Stop the Bleeding

Stop the Bleeding what you need to know about PPH

it was exactly one week after Kristen Kimmel’s healthy baby Kate was born. The in-laws were over; her husband, Tom Mathews, was making lunch. Earlier in the week, she had even taken the dogs for walks. Everything was fine.

As Kimmel sat down to breastfeed her daughter, she felt some unusual cramping.

“They tell you that as your uterus continues to shrink, that [cramping] is normal, especially if you breastfeed,” says Kimmel, who lives in Dallas. So she didn’t think much of it. When she went to the bathroom, she noticed some clots in her pad—again, it’s normal to have spotting after giving birth … but there shouldn’t be large clots, and you shouldn’t go through pads quickly. As a safety precaution, Kimmel called her OBGYN, who told her to watch the bleeding and call back if it worsened.

It did. Kimmel says within 20 minutes, she began feeling heavy and ran to the bathroom. When she looked behind her, she saw a trail of blood. “I passed a clot, but it was a clot the size of a softball,” she reveals. She called her OBGYN again, and this time, she was told to go straight to the office. As Kimmel stood up to leave, she almost passed out. Her terrified husband helped her to the car, and they rushed to the doctor. How was it possible to be feeling perfectly fine one moment, and bleeding excessively the next?

One of the leading causes of maternal mortality is postpartum hemorrhage (PPH)—that is, if it’s left untreated. But only 3–5% of women experience PPH, says Dr. Brian Rinehart, director of the maternal high-risk program at Texas Health Presbyterian Hospital Dallas.

What exactly is PPH? It’s defined as excess bleeding after delivering a baby—some professional organizations say 500 cubic centimeters (or 500 milliliters) after a vaginal birth or 1,000 cc after a C-section; however, the World Health Organization suggests it is 1,000 cc or greater of blood loss in the first 24 hours. Rinehart explains that, ultimately, how much blood is too much will vary patient to patient.

Then there’s also late or secondary PPH, the rarer form, which occurs after the first 24 hours. That’s what Kimmel experienced.

There are three main reasons that PPH occurs: • uterine atony (when the uterus doesn’t contract after the baby is born) • lacerations (or tears) at birth • retained placenta or placenta fragments.

We know the immediate causes of PPH, and research suggests that certain conditions (including placenta previa, overdistended uterus, hypertensive disorders of pregnancy, obesity and having multiple babies) may increase the chances of PPH.

But in the majority of cases, there are no underlying risk factors, says Rinehart—so technically, there’s no sure way to prevent it.

“There is no magical dietary supplement or routine to make yourself healthier to avoid [PPH],” he says, adding that

significant bleeding is harder on someone who is unhealthy. “The best way to prepare is to be in the best shape you can be during pregnancy, so that if this should occur, you can tolerate it.”

Kimmel was still bleeding when she and her husband arrived at the doctor’s office. “I was like, ‘You guys are going to want to have me come back right away, because I don’t want to leave blood in your waiting room,’” she says. Paramedics were called; Kimmel was taken to the hospital. She remembers asking her doctor if she was OK, and the doctor saying only, “You’ve lost a lot of blood.”

At Texas Health, the patient teams are prepared for PPH through regular drills, Rinehart says, and there are medications to treat PPH in every labor and delivery room. Having the right meds, uterus clamps, blood banks, anesthesia (if necessary) and procedures down to a science can save precious minutes. “It’s not about preventing it because it’s not preventable, but how to deal with it in a timely fashion, so Mom doesn’t get sick,” Rinehart explains.

He adds that the vast majority of patients respond to manual stimulation of the uterus (to make it contract) or medication; surgery is considered a last resort.

“Most women recover from postpartum hemorrhage within the normal recovery time for birth,” he says. “Those that require surgical intervention and transfusion of large amounts of blood may stay in the hospital for a few extra days.”

For moms with secondary PPH, treatment is a little different. Kimmel was quickly hauled in for a dilation and curettage (or D&C) to remove part of her placenta that was still inside the uterus. This condition is rare, but when it does occur, it can become life-threatening, according to the American Pregnancy Association. The surgery went well, and by the end of the day, Kimmel was on her way home. She was given medications to help increase her iron levels, and she says it took about a week for her face to gain color again.

“Don’t be shy about asking those questions [about PPH],” she shares. “Trust your gut.” You know your body better than anyone else—if you suspect that something’s wrong after you’ve given birth, call a health care provider immediately to save time and ensure your safety. And if you’re pregnant and concerned about PPH happening to you, find out what precautionary measures your delivery hospital has in place.

Since recovery time is usually brief, the aftereffects of PPH may be primarily mental or emotional—for example, offers Rinehart, PPH can interrupt bonding or breastfeeding, which is hard on some moms.

