Postpartum bleeding follows festive, ‘picture-perfect’ birth

Mom thought of husband and baby: “I don’t know if I’ll see these guys again.”

family with two kids smiling
family with two kids smiling

The birth of Kelly Krenzel’s second child was such a party that even her Sanford Health obstetrician-gynecologist couldn’t bear to miss it. It wasn’t on the schedule of Lacey Krebsbach, M.D., to work in labor and delivery that day, but she came in anyway to deliver baby Finnegan amid an atmosphere of costumes, games and a disco ball.

Soon, though, the birth experience Dr. Krebsbach describes as “picture-perfect” turned into an emergency. Krenzel laid unconscious in an operating room, the focus of two physicians working to stop such severe postpartum bleeding that, had Krenzel delivered in a developing country, she very likely would have died.

Forming a friendship

Listening to Krenzel and Dr. Krebsbach talk, they clearly adore each other. Krenzel chose Dr. Krebsbach at random and first met with her when Krenzel became pregnant with her first son, Henry, who was born three years ago. Now, half of Krenzel’s circle of eight friends have claimed Dr. Krebsbach as their OB-GYN. “We act like she has a secret fan club,” Krenzel said.

Krenzel easily lists some of Dr. Krebsbach’s virtues: sweet, compassionate, smart, relatable. Krenzel felt cared for as a person — “not just a vessel for this baby.”

“I just wanted to come flying at her with a hug every time I saw her because she’s just the best,” said Krenzel.

Dr. Krebsbach, meanwhile, says that even from their first meeting, it seemed like a beam of light shines from Krenzel. “She makes everybody around her feel like they are the most important person in the world.”

Facing her fears

With her first pregnancy, Krenzel said she had some anxieties. Most new moms do, of course, but Dr. Krebsbach agrees Krenzel perhaps had a few more than others.

“I like to know what I’m doing. Things that are new are sometimes hard for me,” said Krenzel.

There’s fear of the actual act of delivering. “A whole human has to come out of your body. That seems scary to me,” Krenzel said.

And then there’s the assumption that you’re ready for the responsibility of taking care of that whole new human. “You’re like, was I supposed to ask somebody?”

But Krenzel took childbirth classes to feel more prepared and credits her circle of friends and Dr. Krebsbach with calming a lot of the fears. Dr. Krebsbach said she tries to get to the root of what’s causing the anxiety and dispel myths encountered online or among acquaintances. “You develop a rapport” with patients over the course of visits, she said, which helps, too.

Special delivery

Both of Krenzel’s pregnancies were pretty uneventful, but because she had moderately high blood pressure, she was induced both times, and both on a Friday. Henry, her first, was five days overdue, and because of her schedule, Dr. Krebsbach couldn’t be the physician to help deliver the 8-pound, 8-ounce boy born at 9:20 p.m.

In a larger hospital, such as Dr. Krebsbach’s group of busy OB-GYNs at Sanford Medical Center Fargo in North Dakota, the physician on call is likely the one delivering the babies, even if a woman has been under the care of a different OB-GYN. However, Dr. Krebsbach considers all patients “hers.”

“I really look at any of those patients that come in as if I’d been taking care of them their whole pregnancy,” she said.

“We want a healthy mom and a healthy baby, and anything that we can do to make that happen, that’s what I’m there to do.”

Krenzel was monitored slightly more with her second pregnancy because, in delivering at age 36, she was considered “advanced maternal age.” This time, when she was induced at 38 weeks in October 2018, Dr. Krebsbach made arrangements with the OB-GYN on duty, Tamara Jacobson, M.D., to manage the majority of Krenzel’s labor, and then Dr. Krebsbach could come in toward the end to deliver Finnegan.

‘A special and fun moment’

Both women were thrilled to be together for the birth, which involved only 17 minutes of pushing this time, compared to an hour and a half with Henry.

“It really was such a special and fun moment and such a wonderful feeling,” Dr. Krebsbach said.

Krenzel agrees. “I had the best birth experience that day, and it was like the cherry on top that Dr. Krebsbach could deliver him.” Everyone in the room — including Krenzel’s husband, Scott Krenzel, and friend Jenny Olson — high-fived and hugged.

