Birth is a dynamic, physiologic process that involves many moving parts. There is the birthing person: their pelvis, the uterus, their nourishment status, their health history and emotional status, to name just a few. Then there is the baby: their size, position and development, their health status and gestational age. So many pieces that come together to create each individual birth song. All people giving birth lose blood, this is an expected and normal part of the process. Learning to estimate blood loss with waterbirth can be tricky and is something that waterbirth providers need to consider. To be clear right up front, it is impossible to gauge EXACT blood loss after a waterbirth, but we do need to practice getting a general idea of when to be concerned. It takes observation, experience and attention to the subjective information from the birthing person to make an estimate.
Waterbirth and hydrotherapy have been an integral part of my practice since the beginning, well over a decade ago. I truly believe and have experienced that they can be instrumental in helping to support the birth process and offer undeniable comfort. (On the flip side, hydrotherapy is not for everyone, for some folks it is not comforting and that is ok! There is no 100% wrong or right way to give birth and having access to multiple tools is the key.) But this post is about estimating blood loss with waterbirth, so lets get down to business. At my center, Seasons Midwifery & Birth Center, we have monthly staff meetings that include various safety drills and educational activities. Recently, we did an educational session on this skill and I thought I would share.
- First off is is important to know the size of the pool/tub you are working with. At my center we have the Dahlia free standing acrylic pool from Waterbirth Solutions. It holds 110 gallons, has a depth of 24 inches and an exterior size of 70x40x26 inches. Here is a shot of one of these pools filled with water and some other pretty touches.
- Next you will need to use a human blood substitute. When I do similar exercises with estimating blood loss out of the pool, I have a lovely homemade recipe for fake blood that I have tweaked over the years. However, that recipe is not too great for our pools as it has A LOT of red dye that can stain the enamel of the tubs. So we have had to get creative and were able to work with a local university veterinary science department to obtain some animal blood. I know sounds gross, and actually is a little, but it is all in the name of education!
- Lastly, have a method to add pre-measured amounts of this blood into the pool at certain intervals to be able to visually assess. Here are our results;
- The first 3 images are all 100cc/ml of blood and represent the initial pouring in to the first 30 seconds of spread. We were all surprised at how this one looked and across the board would have guessed the loss was higher than 100cc/ml.
- These middle images represent, from left to right, 300cc/ml, 500cc/ml and 750cc/ml
- And finally the last three images are 1L of blood, with a little stir (yuck and thank goodness for the extra long gloves!) for good measure.
As you can tell once we got over 300, we felt there was diminishing return in being able to tell the differences between the values, the water just became very dark. An important factor to also be aware of is that the animal blood had an anti-coagulant in it, so no clots were formed. With real birth, the blood does form clots and oftentimes those can be “fished” out of the water and weighed. At our center, for all the land births we practice ‘quantified blood loss’ meaning we weigh all the materials (chux pads, towels, etc) that have caught the initial loss so that we have a very accurate measurement. And with waterbirths, if there are large clots we will remove and weigh them, but there is still some element of ‘guess-timation’ involved. Again, there is no way to measure exact blood loss with waterbirth but we felt this was a valuable exercise. What are your thoughts? Have you done something similar?
Top image credit Lindsey Eden
Have you considered a late pregnancy hematocrit followed up with a postpartum hct?
At my center, we do a PP H&H with all PPH’s