do. But how do we have our safest and most satisfying experience in today's medical culture? Let's dispel the myths and get down to birth.

All right, my name is Allie. I am a 29 year old mama I have three kiddos I was a former nurse I quit in 2021 with all the madness that was happening wasn't actually planned. I plan to quit way before the man has happened. But it just so happened that I got out right in time. I was a NICU nurse and a mother baby nurse. I didn't actually ever work labor and delivery even though that was my dream. I got into nursing because I want loved birth and I loved babies and I wanted to be a part of it. And then I saw the way birth was handled in the hospital and decided I actually didn't want to be part of this. So that kind of led to my decision to birth all three of my kids at home. I was the black sheep. I could have had my babies for free in the hospital and I chose to pay out of pocket to have them at home so definitely was an out of the box thinker kind of started my trajectory down the rabbit hole when I had a brother diagnosed with cancer while I was in nursing school. And you know my mom really didn't want to do chemo with him and they were like knocked it's actually illegal. We'll take your kid away and and do chemo anyways.

We will say what state is that illegal and it's illegal in all United States every single legal way. Did I misunderstand you? Is it illegal to decline chemo that's for a minor, they will take your kid away and give them chemo anyway.

That sounds like it'd be a state law. That's terrifying. Yeah, it is.

So anyways, I was also in an OB class at the same time and my OB teacher was like a midwife wannabe. And so she had us watch the business of being born to write a paper on and so my eyes were kind of opened between like my brother having cancer and all of this going on over here and my OB teacher making us watch this movie. It was like my world was exploding from the inside out. So I decided pretty much done in there before I was ever pregnant that I was going to have a home birth. And I was in my OB rotation watching labor and delivery happen in the hospital too. Right? So anyways, fast forward to my first birth at home and 20

Allie, I hate interrupting I'm so sorry to do that. But how's your brother? That's to hear that a minor has cancer and tonight here just what happened?

He's fine. He's uh, I think he's 19 about 2020 He's fine he went through three and a half years of chemo with with alternative treatments on the side because you couldn't do either one or the other but yeah, he's good. He's totally okay and Allie let's not forget to mention that you are also a very influential Instagram influencer got influence in their three times. You have the you have like the best title for your Instagram page, which Yeah, I'm almost holistic Allie. There's actually story behind that I was just holistic Allie. And then I had a bunch of trolls coming for me. I think when I was pregnant with my third because I was eating Taco Bell all the time. It was like my favorite. You're not holistic enough.

Yeah, you're not holistic. And if and so I kind of did it like as satire. And then it just stuck it it just is who I am. So yeah, well your your your tagline is fabulous. Keeping Western medicine triggered. I love that. Yeah, we need that.

Yeah, it's it's been a journey. I never intended to be like a full blown influencer. But here we are. I actually like to my tagline used to be not your average influencer because yeah, I just kind of show up as I am. And I don't. I don't try and sugarcoat things. And I lose a lot of followers. A lot of times, it's kind of like my goal, I actually want to lose followers, like, please go away.

I want to keep the right ones lose the bad ones, keep the right ones.

And I talked about all the same thing, things you guys do. Like all the things that you guys talked about, I talked about on my page. So like every live podcast I listened to of yours, I'm like, Yeah, I need more of this in my life, people need to hear this.

Well, we love your content. But what really caught our eye was your story of your third birth, in which you were able to avoid having postpartum hemorrhage, which you had with your first two births. So we would love to have you explain to us a little bit about your first two bars, and then what you did in your third birth, to have a beautiful home birth and get around that postpartum hemorrhage, because that's a that's a big factor for a lot of people and considering birth, it's the leading cause of of maternal mortality around the world. So if we can know your tips and tricks on how to avoid that we can help a lot of people.