“You couldn’t have planned the more perfect labor and delivery, I think,” said Dr. Krebsbach.

Olson, a mom of three and another patient and “fan” of Dr. Krebsbach’s, was the one who actually brought the party to the room. As it turned out, Krenzel would rely on her cherished friend for much more in the days ahead.

Postpartum bleeding that wouldn’t stop

Scott Krenzel cut the umbilical cord for Finnegan, born at 6:53 p.m. and weighing 7 pounds 11 ounces. “I was excited,” he said. “I had another boy, and everything was looking good with him.”

Dr. Krebsbach stayed to chat a bit with Kelly Krenzel, who delivered the placenta and was able to start nursing Finnegan. Then Dr. Krebsbach left to go home, assured that her friend was good and stable. Since the delivery had happened during the dinner hour, the family ordered food.

There was no reason to suspect any problems, Dr. Jacobson said. But then a couple of hours after delivery, Kelly Krenzel started experiencing heavy bleeding. “I went from the highest high to the lowest low.”

Nurses massaged her stomach to apply pressure to help the uterus contract. “As they were pushing on it, I could feel a gush of something, and I wondered if they were blood clots,” Krenzel said. “It just kept coming every time they were pushing on my stomach.”

As the bleeding refused to stop, Krenzel and her husband both read concern on nurses’ faces. When a doctor was brought in, Scott Krenzel said, “that’s when it got a little more serious than jovial.”

Kelly Krenzel threw up a couple of times while her stomach was massaged, and she started to lose her hearing as her blood pressure dropped. Her body wasn’t responding quickly as they tried the usual medications and additional techniques that address postpartum hemorrhaging, which a hospital the size of Fargo’s sees minor cases of every day, Dr. Krebsbach said.

‘She didn’t think she was going to come back’

Dr. Jacobson decided it was time to take Kelly Krenzel into the operating room. As is standard, she called in the back-up OB-GYN, Joyoti Saha, to join her there just in case two doctors would be needed. She told Krenzel they planned to try some additional measures, including possibly a dilation and curettage, to stop the bleeding. As a last resort, however, Jacobson told her they might have to remove Krenzel’s uterus.

Before she was taken to the operating room — Olson walking alongside — and placed under anesthesia, Krenzel started to fear for her life. She looked at her husband holding her newborn son and thought, “I don’t know if I’ll get to see these guys again.”

She told him, “I love you. Take care of the boys.”

Scott Krenzel, who had met his wife of four years at a pizzeria and fell in love with her eyes and personality at first sight, remembers that moment well. “She told me to take care of our boys,” he said. “She didn’t think she was going to come back.”

Scott Krenzel’s past experience with a medically induced coma at MeritCare (now Sanford Health) left him with a sense of calm and comfort in hospitals. Clearly, he drew on that in this moment. “I had all the faith in the doctors, and they portrayed that they had the confidence that this was going to be OK.”

Still, the situation was taking a toll on him. “I held it together till she left the room, and then I kind of lost it,” he said.

A friend’s dilemma

Meanwhile, not knowing her friend lay in surgery while she was at home, Dr. Krebsbach received a page from work. That was a little unusual, because it meant a medical situation was occupying both the on-duty OB-GYN and backup OB-GYN, the required staffing level for a Level I Adult Trauma Center like Sanford Medical Center Fargo.

Dr. Krebsbach couldn’t come into the hospital at the time, but she logged on to see what kind of emergency was consuming the doctors’ time and energy. And then she saw the words “postpartum hemorrhage” on her friend’s chart.

Dr. Krebsbach was torn — she wanted to go into the hospital and help, but she also had complete trust in her two colleagues to take care of her friend as well as she would. Ultimately, she stayed awake at home much of the night to communicate with Jenny, who in turn updated Scott Krenzel as they waited together at the hospital.

Scott Krenzel had sympathy for what Dr. Krebsbach was going through at that point, too. “It was a great experience, and then all of a sudden she goes home and finds this out,” he said.

Rare case, rare conclusion

In the operating room, Kelly Krenzel continued to bleed despite measures the doctors were trying. They were giving her several units of blood as well.

“We always try absolutely everything else first,” Dr. Jacobson said. “We ended up doing a hysterectomy to basically save her life.”

