Ever wondered why there's not as much blood during labor as you might expect, given it's such a monumental physical event? Join us as we shed light on the fascinating topic of Estimated Blood Loss (EBL) throughout labor and delivery. We'll navigate the nuances of EBL, from why the birthing process is more about various bodily fluids than blood to the significance of post-delivery bleeding when the placenta detaches.
We'll discuss the use of medications like Pitocin and Methergine and get hands-on with techniques such as 'credeing' that aid in preventing excessive blood loss. Whether you're a healthcare professional, an expectant parent, or simply curious about the childbirth process, this episode will arm you with knowledge and emphasize the importance of being informed about EBL in the magical, yet critical, moments post-delivery.
Visit our website, here: https://birthlearning.com/ Follow us on Facebook at Birth Learning Follow us on Instagram at @birthlearning
Show Credits
Host: Angie Rosier Music: Michael Hicks Photographer: Toni Walker Episode Artwork: Nick Greenwood Producer: Gillian Rosier Voiceover: Ryan Parker
Ever wondered why there's not as much blood during labor as you might expect, given it's such a monumental physical event? Join us as we shed light on the fascinating topic of Estimated Blood Loss (EBL) throughout labor and delivery. We'll navigate the nuances of EBL, from why the birthing process is more about various bodily fluids than blood to the significance of post-delivery bleeding when the placenta detaches.
We'll discuss the use of medications like Pitocin and Methergine and get hands-on with techniques such as 'credeing' that aid in preventing excessive blood loss. Whether you're a healthcare professional, an expectant parent, or simply curious about the childbirth process, this episode will arm you with knowledge and emphasize the importance of being informed about EBL in the magical, yet critical, moments post-delivery.
Visit our website, here: https://birthlearning.com/ Follow us on Facebook at Birth Learning Follow us on Instagram at @birthlearning
Show Credits
Host: Angie Rosier Music: Michael Hicks Photographer: Toni Walker Episode Artwork: Nick Greenwood Producer: Gillian Rosier Voiceover: Ryan Parker
Speaker 1:
Welcome to the Ordinary Doula Podcast with Angie Rozier, hosted by Birth Learning, where we help prepare folks for labor and birth with expertise coming from 20 years of experience in a busy doula practice, helping thousands of people prepare for labor, providing essential knowledge and tools for positive and empowering birth experiences.
Speaker 2:
Hello and welcome to the Ordinary Doula podcast. I am your host, angie Rozier, and it's so great to be with you here today. So I want to talk about a couple things that are important to understand as you approach delivery time and having a baby, and one of those is what we call EBL, and EBL stands for estimated blood loss. So when babies are born, we expect a certain amount of blood loss. Like that's very normal. When we talk to folks about preparing for labor and delivery, some people are very nervous that they're queasy, that they're going to see a lot of blood and guts. They might not, you know, like anything medical and might make them feel kind of nervous. And overall labor is not a blood and guts process. Like very rarely is there anything of that nature involved in the labor part. There are a lot of other bodily fluids. There's amniotic fluids, sometimes there's vomit and urine and feces, and so you know it's a kind of a I call it a juicy process. There are some bodily fluids involved, but blood is generally not one of them until a certain point in labor, which is actually after the baby's born. So after baby's born, we expect there to be a certain amount of blood loss and the physiological reason for that is the placenta, which is. It varies on the size of the baby but is kind of the size of a small dinner plate if to be laid out flat. The placenta is attached to the wall of the uterus, which is a muscle, and it's attached by lots and lots of vessels. It's a very vascular place in the body because of course all those vessels are taking nutrients from the mother's body, taking it through the placenta the placenta kind of filters things and through the umbilical cord into the baby, where the baby gets, of course, its nutrients, and then waste products come out the vein that comes away for the baby, where the baby gets, of course, its nutrients, and then waste products come out the vein that comes away for the baby. There's two arteries that go to the baby, one vein that comes away from the baby and the placenta is the junction point for all of that. So that placenta, incredible organ. It grows just for a period of time, very important, and then we're done with it. It's kind of cool.
