Reclaiming blood
by Katie Oliver
Photo by Karolina Grabowska for Pexels
TW: Graphic descriptions of childbirth trauma, blood loss, PTSD
I’m having trouble stopping the bleeding.
This will never be a comforting thing to hear said about yourself, particularly when the source of the bleeding in question is your own vagina. After thirty five hours of labour, I am given an extended episiotomy as my longed-for baby is nearly born but not quite, and his heart rate has started to fluctuate dangerously. Forceps are produced, to which I grudgingly consent. I am under the influence of an extremely powerful epidural: I can feel virtually nothing from the waist down and for the last twelve hours, various medical staff have been dragging me up and down the bed by legs limp as uncooked sausages.
The forceps have the desired effect; my baby slides out after two more pushes and I feel nothing but a faraway slither in the pit of my stomach. I am elated, and in shock. I repeatedly ask if my child is OK, and call him a beautiful boy. One of the doctors says: that is not a small baby.
Despite my fatigue I am in high spirits, or possibly delirious. I text everyone I know, a fact I don’t remember until I look back at my WhatsApp message history. I look between the medical staff, all women - brilliant, competent women who are the guardians of mine and my baby’s lives - and tell them that I hope they’re going to do their best embroidery as they stitch me up. They laugh nervously. After an amount of time, my husband accompanies my mother, dropping with exhaustion herself, to get a taxi. It is at this point I start to feel unwell. I ask someone - anyone - to take my baby, as I don’t feel well enough to hold him. I demand an anti-sickness injection, vaguely remembering being impaled in the buttock over a day earlier as I retched into a cardboard tray. I have a temperature; I have an infection. So does my baby, who is rolled smoothly out of the room and along to Special Care with a doctor who shares my first name. I find this strangely comforting, as if an arbitrary collection of letters ascribed to someone can make up for my glaring absence in the first crucial moments of my child’s life.
I am now the site of a scientific experiment. Wires are connected to the cannula in the back of my hand and another at the crook of an elbow. Unnamed liquids flow in.
I’m having trouble stopping the bleeding.
To her credit, the surgeon states this calmly, which I suppose is down to practice. I peer over the top of my still-distended stomach and watch her scrabbling at an area that I suddenly, horrifyingly, realise is my vulva. I see genuine panic on her face. Other staff collect my blood in huge, clear plastic bags that balloon and tremble in a manner that might be amusing in another context. They are placed on scales to my left. Am I OK? I ask. No one replies.
I learn on the postnatal ward that I have had a major haemorrhage. They say they will wait to see how low my haemoglobin levels are before deciding whether or not to offer a transfusion. Yet more needles are inserted and blood is taken away to be tested. My parents come to visit but I am in too much pain to focus and send them away. My in-laws come to visit and my mother-in-law, who is a nurse, takes my husband aside to express concern at how pale I am, and instructs him to ask for the results of my blood tests. When I stagger to the shower, my reflection shocks me: two dark half moons under my eyes; lips the same colour as my face. Blood smeared across my hospital gown. Meanwhile, one of the midwives tells my husband that my bloods are fine, that there is nothing to worry about.
As a precaution, I am given an iron infusion: another needle inserted into the crook of my arm. A nice person in the bay opposite has been and gone since I arrived on the ward and has left me her magazines. Kate Middleton has just given birth to her third child and her appearance on the steps of the Lindo Wing a mere seven hours after giving birth is extensively documented, her perfectly blow-dried hair and carefully made-up face at terrible odds with the car crash of my appearance. Kate’s dress is bright red. Holding the front page of the magazine beside my face, I take an ironic selfie for comparative purposes, comforting myself with the fact that I know that Kate will also be bleeding quietly into a maternity pad, unless the royals have come up with a way to put a stop to that and forgotten to tell the rest of us.
