Manual Clot Extraction Following Birth (Sequestered Clots)

There is a new blogger at Science and Sensibility—a science writer (and pediatrician) named Tricia who is going to be writing about patient safety and other interesting topics. She wrote an article for the online medical journal Pulse about her traumatic post-birth experience that involved (among other things) a large number of clots and a painful manual extraction.

What an intense story it was. I had a manual clot extraction following my first son’s birth and my uterus literally HURT while reading her story and remembering that experience. However, unlike Tricia, I was at a birth center and had a very gentle, caring doctor who was wincing as she did the extraction saying, “I’m sorry, I’m sorry. I know this is hurting you.” Even so, it was an excruciatingly painful experience—the most painful physical experience I’ve ever had. Uteruses are simply not MEANT to have hands in them. And, birth is about things coming out, not going in! I was left with lingering questions about why the doctor did a manual extraction instead of having me squat to see if the clots would come out on their own. Perhaps it was a more serious situation that I realized at the time and she was just playing it cool. I can find almost no information online about this type of an experience, just a small mention in one of my midwifery texts about “sequestered clots,” which is I guess what I experienced.

Reading about this other blogger’s experiences really brought back this painful experience for me. I have noticed a tendency amongst childbirth educators and doulas to sometimes only focus on the good and empowering parts of births and to overlook or not mention the “traumatic” parts. Personally, I felt so good OVERALL about my birth experiences, that it seemed like a “betrayal” of sorts to talk too much about the parts that were not as good. While I experience giving birth as the most powerful, transcendent, empowering, and just super awesome cool, experience of my life, when I take a couple of steps back into memory I also realize that each of my births involved a certain element that was significantly traumatic as well. With my first it was the manual extraction and then my postpartum recovery from what I feel like was a very mis-diagnosed/poorly treated labial tear. With my second, it was recovery from a very similar tear right next to the old one (but with the visually traumatic addition of bruises). I really felt like I had “failed” in some way to have not protected myself from tearing again in such an unusual and very awful way. Someday I would like to write a blog post or article about this—I find that labial/clitoral tears are a significantly overlooked subject in the birth and midwifery literature. Indeed, I hadn’t even it was possible to have a non-perineal tear. If they are mentioned, it is in some dismissive way about “skid marks” or “labial split” or “a little burning when you urinate,” not in terms of the fairly significant genital mutilation I experienced.

I also had an intense amount of clots following my third birth (second trimester miscarriage at home)–-“only” the size of grapefruits though, not “frying pans” as in Tricia’s story-–and when I finally went into the ER about it they acted like I was making a big deal out of nothing (“people have miscarriages all the time. They’re very common.”) They were not “sequestered” though, they were coming out (and coming out, and coming out). Despite these experiences, I was never classified as “hemorrhaging”—the ER doctor even said (with a shake of her head like I was an idiot), “you’re not hemorrhaging.” And, indeed, I did not have any postpartum symptoms of hemorrhage—no anemia or anything like that (though yes, loud heart-pounding-in-my-ears after this third birth). In addition to the more obvious trauma of having my baby die, the experience of very truly feeling close to death—of no longer being able to distinguish whether I was fainting or dying—is the thing I can barely talk about from this birth experience.

11 thoughts on “Manual Clot Extraction Following Birth (Sequestered Clots)

  1. I think you’re right about our disinclination to share the traumatic side of birth.

    My first birth was long and hard and my baby needed (very briefly) resuscitated – I know I shy away from mentioning it. Maybe because I don’t like thinking about it, or because I don’t want anyone thinking it was because it was a homebirth. Finally I realized that it was something I should be sharing – “oh, and this happened and the midwife did x, y, z” is more helpful than someone thinking it was an unusually smooth birth and we’re all fine despite being home.

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  4. I had a horribly tramautic birth in April 2011. Despite being a low risk case, I suffered a painful induction, very quick birth, followed by excruciating manual removal of blood clots (in my “recovery room” as my husband lay on one side of me and my new born lay in bassinet on the other side of me). I subsequently developed a condition called vaginismus, the effects of which I still feel today, greater than 2 years after the birth. There were a number of things that, I believe, contributed to the vaginismus, but it was the clot removal that was the most significant contributor. Reading this post has given me the smallest sense of relief knowing that I am not alone (as well as the link to the pediatrician’s story). I have struggled silently and shamefully through this pain – and as I get ready for baby 2 in March, I look forward to the opportunity to work through a birth plan with a caring, lovely midwife who has listened sympathetically to my story and has pledged to help me have the birth I want.

