Blog of Bloodworks Northwest

Not as Expected - Molly's Story (S1 E12)

Bloodworks Northwest Board Member Molly Firth, figured she was just going to have a baby. Then she figured she was just going to have a C-section. What happened next is how Molly Firth survived what turned out to be the fight for her life. But as she looked back on what happened during the dramatic delivery and its aftermath, she made a startling discovery that hit pretty close to home and made her realize the impact that Bloodworks Northwest. Molly Firth calls it a “full circle moment.”

Listen below or read on for a full transcript.

Molly: After three hours of pushing, the doctor was like, “You know, baby’s not really dropping. I think we might need to do a C-section.” I was like, “No, no, I can do this. Give me one more hour. One more hour. I can do it.” I couldn’t.

John: Hi. I’m John Yeager and this is “Bloodworks 101,” a monthly podcast produced by Bloodworks Northwest, a Seattle-based nonprofit providing blood and blood products to almost 100 hospitals across the Pacific Northwest. Thanks to close to 250,000 generous donors and volunteers. About 2,000 people work for Bloodworks Northwest, people like my colleague, Kristen Rohrbach, who comes to us today with a good story. A great story. Kristen, what’s this one about?

Kristen: I had the privilege of sitting down with Bloodworks Trustee, Molly Firth, and Bloodworks Medical Director, Dr. Kirsten Alcorn. Molly is a postpartum hemorrhage survivor, receiving multiple transfusions to save her life. This is a story of connection and digging deeper into what goes into saving a life when someone is having a hemorrhage. Here’s Molly’s story.

Molly: So, I went into childbirth, thinking that I was gonna have a natural delivery, which was hilarious in retrospect because I did not. And I immediately had an epidural. And then I ended up laboring for a really long time, I was determined to push that baby out and I didn’t know what I was having. So, I was very excited and nervous and just kind of on edge about everything but really excited to meet the baby. And after about four hours of pushing, well, after three hours of pushing, the doctor was like, “You know, baby’s not really dropping. I think we might need to do a C-section.” I was like, “No, no, I can do this. Give me one more hour. One more hour. I can do it.” I couldn’t but I tried valiantly. And so they prepped me to go into the OR for a C-section, and I remember looking at my doula and saying, “What’s a C section, everybody has C-sections these days, like, no big deal, this will be fine.” I think I underestimated in general how traumatic a C-section can be.

But I also remember them asking me my blood type and then pulling a sample of blood, and then being told that they had to pull another sample because they always want two samples and I was like, “Okay, well, I’m O pos, so here’s my sample of blood.” Then the baby came out. It was girl, I was stunned because I was convinced I was having a boy because I really wanted a girl. And so, soon after that, I started feeling a lot of pain from what they were doing and started thinking, “Wow, these C-sections you actually feel quite a bit, like, nobody tells you of that.” And at some point ended up losing consciousness and I woke up the next morning in the ICU very confused. I was confused. I remember thinking, “Why am I in the hospital? Did I have a baby? Was I pregnant?” So, all those thoughts of, you know, coming out of being under and just being very confused. And I learned in the ICU that I had lost a lot of blood and had a seven-unit blood transfusion and they were very worried about my blood pressure.

I didn’t get to hold my baby until later that day, they had to bring her up, I was by myself most of the day. And was in ICU for the first two days basically of her life. So, it was very traumatic and not what I expected. You do not go into childbirth thinking that you’re going to wake up in the ICU. You think you’re gonna have the experience that everyone has when they get to hold their baby and have skin to skin contact right away. And my experience was not what I thought it was going to be. I was bleeding at a rapid rate and that the placenta wasn’t coming away from my uterus. And what they thought had happened was this condition called placenta accreta, which was then confirmed in the pathology. If there wasn’t blood there I would not be here because it was coming out at a very rapid rate apparently. I was in the hospital for four or five days. In the hospital, I didn’t do anything to help care for the baby other than feed her because I had a catheter. I wasn’t really supposed to be carrying her for like six weeks because on top of a C-section, you know, just the additional trauma that my body sustained.