Yeah, it's one of the things I get asked about the most actually. And I should have mentioned it right off the bat that I have three of my kids at home and I hemorrhaged with two of them. So my first in 2016, I had a really normal average birth 12 hour labor, I was stuck in transition for about six hours with a cervical lip, but besides that, really typical delivery 39 +b5, and I delivered him and I delivered him in the water. So my midwife couldn't really get a good read on it. And I delivered the placenta in the water. So you know, you can tell the waters bloody, but you don't know how much blood I'm actually losing. And then I went straight from the birth tub into my bathtub for an herb bath. And so again, I'm bleeding into water. You can't tell how much I'm losing. I my vitals were good, I wasn't symptomatic. But I get up from the bathtub to go to the bathroom to go to the toilet. And I passed out on the toilet. And so my midwife was like, Okay, we really should be measuring blood. Let's get you in bed and get vitals on you and see what's up. So I was passing like a lot of clots and bleeding pretty heavily and my blood pressure was all over the place. I remember after sitting in bed for a little while. We were you know, we were doing all the things fundal massage, nipple stimulation, and herbs my midwife was giving me like him halt. And I think shepherds purse, does that sound right. And she and said my uterus was just really boggy. It wasn't firming up, it was really soft. So when after you give birth, your uterus is supposed to contract down and stop that bleeding for you or slow it not stop it, but mine wasn't doing that. And so we made a decision. I was really symptomatic. I felt like an elephant was sitting on my chest. My arms were kind of on and off numb. My blood pressure was all over the place. My heart rate was all over the place. So we made a decision to call an ambulance midwife like normally I would just hospitals five minutes away normally I would just transfer you myself but I was on the second floor apartment and she was like I can't trust you to like walk to the car I don't want to carry you you know I don't want all of us carry new so called an ambulance. My paramedic was an angel he delivered all four of his babies at home. So like no judgment in the room at all. They bolus some saline in because my blood pressure was insane and my heart rate was crazy and and I had I got to the hospital. Anyways, long story short, I had a retained placenta and it wasn't normal. My placenta looked intact. It was like an extra they called it like a finger or lobe off of my placenta. So they weren't fixing for that they did like manual bedside D&Cs four times to get that out. Worst experience of my life, I would rather have quadruplets out of my vagina than ever do that again. Um, but it it was it showed me that like I use the hospital appropriately. This wasn't like an emergency transfer. I mean, it was but it took four hours to get to the point where we're like, okay, we should probably transfer my midwife is like it's no longer within my level of care. We need to get you somewhere where they can take care of you. So I got stable, I got blood transfusions, the baby was never a patient. I was the only patient so I got to do whatever I wanted with him and then we went home 24 hours later. Go ahead.

I was just gonna jump in for a second just so people understand that Um, when you birth your placenta, your placenta was fully intact. So your midwife would not have known that there was any retained tissue. But a leading cause of postpartum hemorrhage is retained placental tissue or, and or lack of tone was they often go together. So your midwife was appropriately massaging your fundus. Because we get a lot of questions about fondle massage. And women really don't want that because it's painful, it's uncomfortable. And it's absolutely not necessary when a uterus is doing its job appropriately. And bleeding is normal. But it's absolutely appropriate in the case of a low tone than the uterus, a uterus that's not contracting, that's baggy, as you described. And so that would be the right thing to do. But of course, if there's still tissue in there, it can't contract down properly. So those blood vessels just never get sealed off. Therefore, the bleeding continues to happen.

Yeah, so it's a really, I think the stats are you can correct me if I'm wrong, I haven't looked into this in like five years, but like one in 10,000 has a retained placenta.