Speaker 2:
So the placenta comes off the wall of the uterus at some point after the baby has been born and so whatever size that placenta is think small dinner plate for most people there is, and it's vascular right. There's a lot of vessels that are on a small level at that point that are interacting with the wall of the uterus. So as that comes off, it kind of comes off gradually, kind of peels itself off the wall of the uterus after the baby's born and then it comes out usually, you know, hopefully with the cord intact. That will come out as a unit within a few minutes to up to half an hour, within a few minutes to up to half an hour, usually after birth. And what is left where that placenta was is kind of this wound, like this open wound. So that is a lot of where our blood loss comes from. So as we're looking at that EBL or estimated blood loss, it's usually after.
Speaker 2:
If there are indications of bleeding, like bright, red and heavier bleeding before, that's concerning. That would mean we would anticipate that could mean that some of that placenta is coming off the wall of the uterus before the baby's done with it. And if the baby's inside, the baby definitely still needs the use of that placenta and all the benefits oxygenation, nutrients and removal of waste products, like that's the baby's lifeline. So that's why we always caution folks, like if you're getting any bright red bleeding during pregnancy or during labor, then that's kind of a concern we're looking for. It's not the only thing it could be, but it's definitely a concern.
Speaker 2:
Some other things and we'll talk a little bit more about estimated blood loss in a moment other things that may cause bleeding towards the end. We might get some as the baby's coming down the birth canal and doing some stretching getting ready for crowning. We might see little trickles of blood at that point and that's just some superficial tissue that might be separating. And capillaries, the little, tiny, tiny blood vessels where exchange of goods, if you will, happens. Those could be kind of bursting so that could cause some bleeding. Sometimes we'll get a vessel, um. I was at a birth last night actually, where we had a bleeding vessel after delivery that was giving more blood than anticipated and with a little bit of exploration the midwife said, oh, this is just a vessel, and she clamped it off, um, until she was able to repair it with stitches. But some of that, the little bit of bleeding we get right before delivery. You may or may not even notice it, but that could be from tissue separation. A tear afterwards could be a source of blood, but the main source of bleeding is going to be that spot on the inside of the uterus where the placenta was.
Speaker 2:
So estimated blood loss or EBL, and I like people just to kind of understand what this is. And by the time this is being done, you are probably just holding a new baby in your arms and checking them out and you're quite enraptured and what's going on there. So you might not be listening for this part, but hopefully you, you know you will understand kind of what's going on If you listen closely. You'll generally hear your midwife or your doctor give an EBL to the nurse and the nurse has to chart this. Sometimes the nurse will ask for it, sometimes the doctor or midwife will just report it. And estimated blood loss is what EBL stands for and it's very estimated. It's just a visual kind of a visual estimation of what the blood loss might be.
Speaker 2:
So for a lot of delivery situations there's some interesting equipment that is used, if you will, and one of them is a catch-all bag, kind of this blue tarp kind of thing, like some docs call it lovingly a landing pad. But it's kind of this blue slick plastic tarp that they'll slide right under if we're in a normal standard delivery position. If you're not, you know we can work with all kinds of positions, but they'll generally slide it right under the bottom of the person giving birth and then that's where they kind of do their work in this space. If you're in a traditional position and it's built with a pocket like this triangular pocket, if you watch, one corner of it goes down into this little pocket and a lot of them have marks on it and they'll kind of mark like all right if it's this full. Here's what the blood loss or the fluid volume is, and that's interesting thing to know.
Speaker 2:
There's other fluid too. You know, like when babies are born they are surrounded by amniotic fluid, so that can come out and mix with blood as well. So we might get a really great gush of amniotic fluid that joins this blood loss fluid in the in this graduated cylinder sack kind of a thing. So docs are doing this. It's very estimated as they do that. I was at a birth last week where and the mom knew she had high fluid, but it was like impressively high when the baby was finally born and this, this baby's head, emerged and it allowed all this fluid that was back behind the baby to come out. It was cool, like everyone who knew what they were looking at was like, wow, that is a lot of fluid, good, very good gush of fluid there. So that's why it's estimated.
Speaker 2:
So a normal kind of normal blood loss for a vaginal delivery would be anywhere from a range of like 250 to 350, 400 cc's is very normal. So a cc is a very small measurement of fluid. It's the same thing as a milliliter, but about 300-ish cc's is very normal for blood loss. So you might hear these terms and these numbers being talked about. For a vaginal delivery, 500 cc's is very normal, normal blood loss. Interesting that the blood loss is higher for a C-section than for a vaginal delivery. And then there's a whole lot of ranges to that. Some people will lose 150 cc's of EBL or estimated blood loss. Others will lose, you know, 700, 1200, 1400. And that you know that's something to watch and be aware of, because as we start getting into those higher numbers, that's, you know, we kind of need to watch closely on the recovery part and we'll talk a little bit about that and maybe take some action as well.
