Midwife Postpartum Haemorrhage: Gibbs

Description

I was caring for a woman following a normal birth when, around forty minutes later, I noticed a sudden increase in vaginal bleeding. I called for help using the emergency buzzer, started uterine massage, and the obstetric and anaesthetic team arrived promptly. The estimated blood loss reached 1.4 litres before the bleeding was controlled with uterotonic drugs and an examination to exclude retained tissue. The woman remained conscious throughout. She recovered well physically, and I completed the documentation, the incident report, and a debrief conversation with her the following day.

Feelings

In the moment I felt the familiar tunnel of emergency work - task, task, task. What stayed with me afterwards was her face: she was terrified, and for several minutes nobody was talking to her. During the debrief the next day she told me the worst part had not been the pain but hearing numbers being called out and not knowing whether she was dying. Hearing that, I felt genuine distress and some shame, because I had been proud of the clinical response until then.

Evaluation

Clinically, the response was strong: early recognition, an immediate call for help, correct escalation, and effective first-line management. Documentation and blood-loss estimation were accurate because we weighed swabs rather than guessing. What went badly was communication with the woman and her partner during the emergency. No one owned that role, and my own attention was entirely on the fundus and the drugs I was drawing up.

Analysis

The literature on birth trauma is clear that psychological injury after obstetric emergencies is driven less by clinical severity than by how the woman experienced the event - particularly loss of control and absence of explanation. Our emergency drills rehearse roles for drugs, notes and airway, but not for the woman herself. That is a systems gap, not an individual one, and it explains why a well-drilled team can deliver excellent care that still traumatises the person at the centre of it. My own silence was not a decision; it was the absence of a prompt.

Conclusion

I learned that in obstetric emergencies, communication with the woman is a clinical intervention with measurable consequences, and it needs an owner in the same way suction or drugs do. A technically successful resuscitation of the birth is not the whole outcome.

Action plan

I have raised at our unit's skills-and-drills meeting that our PPH drill should include an allocated communicator role, and the practice development midwife has agreed to trial it. In any future emergency where I am not task-critical, I will position myself at the head of the bed and narrate simply what is happening. I will also routinely offer a structured debrief within a few days, as I now understand how much the conversation the following morning mattered to this woman's recovery.