Of that kind, possibly, the kind with the extra lobes you mean, that was like really bizarre. Nobody had ever seen it before. That was working that day with me. And my, my midwife had the placenta with her. And the doctors all agreed, like, this isn't an intact placenta. So it was very, not normal. And so when we were talking about when I was pregnant with my second talking about, okay, do we need my high risk? Now? Do I need to have a hospital birth? Do I not really qualify for home birth? Would it be otherwise? We chatted with a doctor and midwife and OB in a midwife. And they both said, it's such a fluke thing, that the chances of it happening again are like, you know, one in a million or whatever. So they both encouraged me, like you can have a homebirth, if that's if you're comfortable, if that's what you want to do. And so we decided, I was really surprised my husband was okay with another homebirth. Because he was kind of traumatized from my first birth. But again, he really felt like, this is why we hire a midwife, right? They, they're the keeper of normal. And when things are no longer normal, or within their scope, you transfer to a higher level of care, I used the hospital appropriately. And my mom felt the same way. It was the first home birth she had ever seen. And so we decided to go ahead and have a homebirth was our second not really thinking about preventing hemorrhage, because we really didn't think it would happen again. Because my situation with the first was so such a fluke thing. But it did. Maybe, I don't know, for the same reason, not the same reason. I don't know if I'm predisposed to bleeding. My mom had all six of her babies at home with Pitocin onboard. So you really don't have a clear picture of what I'm genetically predisposed to. But all both of my sisters who have had babies have hemorrhaged every time too.

Well, I mean, right there, you know that the doctors just didn't have information. And whenever anyone says something is one in a million, you know, they don't have information, it's reasonable to say it's very rare. But what I wish they had said is we really don't know what causes it. So we don't know if there could be a genetic component. Clearly, it looks like there could be. But when anyone says one in a million, you know, if there were data on something, it wouldn't literally come out to one and a million as often as people tell us something is likely to occur one in a million. All right. It says this very handy. It's like when people say, Oh, it's 99%. It's just one of those nice round statistics. And I think it's always worth questioning, do you? So Trisha, do you know if it Yeah, it sounds to me like it, you had a tissue issue, the first time with retained placenta. But on top of that there is so one of the four. There's four core causes of postpartum hemorrhage, right? It's tone, tissue thrombin, or blood clotting ability, and trauma, like lacerations. You can bleed from that. So it sounds more like there's actually an underlying blood clotting issue. And you have both in the first case, and it was you assumed it was because of the retained placenta, which was great. And I want to make, I also have to say I had find it hard to believe it's one in 10,000 that have retained placenta, I've seen many of my own.

It's not sure kind of retained placenta, which was this additional low but retained placenta is much more common than that. But we're talking about a placenta that came out fully intact with this additional lobe that was retained and who would know.

So with my second I ended up bleeding hemorrhaging again. I made an informed decision not to transfer I wasn't I was symptomatic. I did pass out, but I didn't have the scary vital signs along with it. And so my vitals were stable. My uterus was boggy, and but it was able to be firmed with fundal massage. And so my midwife for about an hour and a half sat next to me and just kind of massaged my uterus on and off, giving me herbs. We did raw placenta and a smoothie almost immediately after birth, because that's also proven to help with hemorrhage. And so we did the raw placenta, we did hem halt, we did shepherd's purse, we did the uterine massage, my newborn wouldn't nurse. But my toddler, my two year old was still nursing. And so he nursed a lot to try and get my uterus to firm up. They think it took probably a good two hours for me to become stable. Again, I birthed in the water, and birthed my placenta in the water, so there was no measuring blood happening. And then when I stood up to get out of the pool, it was like, the floodgates opened. And that's when I passed out.

I water-birthed and I was always coaxed out of the water before the placenta came out. And I'm not a proponent of one or the other. We've had Barbara Harper on the podcast who said you absolutely can birth the placenta in the water. But just given all the other precautions you took to avoid hemorrhage the second time, why wasn't that one of them just so that the measurement would be possible?

Why don't we weren't really trying to avoid hemorrhage, I really didn't think it would happen again. And neither did my midwife. And so we just kind of did our thing. And then when I started hemorrhaging, that's when we were doing the Okay, let's let's do the placenta smoothie. I was already planning on a placenta smoothie anyways. It just kind of kick-started. We need this now. Not later. And she had the herbs on hand. So it's kind of just like in the moment, this is what we're doing to try and get the bleeding to slow down.

And there has been research you said that consuming the placenta right after the birth. Yeah. can reduce the likelihood of hemorrhage?