Losing a lot of blood is obviously very scary and stressful as well. Some women may therefore be fearful of having another child and experiencing the trauma of PPH yet again. “We had always kind of thought we’d have multiple children, and after that I was very scared for my health,” Kimmel admits. Though you are more likely to experience PPH if you’ve gone through it previously, the reoccurrence risk is only 15%, says Rinehart. If you’re worried about another delivery after PPH, make sure your provider knows you had it last time, and that they’re equipped to handle it if it happens again.

Despite their worries about having a second child, Kimmel and her husband finally “decided to go for it,” she says. They had moved, and she felt very confident in her new health provider, who listened and took extra precautions. Baby Jorie arrived, and Kimmel says she breathed a sigh of relief when the first week passed without incident.

“It’s not a topic I’d ever want to scare new mothers about,” Kimmel says, “but at the same time, I think it’s important to know about. I think it’s good to be aware.” ●

Best: Moms & Babies 2020 Winners local moms’ picks for all things baby

You’ve got enough to worry about, Mom—let your fellow mamas help you check off some of your todo’s, like finding the right child care provider and signing up for parent-and-baby classes. Every year, we poll our readers to get their top choices for child care, swimming lessons and more. Here are the winners, including people who specialize in helping you get that elusive thing called “sleep.” (The winners were originally announced in the

February 2020 issue of DFWChild.)

Best Child Care Center

Our readers trust Primrose Schools, which was founded over 30 years ago, for their babies’ educational growth. The private preschools provide care and classes for littles as young as 6 weeks old, nurturing infants’ development through movement, music, sign language and more. Titled Balanced Learning, the curriculum places equal value on a variety of learning areas so kids leave fully equipped to enter preschool or big-kid school. All teachers have experience in child development and are first aid– and CPR-trained. Multiple locations primroseschools.com Best Babysitting Service

When our readers and their partners need to take the night off, they call Mom’s Best Friend—a household staffing agency (with decades of experience serving families) that is quite literally a mom’s best friend. Much more than a babysitting service, MBF matches families throughout DallasFort Worth with full- and part-time nannies, housekeepers, personal assistants—even chefs. Their sitters are all certified in CPR and first aid, in addition to completing a 10-step screening process. They can care for littles as young as newborns. Calling or search online to find a sitter. mbfagency.com Best Parent & Baby Classes

For fun time with a side of educational play, The Little Gym’s parent-and-child classes are a favorite among our readers. The 45-minute classes (for babies as young as 4 months) involve age-appropriate activities and exercises; the theme, music and gym setup change each week. As young children are exploring and learning about the big world around them, classes focus on developing strength, balance and spatial awareness, plus social skills. Locations in Dallas, Fort Worth, Frisco, Keller, Mansfield, Plano and Saginaw; thelittlegym.com

Win Kids is a perennial favorite among our readers and their kids. During 45-minute parentand-child classes, littles as young as 6 months learn the fundamentals of gymnastics. Depending on the child’s age and skill level, activities range from gym basics such as rolls and trampoline to handstands and cartwheels (for 2- to 3-year-olds). Win Kids is also offering a Ninja Tots class for parents and toddlers, which still focuses on basic gymnastics skills while incorporating obstacle course activities. Call for a

free introductory class. 3000 Waketon Road, Flower Mound; winkids.net

Best Infant Swim Classes

With heated, saltwater pools (with a max depth of 4 feet), it’s no wonder families flock to Emler Swim School for kiddos to earn their fins. As an added bonus, pools boast ultraviolet water purification systems, and some locations have dehumidifiers. The veteran Best: Moms & Babies winner offers year-round swim lessons for children as young as 2 months. Swimmers move up levels as they get older and master breath control and independent movement; until then, as your little one splashes away, you are right there in the water with them. Locations in Allen, Coppell, Dallas, Fort Worth, Frisco, Plano, Sachse and Southlake emlerswimschool.com

For teaching their kiddos to safely navigate the water, our readers trust Aqua-Tots Swim School. Thanks to an indoor heated pool, Aqua-Tots offers lessons (for littles as young as 4 months) all year long. Parentand-baby group lessons have a maximum of four students per class, but the school also offers private and semi-private lessons. And if you happen to miss a class (because let’s face it—life gets busy), Aqua-Tots has make-up lessons too. 6060 Long Prairie Road, Suite 100, Flower Mound; aqua-tots.com Best Sleep Consultants