It was so much worse than a normal C-section that it took a while to feel myself and it took actually quite a while for my iron to come back up. It was a few weeks before my iron was at a level that they felt comfortable with. They were just pumping the blood in and trying to stop it from bleeding out. I was clearly in the right place when it happened, thankfully. It could have been a different outcome. But being in the hospital, having blood on hand was definitely the critical factor here in saving my life. I had a postpartum hemorrhage and I needed significant blood transfusions. And, you know, they expect some amount of hemorrhage when you give birth because there’s that baby coming out of you. But the level of blood loss that I experienced was about 6 liters.

Kristen: After hearing Molly share her story, we sat down with Bloodworks Medical Director, Dr. Kirsten Alcorn, to learn about what goes on behind the scenes when a postpartum hemorrhage occurs. So, when a woman is hemorrhaging in childbirth, how is Bloodworks involved typically?

Dr. Alcorn: So, in our region Bloodworks is primarily involved through the supply of blood and other blood products including the red blood cells, the platelets, plasma, and the cryoprecipitate. Those are the main four products that we use. And so Bloodworks provides those to all of the regional hospitals. And then each of those hospitals has to have a method to store the blood products, match them up with patients correctly, and get them out from the laboratory area to the patient care area. And that’s the transfusion service. Each of those transfusion services needs to have a medical director and Bloodworks does provide medical staff to do that at many of our local hospitals. So, what most of us have is something along the lines of what we call a massive transfusion protocol. And that usually has some special considerations when it occurs in an obstetric setting. And the main special consideration in the OB setting is that women who are pregnant have very high fibrinogen levels, and those levels drop very rapidly in the setting of a peripartum hemorrhage.

Fibrinogen is a protein made in the liver that has an important role in clotting. And so, it goes up as a so-called acute phase react when our bodies are reacting to something it will go up. When we’re pregnant, it goes up a lot and it stays high for most of the pregnancy. So, when we don’t have enough our body doesn’t clot properly. And so, we can refill the tank, so to speak, just like with red blood cells, we can replace fibrinogen in the form of this blood product we call cryoprecipitate. Cryoprecipitate is made from plasma, and plasma is the liquid component of blood. When somebody donates whole blood, we separate it into components. We generally will make red blood cells, platelets, and plasma from it. And then we can freeze the plasma, that’s the most common way that we store plasma. After it’s frozen, we can thaw it in a refrigerator and a little bit of proteinaceous material falls to the bottom. And that little blob of protein is cryoprecipitate.

So, we remove that from the plasma and we can transfuse it on its own as cryoprecipitate. So, one of the things that we do special for OB hemorrhages is to provide extra fibrinogen in the form of cryoprecipitate.

Molly: I have been a trustee now for a couple of years and I just one day happened to be looking in my chart from Polly Clinic. So, because of the fact that Polly Clinic is staffing the ICU at Swedish First Hill. I realized that there were a bunch of unread lab results and I was like, “What are all these unread lab results?” And so I was going back through and they were all from Claire’s birth. And then I saw a familiar name, Dr. Alcorn early in my days at Bloodworks, and so I was like, “Oh, look at that. I see her name, cool. I’m gonna email her and thanks for being a part of this and helping to save my life.” And it was just a nice, like, full-circle moment, which I’ve had many of in doing different advocacy work around maternal mortality and morbidity. And this was one of my favorite full circle moments to be able to say thank you to another person who was involved in helping to keep me alive.

So, I knew that Bloodworks was involved and that’s why I was on the board. That’s what drew to being on the board and being involved in the organization. Because I knew that without this organization, I wouldn’t be here.

Dr. Alcorn: Well, I think it’s sweet and gratifying. And it is nice to know when you touch somebody directly. And so, thank you for sharing that. I’m glad that we had all of those processes in place. It’s just an amazing thing to see in the laboratory, to be honest, when we have these massive transfusion situations because the laboratory staff goes into this groove where they are really coordinated, and moving quickly, and following up, and making sure everything that’s needed at the bedside is there. There’s a lot of different communication and all that stuff has to get coordinated. Cryoprecipitate, like I mentioned, it’s stored frozen, plasma is stored frozen, red blood cells are refrigerated, platelets are kept in an incubator at room temperature. So, each one of these products is coming from a different part of the room just to begin with because they’re in a different type of storage container.