Speaker 2:
So what's considered a hemorrhage, a postpartum hemorrhage for a vaginal delivery, is anything over 500 cc's and hemorrhage isn't always super bad, it's just says a little more blood was lost. We can have severe hemorrhages. One of the most challenging things after the baby's born is the management they call it management of third stage, so the delivery of the placenta. I was chatting with a group of midwives a couple of days ago and you know, and labor and delivery nurses who've been doing this a long time and and they were like, oh yeah, we, you know, the delivery's fine, labor's fine. When we get worried is about the delivery. After the delivery, the placenta out and making sure that the bleeding is normal. So that's kind of when the medical team ratchets up their concern, because sometimes that's when problems present. We can have a beautiful, fine delivery but depending on how that uterus responds and the amount of blood that is lost, can cause a lot of challenges in the postpartum period. So for your teen, realize that as you're holding and enjoying this new baby, they are still doing a lot of work and taking good care of you. So for C-sections, anything over a thousand cc's is considered hemorrhage and I have seen these numbers change a little bit. That's pretty standard for now, but we can have over a thousand is considered postpartum hemorrhage. So there are.
Speaker 2:
So I want to talk about one more way to measure blood and you may see this as well, especially if they're concerned, if there's like any reason to think that blood loss is high or they needed to keep a very, very close eye on it and do a little more than estimated blood loss, and that's called QBL, so that is quantitative blood loss. So they will actually and some hospitals kind of have a standard practice of doing this they will actually measure the weight of things. So they have every room will have a small scale in it. So if there's like a chucks pad underneath that's catching some blood, they might weigh that chucks pad. They might get a better idea of what the blood loss is. And again, this policy can change a little bit based on place and the hospital that you're at. So they may be measuring things that way, especially if they have concern.
Speaker 2:
So if the blood loss is on the higher end of things, they can do things to stop it. There's kind of a regimen of medications that they will do, the first one being Pitocin, and that is a first line of defense kind of. They like to give that to everyone generally in an IV after delivery. So that's also something to be aware of and to expect and to watch and listen for. They'll give generally two bags of Pitocin if blood loss is still more concerning, and they still. They will also in most facilities. It can be a little different in some low intervention places.
Speaker 2:
But they're going to crede. It's called credeing or massaging, really cranking on. You could say Massage is too kind of a term for what they're doing. But they kind of firmly rub the uterus and that's a stimulation, a physical stimulation from the outside to stimulate that muscle to clamp down. So just as pressure stops bleeding, the pressure as that uterus which is baby size and then goes back down to like an orange or even smaller size pretty quickly, like within a few hours, as they stimulate that firmly from the outside, it stimulates it to contract and be small. And that contracting of the uterus puts pressure on that dinner size plate opening where the placenta was to stop the bleeding. So they're checking from the outside. Then they have some medications they can use beyond that.
Speaker 2:
Wait one more quick thing about Pitocin. So they'll generally administer Pitocin through an IV. But if folks don't have an IV then they might just do an intramuscular injection in the thigh. I was at a birth last night where the mom did not want an IV and she had no medical reason to get one and the staff was cool about that. Not every hospital is as cool about that, but she didn't have an IV placed and they were watching her blood loss closely and they said we might have to give you IM-PIT or just intramuscular injection of Pitocin, which turns out they didn't. But that is something they can do. If there's not time to place an IV, or if someone's chosen not to get an IV and they need to do something, they can still take action if needed.
Speaker 2:
There are other medications. Methogen is another one that they will use to stop blood loss. Methogen is another one that they will use to stop blood loss Cytotec and cytotec is they'll actually use a little pile of white pills. That's what cytotec is. I think they use four pills and they put them rectally. Actually they go right in the rectum where they dissolve very quickly and help the bleeding to be controlled as well. There's another medication called Hemabate that might be used and one called TXA. So all there's.