Families in North Texas turn to Live Love Sleep to help their littles start catching their ZZZs. Founder Kaley Medina starts working with families as soon as baby comes home to set them up for success before sleep training can begin (around 3 months old). LLS creates a customized sleep plan depending on your family’s needs, taking into account your parenting style and your child’s personality. Local parents typically select the in-home consultation, during which LLS experts pay a visit to review the new sleep plan and help you implement techniques to get your baby to sleep. Recently, LLS also began offering services for adults—because we’re all at our best when we’re rested. livelovesleep.com

Our readers continually trust certified sleep consultant Mary Cantwell for her dedication to bringing restful nights to families across Dallas-Fort Worth (and beyond). Rest To Your Nest was born from Cantwell’s own exhausting struggles with sleep upon giving birth to her first son. Her program (which takes a holistic approach) begins with an evaluation call, followed by a customized sleep plan. Cantwell educates families on the art and science of sleep, with the goal of bringing clarity and sanity back to your brood. resttoyournest.com Best Sleep Disorder Experts

Sleep is baby’s (and Mom’s) best friend, we know. So when things are going awry in the snooze department, our readers call the Children’s Health Sleep Disorders Center. Their boardcertified physicians, psychologists, respiratory therapists and sleep technologists (yep—it’s a whole team!) determine your child’s diagnosis and come up with a personalized plan. Plus, their facilities feature amenities for ultimate kiddie comfort, including TVs, games and themed rooms. 2620 N. Stemmons Freeway, Dallas 7609 Preston Road, Suite P1100, Plano; childrens.com

When their littles are tossing and turning, our readers trust Cook Children’s Sleep Center to diagnose their troubles and help them get some muchneeded rest. The center has pediatric sleep medicine physicians and a sleep psychologist on-site and boasts kid-friendly rooms so your child feels right at home during overnight testing. This year, the center is welcoming a new nurse practitioner who specializes in sleep disorders. Though the Fort Worth center has the overnight sleep lab, sleep specialists also see patients in Denton, Southlake, Alliance and Mansfield. Cook Children’s is welcoming pediatric sleep patients at its brandnew Prosper location this year too. 1500 Cooper St., Fort Worth cookchildrens.org ●

When it comes to your health and the health of your baby, there’s no room for compromise. Each year we call upon our readers to nominate a special doctor who’s gone above and beyond. Visit our website’s Mom Approved directory to find your favorite future doc.

Jim Schermerhorn, MD Obstetrics & Gynecology 6x Mom Approved

Women’s healthcare and grandkids are Dr. Jim Schermerhorn’s passions. He and his family have been living and working in the East Dallas area for over 30 years. The moment you walk into the office, you’ll be treated like family. Dr. Schermerhorn provides the most up-to-date medical care, from obstetrics to minimally invasive treatments like robotic da Vinci® surgery, aiming to get you back to your life quickly. His medical care focuses on your very specific needs. Your story is what matters, and Dr. Schermerhorn will take the time to learn about you. Let Dr. Schermerhorn show you that personalized, family-centered medicine still exists! In fact, Dr. Schermerhorn personally delivers almost all of his patients’ babies. His practice is located close to White Rock Lake. Serving as chairman of the Obstetrics, Gynecology and Pediatrics Department, Dr. Schermerhorn is your healthcare champion in the White Rock community. Please call today to speak with a staff member about scheduling your appointment.

James E. Schermerhorn, MD, FACOG 1151 N. Buckner Blvd., Ste. 206 Dallas, TX 75218 • 214-320-8447

Dr. Diane Colter’s passion to be the most caring and compassionate pediatric dentist led her to open All About Kids Dentistry, which specializes in treating infants, children, teens and kids with special needs. She loves working with children and has a very caring and compassionate personality. It is of utmost importance to provide outstanding care along with an inviting atmosphere where both the parent and child will have a positive experience.

Dr. Colter grew up in Athens, Texas. She completed her degree from Baylor College of Dentistry, where she graduated in the top of her class. She completed a Residency in Pediatric Dentistry at the University of California Medical Center in Los Angeles, serving as chief resident.

Dr. Colter is a board-certified pediatric dentist recognized as a Diplomate of the American Board of Pediatric Dentistry. She also holds a staff appointment at Children’s Medical Center. Dr. Colter is a member of the American Academy of Pediatric Dentistry, American Dental Association, Texas Academy of Pediatric Dentistry, Texas Dental Association and Dallas County Dental Society. Dr. Colter has also been recognized many times by her fellow dental professionals as a top pediatric dentist in the area as published in D Magazine D Best and Texas Monthly’s Super Dentists.

Away from the office, Dr. Colter enjoys spending time with her husband, Dr. Shandon Colter, their beautiful children, Sydney and Landon. Dr. Colter also enjoys traveling, and time spent with friends and family.

All About Kids Dentistry 12300 Inwood Rd., Ste. 220 Dallas, TX 75244 972-233-4439 allaboutkidsdentist.com