India Rutherford’s childbirth story isn’t for the faint of heart. The Nebo resident underwent a routine cesarean section (C-section) to have her daughter, Ayiah, delivered.
During the procedure, fibroid tumors were encountered, which contributed to a massive hemorrhage. In all, Rutherford lost 6.5 liters of blood—essentially, the entire amount of blood in her body.
Such an event seems unlikely to have a happy ending, but thanks to a quick-acting team of providers and a new hemorrhage protocol, Rutherford survived the ordeal and quickly recovered.
“I was awake while most of this was going on,” said Rutherford. “I was bleeding all over the place, and they had to give me 6 liters of blood—but they didn’t panic. They did what they had to do, and it worked.”
Rutherford’s providers were ready to spring into action quickly and effectively because of a hemorrhage protocol Mission Hospital recently initiated. Breanna Bolivar, MD, MPH, an OB/GYN with MAHEC OB/GYN Specialists, said the protocol is a multistep process:
Risk assessment: All patients who are admitted to labor and delivery are given a hemorrhage risk based on history and current risk factors. “This assessment helps us plan for the patient’s labor and delivery accordingly,” said Dr. Bolivar.
Rutherford said she clearly remembers discussing her risk with her doctor. “We talked about how I was at high risk for a number of reasons,” she said. “I was anemic; I had fibroid tumors; and I had a minor hemorrhage two years ago following another C-section.”
Education: Physicians, nurses and other labor and delivery staff are educated on the stages of an obstetrics (OB) hemorrhage.
Availability of a hemorrhage cart: “We have a cart similar to a code cart that is specifically made for postpartum hemorrhage,” explained Dr. Bolivar. “It can be taken into the patient’s room or the operating room, and it has all the supplies needed to take care of the patient.”
Establishment of code and code team: Another element of the protocol is the addition of Code OBH. The code is called overhead during a massive OB hemorrhage and brings a code team to the patient’s bedside. The team consists of nine members: OB safety consultant, labor and delivery nursing unit secretary, OB nurse, anesthesiologist, certified registered nurse anesthetist, rapid response nurse, transfusion services representative, phlebotomist and the chaplain. “Having a large team of staff who is well prepared to help allows us to aggressively resuscitate the patient and hopefully avoid organ damage, emergent hysterectomy and avoid transfer to ICU,” said Dr. Bolivar. “We know that early transfusion is key in preventing adverse outcomes in massive OB hemorrhage.”
Due to the availability of the cart and the quick action of a well-educated code team, Rutherford was able to receive treatment right away without being moved to another location. “I can’t believe how quickly and smoothly it went,” she said.
According to Dr. Bolivar, the Code OBH team at Mission Health is practiced at dealing with high-risk patients who have been transferred from throughout western North Carolina. “This means we have to be ready for anything,” she said. “As a result, Mission is a safer place to welcome your newborn into the world.”
The expertise of the Code OBH team and the efficiency of the protocol undoubtedly saved Rutherford’s life. Despite the dramatic blood loss following her delivery, she recovered quickly. In fact, she didn’t have to remain in the hospital any longer than the average three-day stay.
“For me to be alive right now is amazing,” said Rutherford. “I thank God every minute that I’m alive, and I’m very thankful to all the people who worked so quickly and calmly to save my life.”
For more information on the maternity services provided by Mission Health, please visit mission-health.org.
Breanna Bolivar, MD, MPH, is an OB/GYN with MAHEC OB/GYN Specialists. (828) 771-5500
By Jennifer Sellers
Postpartum Hemorrhage Risk
The overall risk of postpartum hemorrhage (PPH) is approximately 3 percent to 5 percent of all deliveries, said obstetrician Breanna Bolivar, MD, MPH. Anyone who has had a prior PPH is at an increased risk for another PPH. Other factors that increase risk are:
– Prior C-section
– Multiple gestation
– Suspected large baby
– Placenta previa
– Active bleeding
– History of bleeding disorder
One Pint of Blood Can Save Up to Three Lives
In 2013, more than 5,300 patients received blood transfusions at Mission Health. Consider donating blood. With about 45 minutes, you can help save a life of someone you may know. The Blood Connection is Mission Health’s exclusive supplier of blood. “Since we are the area blood bank for area hospitals, the blood we collect helps save lives in the community,” said Donna Ehrlich, director, Donor Resources and Marketing, The Blood Connection. “It’s a great way to give back.” Find locations and times for Mission Health blood drives in the insert between pages 16 and 17 of this magazine. To learn more about the blood-donating process, visit thebloodconnection.org.