Showing posts with label APH. Show all posts
Showing posts with label APH. Show all posts

Friday, October 26, 2012

an observation of a placenta's healing property

Those who have been reading my blogs over the years probably realise that a great deal of what I write comes out of reflection on actual recent experiences in my midwifery practice.  Today I want to write about a placenta.

As I sit down at the computer I am conscious of my weariness, overlaid with the 'buzz' of good cup of coffee that I have just consumed.  I was called out at midnight last night; the baby was born at about 2:30; and I returned to my bed for a few hours at about 6:30.  I accept this weariness and irregular sleep pattern that comes with the territory, and my heart is content and thankful to God the creator of life, because once again I have witnessed the awesome yet unremarkable event of a healthy woman giving birth to a healthy baby.

I have headed this post 'an observation of a placenta's healing property'.  That's what I think I observed, and will try to document here.

Last week I attended another spontaneous birth at home.  Uncomplicated; great 'outcomes'.  But there was one unusual feature that set my reflective mind in action: a considerable amount of fresh bleeding during the labour.  I have estimated 50-100ml in total, which is considerably more than a bloody show.  It would be classed an antepartum haemorrhage (APH).  The show usually comes from the cervix, while this APH must have come from the placenta. 

Anyone who is familiar with my midwifery practice will probably ask, how did this baby come to be born at home?  If the woman was having an abnormal blood loss, is that not an indication for transfer to hospital, continuous electronic fetal monitoring, and closely managed obstetric care?

Yes.  That is what would usually happen. 

The realisation of what had just happened only settled in on my mind after the baby had been born, when I went to the bathroom and saw a collection of blood-stained toilet paper not yet flushed away.  When I spoke with the mother about it she confirmed that there had been a significant amount of bleeding through the labour.  By the time I arrived, and she was ready to get into the birth pool, already feeling a strong urge to push, there was no bleeding; the fetal heart sounds were good; so we proceeded with the birth.

The second realisation that I had in this case was when I took the placenta to the kitchen sink, and checked it under the bright light (rather than the dull light of the birthing area). 

The placenta was complete, with no unusual features.  However the membranes were clearly torn into the placenta at one edge.  The interesting observation I made was that the torn edges of the membranes, for 2-3 cm from the edge of the placenta, appeared to have shrunk slightly as though an astringent had caused them to pucker.  [I wish I had taken a photo of this, but I didn't, so words will have to suffice].

Ummm.  Interesting, I thought, and completed my check of the placenta, placed it in the bowl provided by the mother, and went on with my work.

I had not previously observed this phenomenon that I have described as astringent, or drawing together of the tissue.  But as I turned it over in my mind, this is what I have wondered.  The bleeding obviously came from the point at the placental edge where the membranes had torn.  The bleeding did not compromise either mother or baby's condition.  There appears to have been something that had an astringent effect on the torn part of the placenta and membrane, that worked to heal the tear and reduce blood flow.  That is what I mean by the placenta's healing property.