That night, after delivering a baby vaginally but spending just a short time with him, Krenzel lay in a room filled with two doctors and an assortment of nurses and anesthetists, all focused on keeping alive a woman who meant the world to Scott, Henry and Finnegan Krenzel. She had her uterus removed, but she survived. It’s the rare postpartum bleeding that a hospital the size of Fargo’s sees only two or three times a year, when a woman’s body won’t respond to the usual interventions.

Globally, postpartum hemorrhage is the primary cause of nearly one-quarter of all maternal deaths, according to the World Health Organization. Women in developing countries are far less likely to have quick access to interventions used to treat severe bleeding after birth, such as effective medications or a medical team skilled in proper procedures.

Dr. Krebsbach said doctors have to respond quickly in these types of situations. They train for emergencies in OB-GYN residences, doing simulations and repeatedly going over the steps to follow based on protocols, with the goal of keeping a calm and level head. Nurses train for them, too.

Doctors also keep up with innovations, such as new medications or new tactics to try in situations like this, Dr. Jacobson said.

Doctors are aware they’re making decisions that could affect patients’ lives forever, Dr. Krebsbach said. “It’s a very scary time for patients.”

‘So grateful to just be alive’

After she woke up from anesthesia, Krenzel’s back hurt so much that it was all she could focus on. “I probably wasn’t acutely aware that I’d just had a baby,” she said.

The next day, she was still in a fog of medication, but she could start to process the fact that her uterus and Fallopian tubes were gone, though her ovaries remained.

“We were 75 percent sure we weren’t going to have more kids,” she said of her and her husband’s outlook for the size of their family. Still, “it’s hard to not have that decision be yours.”

But as she talks about a visit Drs. Jacobson and Saha made that day to explain everything that had happened while she was under anesthesia, gratitude warms Krenzel’s voice. “You could just tell they are quality people at their core, that it hurt them they had to do that. I was just so touched by their kindness and compassion; they deeply care what they’re doing,” she said.

“I was so grateful to just be alive.”

Doctors are affected, too

Dr. Jacobson easily recalls that conversation with Krenzel. “I just tried to approach her like she was a friend,” she said. She explained the technical aspects of the surgery but also took care to emphasize the necessity of the hysterectomy so Krenzel could continue to be here for her family. “It was mainly helping her understand why we’re making the decisions we make.”

Circumstances like this weigh on the physicians involved as well. Afterward, they don’t simply throw open the operating room doors and say, “OK, next patient!” “I feel like sometimes people think that we don’t get emotionally affected by what happens to them,” Dr. Jacobson said.

“It’s very mentally and physically exhausting.” After leaving the room, Dr. Jacobson said she just needs to sit for a few minutes, not talking or anything. “It’s just so much stress in the moment that you have to give your body time.” Then she goes over the steps of the situation in her mind, ultimately to reassure herself that she did everything she could have for the best possible outcome for the patient.

Dr. Krebsbach agrees about the challenges doctors can face. “As women and mothers, we use our clinic brain and skills to do what is right, but often our heart is breaking for the patient and their family when we are making those decisions.”

‘First time I took a breath in 24 hours’

Dr. Krebsbach, meanwhile, had planned to run the Sanford Fargo Half-marathon that morning with her husband. After not getting much sleep the night before, however, she wasn’t sure whether she was up to it. She had continued getting updates on Krenzel’s condition that morning, and in the end, she decided to run after all. “I think that was my way of handling the stressful situation.”

Apparently, it worked. She ran her personal best time ever, and she credits that to her eagerness to visit Krenzel afterward.

After all the trauma of the night before, Dr. Krebsbach anticipated Krenzel to be less than her typical sunbeam self, but then she stepped into Krenzel’s room.

“With Kelly, it always starts with a massive hug,” she said.

Reassured by Krenzel’s smiles and laughter, “it was the first time I took a breath in 24 hours,” Dr. Krebsbach said.

Still, the night had been rough. Krenzel lay in bed tired, sore, swollen, low on hemoglobin, foggy with medication and with an arm numb from attempts to find veins. As a result, Finnegan had turned 2 or 3 days old before she really could spend much time with him — or even decide his name with her husband.