It turns out that the midwife was wrong. She had checked the wrong person’s blood results, and my haemoglobin is plummeting to dangerous levels, putting me at risk of heart failure. A call is put in for units of blood, and we wait. During this time I am asked to sign a consent form and given a leaflet that says things like Blood transfusions are usually safe. At 8pm the first unit is wheeled in and I am hooked up to the machine. My baby, the poor thing still unwell and continually shuttled back and forth between the postnatal ward and Special Care for regular tests and antibiotics, is hungry, and so in a ludicrous ballet of wire avoidance I feed him, hunched over and sore as the cannula in the back of my hand snags at my skin.
I clutch at my child, sweating against me in the thick May heat and watch as blood travels slowly down the clear tubes towards my veins. There are bubbles there, lots of them, and I’m sure I’ve heard somewhere that if one gets into your bloodstream then you die. Not wanting to take any chances, I call for the midwife, who is bemused: A little bit of air is fine, she says. I start to panic, and she takes pity on me and lets them out. She does this for me twice, three times.
The blood transfusion leaflet says You may feel a sharp prick as the needle goes in, but shouldn’t feel anything at all during the procedure. As the new blood travels through my veins it is icy cold and I feel as if I am being inhabited by a ghost.
It is decided that I need a second bag of blood and it takes a further two hours, finishing at midnight. Our section of the ward is deserted: everyone else in my bay has since completed their postnatal checks and has been allowed to go home. My husband leaves to get some sleep, ready to be back first thing in the morning. I am alone again with my thoughts, a mercifully sleeping baby, and veins full of someone else’s blood.
I become strangely institutionalised in the five days that I am on the ward, days that seem to shift and stretch interminably since they are not drawn to a close with the usual marker of sleep. My baby and I are visited by a bewildering range of medical professionals who frighten, confuse and nurture us in equal measure: the paediatric doctor performing checks on my baby who casually mentions that she thinks that he is not getting enough from my milk and that he will decline drastically if I don’t start bottle feeding; the midwife who bursts into the cubicle straight afterwards to tell me that’s a load of bollocks and to continue exactly as I am. The other midwife who, after taking my morning observations, asks me to let her know if I need a hug at any point. The terribly nice junior doctor who breaks it to us that our baby will need a lumbar puncture, comforting me as I weep into a blue muslin cloth; sincere in his sympathy when I apologise for being too sore to sit down, for still being dressed in my gore-smeared hospital gown. You’re allowed to put some proper clothes on, remarks a midwife.
I am temporarily incontinent, and there is talk of moving me to a private room: something I should jump at the chance of. Instead I shrink from this offer, strangely fearful. I like Bay E and my bed in the corner, even though I hate the constant noise and light and disruption. I like ordering either vegetable lasagne or macaroni cheese for my lunch, waiting for my husband to bring me a takeaway cup of tea with two sugars. These small certainties provide me with moments of stability in a reality that is beyond my recognition.
There are light moments, too, amidst the chaos. My milk comes in on the third day during the small hours and I manage my first really successful breastfeed with no assistance. I lay my tiny baby across the pillow on my lap and enjoy his blissed-out expression, fizzing with the feeling that my body is functioning on some primal level, dragging back the tiniest scrap of control from the wreckage of the birth.
When it comes to the time where both myself and my baby are ready to be discharged I am both euphoric and terrified. I hunch over him, tiny in his car seat, convinced he will stop breathing. We arrive back at our flat where it feels as if nothing has changed. The students next door are sitting on the driveway, smoking.
Congratulations! they call out.
I cry on the doorstep, knowing that I am truly on the threshold.
At home, life continues.
I am in near-constant pain, knocking back painkillers four times a day, along with two different types of antibiotic and nightly Clexane injections to prevent blood clots. These my husband administers while instructing me to count down from one hundred, and over the days that follow my thighs constellate with tiny purple bruises. I perform regular checks of my maternity pads, eyeing each clot in my lochia in watchful terror, now that I know that blood is a dangerous, transient property. I make a circle with my finger and thumb and try to remember the size of a fifty pence piece. I spend a lot of time on the internet, becoming obsessed with trawling the dark recesses of message forums to find accounts of childbirth gorier than mine, more life-threatening; gorging myself on trauma. The more catastrophic the birth injuries suffered, the more satisfied I am. I scroll grief-sodden threads about prolapse, piles, postpartum psychosis, my face lit up by my phone in the dark as I persevere with breastfeeding my child, who steadily gains weight; thrives. My nipples crack, then start to bleed.