Yeah, I can send those studies to you. I also have, I think it might be the same study the cord to like women actually putting the cord in their mouth and chewing on it can stop bleeding. It is so bizarre. I never did that.

Well, that's interesting, because I wonder I wonder if women did that 1000s of years ago?

Yeah. Probably. That's what animals do. Right?

It is. So anyways, fast forward to my third, right. I'm like, Okay, now I really should maybe have a hospital birth, I don't know, couldn't afford it. Didn't have insurance. I hadn't quit my job. But I was a PRN position. And so I didn't have benefits anymore. I gave up my benefits. And my husband lost his job four weeks before I gave birth, he carried our benefits. But even then, you know, when we were kind of in the decision stage of, do we have a baby at home or in the hospital, he had a different jobs didn't carry insurance. So like, it just was a mess. And I was like, I don't you know, you don't know what we're gonna do, we ended up deciding that we were going to prevent hemorrhage this time, and that we were gonna have homebirth. And if we needed to transfer for hemorrhage again, okay, we transfer, you know, we're using hospital care appropriately. But I was obsessed with having my babies at home. And I knew I didn't want to have them in the hospital. And so I just decided we're going to do this, and we're gonna do all the research on preventing hemorrhage. So that's what we did. And I actually was able to prevent hemorrhage. I did not hemorrhage with my third baby. And my sister who had hemorrhaged with her first two at home as well prevented hemorrhage six months after I had my third, she had her third and she also prevented hemorrhage, the same protocol that I took. And so it's, you know, we kind of have it under our belts now, like, Okay, well, we're good for birthing at home, we know what we're doing, and only two or three times. But so we did the third we did get out of the pool immediately. I think it was two minutes after she was born. We got out of the water and into bed to deliver the placenta. So two minutes after she was born, we got up we moved to the bed. I delivered the placenta in the bed. We did healer Chrism essential oil on my uterus. On my abdomen, both before placenta came out and after we use hem halt which is a tincture that contains your Yarrow and Bayberry and blue cohosh, which are all known herbs to help with hemorrhage. My midwife carries it with her because in the state of Arkansas, she can't carry Pitocin with her, she probably would have given me Pitocin prophylactically if I had asked.

They they're not allowed to carry any med besides oxygen?

Why? Just out of curiosity was she a certified nurse midwife? We don't have we don't have a preference for one credential versus another. She's a CPM. But Arkansas does not allow certified nurse midwives to practice at home, they are only allowed to practice in birth centers or hospitals. Wow. So your options are really not very supportive of home birthing in Arkansas.

Yeah, but you know, wildly enough, you can have a baby anywhere between 36 and 43 weeks, so they kind of give you a weekly way more than other states do.

It all just goes to show you that it's just political nonsense. And there's not a lot of substance behind it. I mean, to not allow midwives to carry medications that can prevent the most common cause of death and mothers at birth is crazy. But again, they don't want you to be birthing at home. So right, right. Now, let's make it difficult, right? Okay, we were also using shepherds purse, which is in the hem halt tincture, but just kind of another thing to throw at it to get more of that herb. In my system. We did a placenta smoothie, and when my mom was making the smoothie for me, and I did I was nursing the baby, obviously. But my midwife really didn't have to do a ton of fundal massage. My uterus really wasn't boggy, it was pretty firm most of the time, anytime I was like, because that was all in my head about it. So I would be like, Oh my gosh, like I'm feeling a lot of like gushes coming out she would check and she'd be like, Okay, that's normal. It's okay. Like this is normal bleeding where nothing scary is going on. Um, you know, I was nervous. I was a postpartum nurse. So I knew what normal bleeding was and what it looked like for other people, like never experienced it myself. So it was kind of different being in that spot. But really, we never even had like a scare with my third baby. It was all very controlled. I was still a little bit symptomatic. I think my body just really doesn't like blood loss. I felt that like heavy chest and it was difficult to breathe if I was up and walking. So and I felt like lightheaded walking to the bathroom. But we checked my hemoglobin like the next day. And it was within normal limits. It wasn't low, it wouldn't even qualify for a blood transfusion.