A hospital ‘family’

Krenzel and her newborn spent a total of five days in the hospital. She feels blessed to have had the love and support of her friend Jenny, who spent the majority of the time in the hospital with her, including overnights, and helped with things her recovering body struggled with.

Krenzel also can list names of nurses and what they meant to her, including Julie, who helped her walk for the first time and give her a shower. She found the lactation nurses and specialists to be especially supportive, too, during her hospital stay and afterward. And she appreciated the two massages she received in the hospital.

By the end of her stay, “I truly feel like we left that hospital with a little tiny family of people who cared about us,” she said.

Nurses even came in during coffee breaks or lunch breaks to visit the family, Scott Krenzel said.

“We felt very well taken care of.”

Scott Krenzel brought their older son to visit his mom during her hospital stay, and the 3-year-old’s politeness impressed one of the cafeteria workers so much she gave him a cookie. Then the next day when Henry came in again, Krenzel said, the same worker had bought him an “I’m a big brother” balloon.

“We’re just very grateful for the generosity of the people at the hospital, and the way they treated us was fantastic,” Scott Krenzel said.

Lasting effects

Before Kelly Krenzel had her second son, she maintained a busy life. She works as a marketing and communications specialist for Hospice of the Red River Valley. In that role, she tells stories of people who, even as their lives draw to a close, are making the most of the time they have left.

Hospice work and her grandmother Freda, who had taught her gardening and much more, inspired Krenzel to start a nonprofit soon after Henry was born called Hope Blooms. That volunteer-driven group repurposes donated flowers from special events, grocers and wholesalers, taking the arrangements apart and delivering new bedside bouquets to community members who may benefit from a message of hope. “We’re on a mission to spread more joy and love in the community,” Krenzel said.

Six thousand bouquets have been taken to vulnerable people in a variety of places, including hospice care, a women’s shelter, nursing homes, the Ronald McDonald House and Sanford Roger Maris Cancer Center. Kids at Sanford Children’s have received floral crowns.

Before Finnegan was born, multitasking was a way of life for Krenzel, who tried to fit everything she could into her schedule. But she approaches life a little differently since his eventful birth.

“The universe was saying to slow down, and I’ve done that, for the first time in a long time,” Krenzel said. She recognizes now that it’s OK to say no to some things. And she recognizes it’s OK to say yes to others -– like carving out one-on-one time with Henry, even if it means he’ll stay up past his previously rigid bedtime.

Compelled to talk about ‘hard stuff’

Physically, Krenzel has healed well and feels back to normal. Emotionally, she has worked through a grieving process related to the hysterectomy. “Those first several weeks were really hard,” Krenzel said.

But she now feels strongly about revealing real life with others, not just lighthearted snippets on social media. It’s especially important to talk about the “hard stuff,” she said, to help women who might feel isolated and alone.

After having Finnegan, “I definitely feel stronger as a person and more passionate about sharing that experience with other people,” she said.

“I’m so thankful that I’ve been selected to be the mom of these two beautiful boys, but that doesn’t mean it’s easy. If I can make one person feel less alone, I’d like to do that.”

More information

Risk factors for postpartum hemorrhaging

About 1 to 5 percent of women delivering a baby will experience postpartum hemorrhage, which usually happens within a day of giving birth but can occur weeks later. Some women are at greater risk for postpartum hemorrhage than others. Since Kelly Krenzel’s blood pressure was under control, Dr. Krebsbach said Krenzel wasn’t considered to have a high risk of postpartum hemorrhage.

Conditions that may increase the risk include:

  • Placental abruption: The early detachment of the placenta from the uterus
  • Placenta previa: The placenta covers or is near the opening of the cervix
  • Overdistended uterus: The uterus is larger than normal because of too much amniotic fluid or a large baby
  • Multiple pregnancy
  • High blood pressure disorders of pregnancy
  • Having many previous births
  • Prolonged labor
  • Infection
  • Obesity
  • Use of forceps or vacuum-assisted delivery
  • Being of Asian or Hispanic ethnic background

Find more information

Posted In Children's, Emergency Medicine, Family Medicine, Gynecology, Pregnancy, Women's

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