So, just to get all of that together into a package and out the door, and potentially in pieces, because, while the plasma is thawing the red cells can be getting transfused. So, it’s really kind of a beautiful thing.

Kristen: Are they bringing you in when it becomes a more extreme case and then consulting with you along the way as this all progresses? Can you kind of explain how that might happen?

Dr. Alcorn: Sure, we have basically a trigger call. Any time a massive transfusion protocol for any reason is called, that physician on call gets paged. So, they know right away that something is going on. And then we can gather from the initial information as to exactly how much involvement might be needed. Sometimes though it goes on a little bit longer. And so, that’s where we tend to be more involved when there’s a larger volume of need.

Kristen: And so, in Molly’s case, I know you don’t know the specifics, you haven’t delved into specifics of Molly’s case, but someone like Molly who was losing over six liters of their blood. How long of a process is that to figure it out just to give some context?

Dr. Alcorn: Probably for a case like yours, the event was probably two to three hours long, would be my guess.

Molly: Might have been a little bit longer.

Dr. Alcorn: Yeah. From the time of transitioning from a routine C-section to we’re getting a lot of blood loss, and let’s transfuse a little bit to see how we can do, to, oh no, this is a lot of blood loss and we really need to turn on that massive transfusion protocol, to all the stuff they’re doing surgically to help resolve it. And in your case, that would have been a significant amount because a placenta accreta, that’s exactly what it is, the placenta is stuck in the uterus. And that requires surgical attention. So, this will take some time to resolve while the surgical issue is being dealt with, and then the patient is being closed after that. And then there are all of these metabolic and physiologic changes that happen when you have a hemorrhage called coagulopathy of hemorrhage because our coagulation system just doesn’t work normally and it requires all of this transfusional support.

Molly: I think also the, like, you don’t just lose blood and get blood, you get blood in different combinations. And so, it’s actually funny because I realized I had this light bulb moment within the last year that I didn’t actually get seven units transfused. I got seven units of red blood cells transfused and like a little magical combination of cryoprecipitate, platelets, and plasma. And I haven’t exactly, like what it was, but in my mind being totally educated on this beforehand, like, I was just like, “Oh, I lost six and a half liters, I got seven liters. Like, that makes sense to me.” And what I didn’t understand was that it was actually more than that. I think when I added it up, it was like 16 units total.

Kristen: It’s like this mathematical concoction that we don’t realize happens.

Molly: Yeah, it’s so easy to just think about the, like, somebody gave blood, blood came to me. Cool. Like, that’s awesome. But when you like have to understand, like, all the work that goes on very quickly to separate the blood out into the components, to make sure it gets to the right places. I mean, it’s all so fascinating and crazy, and that’s why this is such an important operation as an organization, I mean, it’s just so much bigger. And then you get beyond that and realize that it’s so much more than just the, like, transfusion piece. And that we’re doing all this research, and center for bleeding disorders and all this other cool stuff.

Dr. Alcorn: Pretty much anything that touches blood or blood therapeutic we do it.

Kristen: You’re there. You’re in it.

Dr. Alcorn: We’re doing it. And that’s a big commitment and something that our healthcare teams take really seriously. I really love educating the community, getting people excited to understand why they should and would be interested in donating blood. If you aren’t gonna roll up your sleeve and donate some blood product, that’s fine. There are a lot of ways to participate. And I think that that’s one of the great things about it because there is a way for everybody who’s interested in supporting the blood supply, blood research, taking care of patients through any kind of blood related therapeutic to participate with Bloodworks and help keep it going and moving forward.

John: Thanks, Kristen. Well, that’s about it for today’s edition of “Bloodworks 101.” If you like what you hear, please subscribe to “Bloodworks 101” or if you have an idea for an amazing story we should follow up on please contact us at I’m your host, John Yeager. Thanks for listening.

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September 1, 2020 4:25PM

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