Do you remember what your hemoglobin was the two times prior compared to the third time?

The first time I believe it was 6.1. When I got to the hospital managing at home the next day. It was seven. That was my second. So pretty low probably could have gotten a blood transfusion, but was fine at home. So decided to stay. And with my third the next day it was nine so not terribly low.

Did you have anemia throughout pregnancy in any of your three pregnancies?

Yeah, I struggled with anemia all three times.

And you struggle with anemia normally, is that something? That's? Nope.

No. No. Another thing to note that my birth probably played a role in for hemorrhage, like putting me at risk for hemorrhage. Well, my first I was stuck at six centimeters for around nine centimeters for six hours rather. And I also had prodromal labor with him for like six weeks. So my uterus was tired. My second her delivery was an hour and a half long. So her her labor I should say so precipitous labor put me at risk with that one. My third was eight hours. It had a beautiful crescendo. I prayed my entire pregnancy like, Please, just longer than four hours. That's all I'm asking because my two hour birth was fast and furious and I hated it.

First time I've heard of a woman praying for a longer birth but it makes sense, given your experiences.

Yeah, my second just felt really out of control like a freight train barreling downhill without brakes like there was no getting Zen and trying to like, be one with the contraction or breathe through it. It was just like screaming for an hour and a half. While baby rocketed out of me.

Was there anything that you did differently in your third pregnancy? You certainly did things differently in the immediate postpartum and maybe throughout the labor but just anything that you did differently other than praying for a longer labor, you think contributed to a more normal labor pattern and not bleeding Yeah, I took copper, my whole not my whole pregnancy, I think after my 12 week appointment where they're like, Yeah, your, your hemoglobin is already low. And they got bloodwork done, I started taking copper, one of my friends sent me information that you need in order to build iron, you actually need copper, and a lot of us are deficient in copper minerals in general. And so it's hard for the body to make Iron without copper. So I started supplementing with copper, and I was taking beef liver pills too. And to get my hemoglobin up, so that was the first time that I didn't have to scramble at the end, you know, you need to go for your 36 week appointment, you get your bloodwork done, and they're like you're borderline home, but you're not going to be able to have a homebirth. If you're, if your hemoglobin doesn't rise, I was thinking I was like 10 points something both times and below 10, you're not allowed to birth at home. So for my first and second, I had to scramble those last four weeks to try and get my hemoglobin up taking all the pills and all the herbs and eating all the red meat. With my third, I didn't have to do that because my hemoglobin I think was like 12 or 13. At my 36 week appointment. So not great, not amazing, but way better than it had been previously. Because I've been taking copper and beef liver my whole pregnancy.

I'm sure that was a contributing factor. No doubt that made a difference. Yeah, I think there was a lot, a lot going on there that we hadn't even like considered previously, I also had Homeopathics on hand with my third birth to prevent or control hemorrhage. I didn't end up using them. But I have a whole list, I have a link with a list of Homeopathics that you can use Homeopathics are very specific, like if you're having bright red, cloudy bleeding, use this homeopathic, if your uterus is exhausted from a long labor birth use this homeopathic, they're very specific to what's going on. And so I had a couple on hand so that I kind of hit all my bases, but didn't end up meeting them. So I ended up the same midwife for all three births. So she sort of knew what was normal for you and what was not and what the threshold looked like.

I did, she called me her problem child. Which is kind of funny, because in the nurse world, it's like, if anybody's gonna have a complicated labor, it's gonna be the nurse that comes in. So she's like, you know, of course, you're a nurse. And in your mind,
you know, I think I think really, if if I were she, I would be very grateful to have attended your births. Because if she's not allowed to bring Pitocin to the births, she, I'm sure you did more research on this than any professional in a 400 mile radius of you. And she probably learned a lot and is now able to better support the women that she's serving and attending. Because of all these now she can have these things on hand or educate them and their births and their pregnancies. Yeah, now, it's not just like this, this was a problem. This was, you know, because of what you did with it. You're learned and here you are educating all these other women who are getting value out of this. You did something good good with it.