  5. Hi I was glad to find your blog, obviously not glad to hear of your experience but it made me feel less alone. I gave birth 6 weeks ago and the birth was wonderful, just gas and air,3 pushes and my beautiful son was born.
    My uterus stopped contracting afterwards and they didnt realise. By the time they did I was hemmorhaging badly and had to have manual clot removal in the delivery room which was worse than giving birth as I had no pain relief until someone shouted to give me gas and air. I lost 4 pints of blood in the end and my hb levels in blood went down to 6 from 13, i had to stay in hosp and have a blood transfusion and am on ion tablets for at least 6 months. I have felt so so ill and tired and trying to breast feed has been so hard and to look after our baby has seemed almost impossible at times. Now I am starting to feel better physically I have started to feel worse mentally about what happened, i just cant shake it and it was good to know Im not just being stupid. Everyone is so happy the baby is here and I am too but underlying all that I feel like I have been in a car crash and really vulnerable.

    • I’m glad it helped you feel less alone, but I’m also sorry you went through it too! 😦 I have not read many other women’s experiences with this type of extraction. It took me a long time to acknowledge my feelings of trauma after this experience (And, I can *still* feel that uterus “twinge” when I think about it). Best wishes for a full, healthy recovery and I hope caring for your baby becomes easier soon!

  6. Please contact me.
    I went through this manual extraction after birth and do not find a need for it, as I only lost 400ml blood.
    Why do they perform it?
    Is clotting due to stress in pregnancy and or labour?
    It was mentioned my placenta had torn from uterus. This may have been from my midwife tugging at my umbilical cord.
    Why couldn’t I just let the clots come out naturally over time?
    I felt how you did with the pain, in my words “horrific bullshit”
    Hope you can enlighten me as I’m 3 months pregnant with the next child. I’m looking at hiring a birth doula to advocate for me n even a possible home birth.

    • They perform it because it interferes with the proper clamping down of the uterus and can contribute to more bleeding. However, I question why other means are not tried first—like getting up or squatting to let them come out on their own, rather than going for a painful extraction. The clotting itself may be related to being in a prone or lying down position and is the body’s effort to “flush out” the placenta.

      Yes, your midwife could have contributed to the problem by tugging the cord (I think mine did too).

      I never experienced this problem again—I had two more full-term births after this one with no excessive bleeding at all. I hope the same is true for you with your next birth!

  7. Hi ladies!
    I suffered the same experience after the birth of my son in Oct 13. I had a successful vaginal birth without any pain relief( I wanted it but it was too late). My placenta was delivered and I was stitched up after a 2nd degree tear. Maybe 30mins after birth, I was holding my son and asked my husband to take him as I was either going to faint or throw up. I felt so sick. The OB came in and advised I am going to need to suck on gas through what he was about to do. I cannot remember an explanation. I do remember thinking, if I delivered the baby without gas then this is REALLY going hurt. Boy was I right! I have never felt pain like it in my life. He removed a 1kg clot and I passed further clots naturally the following day. I too was traumatised by this and found it hard to bond with my son immediately because I had been separated from him for hours, my parents were with him. Being bed bound with a drip and catheter for the following 24hrs also made it difficult. I required blood transfusions.
    When we got home, breastfeeding was becoming more of a challenge, Bub was more unhappy and I was running a fever. My bleeding also hadn’t slowed down. Luckily upon a visit to the lactation consultant at the hospital she registered that something wasn’t right. 5 days prior, when leaving hospital I had plenty of milk and at this appointment I had none. My little man was starving. Milk doesn’t dry up overnight for no reason, my OB saw me straight away and an ultra-sound showed my uterus was full and a mess. I was admitted for a D&C immediately. I had retained placenta and had an infection. I had to re- establish breastfeeding, which meant feeding and pumping around the clock. The whole experience was traumatic and I believe I was quite depressed for the 3 months following birth. To this day, I am angry about what happened. I couldn’t understand if they have all the equipment there. Why didn’t they do an ultra sound immediately after the clot extraction?
    I often wish that I could have a second child so I could have a do-over of those first few months just to heal and help with the guilt of not being a great mum in the beginning.
    It brings me comfort to know I am not alone. X

  8. Hi, I also had a manual extraction and I’m really struggling with getting over it. I had a fairly smooth labour with second degree tears, the extraction happened twelve hours later after I passed a large chunk of membrane, I sent my partner to get someone to help tidy up and he came back with a Dr who instructed me to lie on the bed and said nothing more than let have a look. No-one explained what was happening, I begged for it to stop and was too weak to get away whilst she put pressure on my uterus. I’m sick to death of thinking about it and the nightmares and of the tinge of bitterness I now feel towards my partner who brought the Dr to me, who stood and watched and did nothing while I begged for it to stop. I feel raped. How did you move past it? My partner is so wonderful, I hate feeling this way. I’m so angry that it happened. I’m struggling to believe it was necessary and terrified that it might have been and could happen again if we ever have another baby. I don’t know how to move forward and I desperately want to.

  9. My first child was born 34 years ago. My doctor didn’t make it in time for the birth. It was 2:30 am and the attending physicain didn’t wait at all for the placenta to be delivered. Before I knew it he just reached in and forcefully ripped it out. Within the hour I was passing clots the size of dinner plates. I am not kidding. I have not been well since that day. I know the pituitary gland can be damaged when this happens. My hormones are so messed up. I just learned this so now I have to find a doctor who will listen to me.

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