You Will Die if You Conceive

Behold, children are a heritage from the LORD, the fruit of the womb a reward. Like arrow in the hand of a warrior are the children of one’s youth. Blessed is the man who fills his quiver with them. Psalm 127:3-5a (ESV)

It was 2:30am as I placed some large, wet sponges over the open wound to keep it and the bowel moist. “Now, we wait to see if her bleeding slows,” I said to the OR tech across the table from me. I had just tied off the blood vessels feeding the uterus in an attempt to stop the hemorrhage. If that failed, hysterectomy was the next step.

My patient, 27 years old, had given birth just hours earlier. Nothing I had done helped slow the ensuing hemorrhage. Hemorrhage after or associated with childbirth can be so heavy, so much and so fast that it frightens the most seasoned OB doctor, and I was no exception. Women still die in childbirth and hemorrhage is a major cause. God was merciful to her that night. The bleeding slowed to a trickle. After several units of blood and a night in the ICU, she recovered completely.

“Can I have another baby?” she asked me on her day of discharge. I thought back to the horror of four nights earlier–my fear that she would die in my care, that I wouldn’t get the bleeding slowed in time to save her life. I got sweaty again just thinking about it. But, the bleeding did slow. The uterus still had plenty of blood flow to it in spite of the blood vessels I had ligated. I explained she could have more children, but that her risk of hemorrhage would be somewhat higher. And she did. Several more children, all without complications.

Several years ago, I was busy in the OR when my partner needed help with a patient hemorrhaging after childbirth. Since I couldn’t leave, they called someone else to help my partner. When I finished my surgery, my partner was already done and told me about the case. “I went right to hysterectomy. It was easier. Besides, she had three healthy kids already.” My partner had tried no conservative surgeries. Why? Possibly because of the severity of the hemorrhage (but I knew that not to be the case), or because of lack of skill to perform the more conservative operations (possible), or because my partner didn’t want the hassle of missing office with a long drawn-out affair in the OR when a hysterectomy could take care of the problem quickly and, besides, she had three healthy kids already.

Besides, she had three healthy kids already. My partner’s implication was clear. Time to stop. Three’s plenty.

Two times this week I’ve had consults with women who were told by their doctors to have no more children because of risk to their lives. After I reviewed the past records, I saw nothing with either that would preclude more children. The first patient hemorrhaged with her sixth and then told me the clincher. “My OB doctor told me six children was more than enough for anyone, anyway.” The other patient’s husband underwent vasectomy because the doctor told him his wife would die if she had another baby. How tragic.

I’ve done OB now for over 30 years now and I’ve cared for women experiencing about every complication that can occur related to childbirth. Hemorrhage, eclampsia (seizures), heart failure, kidney transplants, long-standing diabetes, uterine ruptures, fetal distress and severe infections to name a few. Many pregnancy complications are more likely to occur with subsequent pregnancies and can entail significant risk. When I counsel women on future childbearing, I never sugar-coat the risks. But, I’ve yet to tell a woman to never conceive again. I’ve yet to recommend a tubal ligation or hysterectomy because of pregnancy risk. (One of my patients underwent cesarean section seven times–so much for the “you can only have two or three cesareans” theory.)

Unfortunately, I see women again and again in my practice who have undergone a tubal ligation on the advise of their OB doctor, or been advised to stop childbearing because of excessive risk, or, as above, had a hysterectomy when a lesser surgery would have likely helped. Women who have received such advise should take it with a healthy grain of salt.

* Details of above stories altered to protect privacy.