Yeah. And I honestly have no complaints. You know, even I get asked a lot if I have trauma from my first birth experience with transferring to the hospital. I don't, I had an incredible birth, like everything I could ever dream of my birth was amazing. The postpartum wasn't necessarily what I had envisioned. But I feel like I'm the poster child for using the hospital care appropriately and showing people like you can birth at home and still use the medical system if it's appropriate. My mom had never seen a home birth before I was that was her first home birth experience. And she was like singing homebirths praises. She was like this is why we hire midwives. This is why we have babies at home. I wish I'd had all my babies at home.

And this is also a you know, a good reason that we have somebody in attendance at our birth, watching and knowing and making the difficult decision of when it's time to transfer. Not transferring too early. Not transferring too late.

Yeah, my midwife did everything right. You know that first time that we had to trace through the hospital I think it's really easy for family members or even for the midwife to like beat themselves up like what did I do wrong here? What did I miss? Well, she's not allowed to state law. She's not allowed to go fishing for a retained placenta. And she didn't even suspect it anyways, because my placenta was intact but she my mom was even like she did everything right. She did everything she was supposed to and when it was no longer within her scope of care.

So Allie, what would you tell mothers who are concerned about postpartum hemorrhage? Or have had a postpartum hemorrhage and are considering homebirth? And we're having a home birth? What would you tell them to do in pregnancy? And how to be prepared in birth? To manage this? or prevent it? Yeah, I would. I would tell them to keep an eye on hemoglobin and you know, blood levels while you're pregnant and make sure that you keep those high. I'm not a fan of supplementing with iron. I prefer copper and like food sources.

Can you give us can you just give us maybe like your top three suggestions for getting healthy levels of iron in your diet and pregnancy?

Yeah, so oysters, sardines, and beef liver. All food sources all sound disgusting. I promise there are ways to eat them that aren't horrible. beef liver, I eat it raw on a normal basis. I can't do that when I'm pregnant, I would barf. So I take it in pill like capsule form. Sardines are really easy. For me, I grew up on sardines. You know, if you can't stomach them, you'll just have to find a way to eat them. Make a tune out of them. They written mix really good into like a tuna salad. Oysters you can eat with like hot sauce on a cracker. Not my favorite, but I can stomach them. If I can stomach them, anyone can stomach them. But really high sources of copper, and zinc and like really high in minerals, which is what your body needs; your body's so depleted of minerals when you're pregnant.

And then as far as like, hemorrhage, you know, I totally get being like a bit stuck between a rock and a hard place like I want to homebirth but I might be high risk. And so just taking that into your own hands and deciding like, where do you feel safest. And knowing that, like hemorrhage doesn't happen in a split second. It is you know, typically very, it's not slow, necessarily, but it's a thing where you can take your time deciding like, okay, is this beyond normal limits and do I need help? It's not like I need to be at a hospital within five minutes of having my baby. My first one, it took us four hours to make the decision, like we're gonna go to the hospital, it wasn't like this rushing around like chickens with our heads cut off trying to get the door immediately after a baby was born. So just keeping that in mind that you can transfer to a higher level of care with a level head if that's what you need, and it doesn't have to ruin your birth experience. You can still have your baby at home. But also there are ways to prevent it and to just take your birth into your own hands and and really dig in and research about that and realize that there are so many things you have at your disposal - and hire a midwife.

Thank you for joining us at the Down To Birth Show. You can reach us @downtobirthshow on Instagram or email us at Contact@DownToBirthShow.com. All of Cynthia’s classes and Trisha’s breastfeeding services are offered live online, serving women and couples everywhere. Please remember this information is made available to you for educational and informational purposes only. It is in no way a substitute for medical advice. For our full disclaimer visit downtobirthshow.com/disclaimer. Thanks for tuning in, and as always, hear everyone and listen to yourself.