Speaker 2:
There's different levels of care that are needed, based on the EBL or the estimated blood loss, so kind of. If you don't know what your EBL is, find out what it is. It's after delivery. If you're going into this, if you're preparing to have a baby, find out what it is. It's after delivery. If you're going into this, if you're preparing to have a baby, find out what your EBL is. That could have some impact on what's going on later. Now. If it's really high, you'll probably know about it. They may even offer, like kind of a. One of the last things they would offer in extreme situations is a blood transfusion. So they, you know, for some people who have a high EBL if we're, you know, looking at 1,500, know for some people who have a high EBL if we're, you know, looking at 1500, 2000, then they're going to want to do a blood transfusion to help the blood cells replenish themselves.
Speaker 2:
The highest, probably the lowest blood loss I've seen is like 100 cc's and that's kind of rare. Average is 3, 350. I've seen lots of 700, 1,000, 1,200. The highest I've seen was 4,500. So we have about 5,000 cc's of blood loss in our body or, excuse me, of blood volume in our body. And in this very extreme case it was scary, super scary. This woman lost 4.5 liters of five liters of blood and so they were doing a lot, a lot of work, a huge team of doctors, to keep her alive. And she is alive and her baby's alive and he's 10 years old today and doing just fine. But gosh, that was scary. So that is something definitely to pay attention to.
Speaker 2:
Is that blood loss afterwards? So blood loss afterwards can be impacted by how labor was, how long labor was, how short labor was. If pitocin was used to kind of accelerate the process, that could wear out the uterus and have it be a little bit lazy to kind of contract down again. Very long labors also give us tired uteruses that don't want to clamp down again. Very short labors can kind of be shocky to the system and cause a little extra blood loss. Sometimes very large babies are very small babies. So there's a lot of factors that go into the amount of blood loss and there's a lot of ways to approach taking care of that. So some ramifications for different blood loss afterwards fatigue in recovery. So there is a serious time of recovery after childbirth and we should take that seriously. Those who have a higher blood loss should be even more cautious about that. So you're going to be tired, more tired.
Speaker 2:
Your body is kind of recovering and replenishing. I mean, it was just pregnant, it just grew a baby, it just delivered a baby and then when we have some blood loss on top of that, that can be have a lot of impact on the physiology of the body and definitely how that plays out in postpartum recovery. So being cautious and replenishing with awesome nutrition, with rest, with high and quality fluid volumes can be helpful. We also want to look at postpartum mood disorders. If I have had, or postpartum mood challenges. If I've had a client who I know has had a high blood loss during pregnancy, I am checking in on her a little bit differently in postpartum than I am somebody with an average or low blood loss, because I know that can impact some postpartum mood challenges. Also, breast milk supply. So high blood loss and we're talking pretty high can impact when the milk comes in. The body can only do so much and it's hard to replenish its own blood supply if and make milk Um, so sometimes that is a challenge as well. I have seen people with very high blood losses make plenty of milk Um. I've seen people with average to low and there's a lot of factors that go into that too to milk production.
Speaker 2:
But that's a few things to understand about that EBL or estimated blood loss. It's being done. Whether you know it or not, it's being estimated. You are being taken care of, whether you're doing a home birth, birth center birth, hospital birth kind of know what to look for. Any awesome provider is going to be obviously very responsible and reasonable about taking care of that and watching that.
Speaker 2:
So again, this is EBL estimated blood loss and it happens, like blood loss happens, after pregnancy. We absolutely expect that. There's different ways to manage it at different levels, but just want you to understand that. So listen for it and if you don't know, ask. It's in your chart. So that is all I've got today about EBL or estimated blood loss. I hope that helps as you prepare for your upcoming delivery or if you just want to learn more about pregnancy and labor. Hopefully that's an important piece for you because it's kind of key in the management of after that baby's born, after you've done all the work. There's still a little bit of work to be done for sure, because our bodies are amazing. It's cool how they work. Thank you so much for being with us here today. I hope you do something wonderful today Connect with someone close to you and make their day a little bit better. And this again is Angie Rozier signing off with the Ordinary Dula podcast. I hope to see you next time, thanks.
Speaker 1:
Thank you for listening to the Ordinary Doula podcast with Angie Rozier, hosted by Birth Learning. Episode credits will be in the show notes Tune in next time as we continue to explore the many aspects of giving birth you.