I haven’t stopped bleeding since, in one way or another. My lochia doesn’t stop for six weeks, and my episiotomy is slow to heal. This, along with other injuries that persist for many months afterwards, means that I am continually losing blood in small quantities. I am simultaneously resigned to it and traumatised anew each time, the splash of shocking red on the toilet paper still unsettling and difficult to process. I have to get my blood checked regularly over the following months and offer up yet more of the contents of my veins. I attend physiotherapy appointments where I endure having various items inserted into me, and something called PTNS which involves electrical stimulation of the pelvic floor via a needle in my ankle.
When I start to cry, one of the physios tells me I need to change my attitude.
I’m having trouble stopping the bleeding.
I become angry. I pick fights with my husband. I Google PTSD symptoms, confused and afraid. I start to see a bag of blood in my peripheral vision, always on the left side. This image is an imprint on my retinas, a scarlet tattoo. I am a modern-day version of Lady Macbeth, the delicate thread of my sanity unspooling ever further as I attempt to scrub the damned spot from my subconscious. Even when I think I might be having fun it shows up, quivering, demanding my attention. I learn to smile and pretend I am not being haunted by a bag of my own bodily fluids. I learn to say I’m doing fine, thanks, at baby groups.
I struggle to contend with the brush with my own mortality, something I had been fortunate never to have previously experienced. I have constant flashbacks to the birth, turning over every key moment, berating myself for not doing more. I watch my son sleeping and feel visceral terror at the idea of leaving him motherless, the unrelenting red tide of my fear ripping through me until I am weak from being carved open by my own thoughts. The difficulty of it is that it seems an entirely rational fear to me; I cannot tell myself that I am overreacting when my scurrying thoughts are backed up by hard facts: a 2016 study cites Postpartum Haemorrhage (PPH) as a leading cause of mortality post-childbirth, with 225 deaths from it every day worldwide. Many of these deaths occur in low income countries, and I feel variously enraged at how others around the world are forced to play roulette with their lives, grateful that it wasn’t a bleaker outcome for me, and haunted that it so easily could have been if it wasn’t for the sheer good fortune of being a citizen of a country with adequate medical provision, and of course - a white, cis, middle class woman. I do not forget the fact that it could have easily been a lot worse, given that it has been found that there is a persistent culture of racism in maternity services in the UK.
Eventually, despite an initially successful return to work, I am diagnosed with PTSD. Recent studies have estimated that 4% of those who have given birth go on to develop the condition; given that some 130 million births take place around the world each year, this represents an enormous amount of trauma being held by so many, often with little to no support; we cannot ignore the impact witnessing birth trauma has on birthing partners. But I cannot think of anyone else for too long. I am lost, furious, clawing erratically for answers. I am unable to stop crying, and powerless against the intrusive image of the bag of blood in my peripheral vision. The first GP I see stoutly insists I just have a touch of anxiety, the second is sympathetic. But the waiting list for the type of therapy I need is at least six months long. Instead I have a month off work, start taking antidepressants, and do my best to cope.
As I recover I think a lot about the person who gave me their blood: whether they gave it voluntarily, whether they died and it was taken from them. I study the veins in my inner wrist, the faint blue network of life that flows up my arm like a branching river. My skin seems so translucent, the blood dangerously close to the surface. I feel peeled back and raw, too vulnerable to be allowed to walk around outside by myself.
Miraculously, the medication seems to banish the intrusive haemal images that have been plaguing me for so long. I am left with debilitating residual anxiety that manifests itself as severe chest pain and heart palpitations, but without my subconscious continually bringing me back to the delivery room I feel able to reinsert myself back into the world. I return to work, and at the weekends, finally begin to see glimpses of the mother I hoped I would be, although this remains a work in progress.
