I’ve been asked many times what’s the weirdest thing in my homebirth bag… Well, I’d have to say condoms now! Yes, you read that correctly. I’m now carrying latex-free condoms. Yes, they work well for preventing pregnancies and STIs, so why would a midwife, delivering babies, be carrying them?
Well, I recently attended a great workshop put on by the Oregon Midwifery Council who brought in a local OB-GYN from the area. I had been hearing about this interesting method for controlling postpartum hemorrhage but hadn’t yet been taught how to use it (or even seen it used).
In Oregon, as a Licensed Midwife, I carry specific medications in case of a postpartum hemorrhage (when the birthing person heavily bleeds after the birth). I sometimes start with certain anti-hemorrhagic herbs such as Shepherd’s Purse, Angelica, or cinnamon. It really depends on the situation and how the birthing person is handling the bleeding. Sometimes the herbs work wonderfully well and we can all focus back on the normal immediate postpartum (you know, cooing over the cute baby, helping mama nurse, doing a full newborn exam on the baby, cleaning up our supplies…). But sometimes, we need more help. Occasionally I’ll go right for the pharmaceutical medication if that’s what indicated instead of herbs and other times, I’ll try the herbs first and then use the meds. I carry Pitocin, Methergine, and Misoprostol- all have their specific indications for use. All but rarely, these medications stop the bleeding and we can, again focus on the more-normal parts of the immediate postpartum and replenish the mama as needed (an IV can really help in this situation and then iron building supplements soon after).
So what happens in those rare cases that all our herbs and medications don’t work and bleeding continues? This is an instance where, as midwives, we go into emergency mode, place our hands on the mama in specific positions (it’s called bimanual compression) to limit anymore bleeding and transport to a hospital immediately for more tools.
But wait, here come the condoms! So, a devise had first been described in 1951 as a balloon tamponade and then in 1999 a more specific uterine balloon tamponade came in to play. The FDA approved this devise, called the Bakri balloon in 2006. It’s basically a balloon that you inflate in the uterus to put pressure from the inside to stop uterine bleeding. Great, right?! Well, it gets better… that devise is very expensive BUT you can use a condom and some supplies from our own homebirth kits to make a homemade uterine tamponade! And, according to studies it works just as well as the expensive Bakri balloon. With the insertion of this devise, it gives us time and breathing room to get to a hospital safely for further help without the birthing person losing more blood. It’s also amazing to have for rural home births or in other countries where hospitals are far away and transporting to the hospital with someone bleeding could be a very scary situation.
I’ve dealt with my fair share of bleeding as a midwife, but I’m excited to have learned a new method for those more intense bleeding situations. It’s cheap and easy to make and now I get to say I carry not only cool instruments, lots of gauze, some herbs and meds, but also condoms now! Honestly, I’d be OK with not having the need for this devise but I’m ready if we do need it!
Here’s to continually learning, updating our midwifery practices and condoms for the win!