I wrestle with the idea of having another child daily: more specifically, how it would happen. Two consultants tell me that I must have a C-section if there’s a next time; one states in no uncertain terms that I shouldn’t attempt another vaginal delivery if I want to hang on to my continence. But despite the relative level of certainty surgery would provide, it still doesn’t allay my fears around bleeding out. It’s unusual to haemorrhage from an episiotomy, which begs the question: am I a bad bleeder? A nasty haematoma from a biopsy site a couple of years later suggests that this could be the case. I am unable to expel the image of my skin, my abdominals and my uterus being carved up like a ripe watermelon, my stomach yawning open in a terrible, drooping parody of a smile and red, red blood trickling from the sides as my guts are rearranged. Then there’s the prospect of recovery. People say that you forget the pain, but I have not, and will never.
I manage to keep up breastfeeding for a long time, through a combination of dogged persistence and good fortune. It is undeniably tiring, waking several times a night, but I am glad that I have done it when the birth itself was so far from how I imagined it. I know that soon I will have to start cutting down on the number of feeds; I know that this means that the resumption of my period will not be far away. I’ve been told that this could help with my recovery overall, but I am also deeply afraid of bleeding again. I feel that I have lost too much blood already to accept that one quarter of my life will involve shedding more.
Not more than two weeks after stopping night feeds, my period arrives; an insignificant brown stain that appears just before I’m about to leave the house. I try to use tampons but after everything, they feel like an assault. So I make a decision that feels radical to me: from now on I will use cloth sanitary pads and period underwear. During my twenties, I’d baulked at the idea, finding the idea of grappling with my own insides once a month almost comically hideous. It was something for people who lived a long time ago, a relic best consigned to a museum. But the more I consider it, the more I understand that reusable sanitary protection is empowering in itself. You only need one set and the monthly expense of disposables vanishes, chipping away at some of the insidious tax that comes with having a uterus. It is better for the environment. I research charities that provide reusable pads for those who aren’t able to access any sanitary protection at all, and the scandal of pads on sale across Africa potentially being treated with harmful chemicals that cause rashes and burns, and realise how privileged I am to have the choice; period poverty is, unacceptably, a persistent issue both at home and abroad. In short, I understand that it represents an invaluable opportunity to reclaim a part of myself. To make peace with blood.
The pads I select are pale blue and covered in patterns of swirling birds and flowers, a choice that forces me to confront the bright red stains, the reality of what my body is expelling. They are surprisingly soft and comfortable.
The methodical routine of hand washing them before they go in the machine is simultaneously tiresome yet soothing. I will often have to keep rinsing for so long that my knucklebones pinch and throb with the cold. Several times I have to cheat and add in some warm water to give myself a break, even though I know that this risks baking the blood in for good. But no matter how painful the ache in my bones, I know that I can always turn off the tap. I can find a pair of gloves, or warm my hands over the radiator. And no matter how many bright red clouds of blood stream into the sink and gurgle away down the plughole, I know that eventually they will turn rusty brown, and finally, the water will run clear. I know that here, I have the power to stop the blood. In this small way, I have won.
One day my son, aged two at the time, comes into the bathroom as I’m washing a pad, and stares in surprise at the bright red stain.
What’s that? he asks, with the childlike openness that means he speaks with neither judgement or awkwardness.
Just a pad, I reply. Satisfied with this straightforward answer, he wanders off to look at something more interesting.
And that’s all it is: a pad. But it is a piece of cloth that holds more power for me now than the blood it absorbs, and that is no small victory.
Katie Oliver
Katie Oliver (she/her) writes from South West Ireland, and her work has been nominated for the Pushcart Prize, Best Small Fictions and Best Microfiction. Her debut short story collection, I WANTED TO BE CLOSE TO YOU, will be published in December 2022 with Fly on the Wall Press.