Tuesday, January 24, 2017

A Very Austen Valentine's: Northanger Abbey



In preparation for Valentine's Day this year, and to commemorate some of my favorite books by a beloved author, I've decided to write a series of blog posts exploring love in Jane Austen's books.

Today, Jane is mostly known as the author of Pride and Prejudice, and for good reason: it is without question her most popular work, and it's film adaptions probably spawned the whole genre of modern Romantic Comedy.

What strikes me when I read her books, though is her distinct narrative voice. She isn't just telling a story, she's also giving a social commentary and it's a lot of fun to read about the people of her day, and notice the ways people have--or haven't--changed over the years. Even in her polite, restrained society people were delightfully eccentric

When it comes to romance, one of the fascinating things about Jane's writing is how pragmatically she approaches the subject. Ms. Austen is under no delusions when it comes courtship: It is, at it's most fundamental level, a business transaction; and that's not something to be feared or resented, but understood, utilized, and celebrated. As long as you understand the process, and understand your own worth (your assets and liabilities), you too can successfully invest in the marital economy!

Jane Austen's stories are less about finding "The One" and more about finding the relationship that works for you.

One of my very favorite of Austen's books is "Northanger Abbey". Like most of Austen's stories, it's primarily a coming of age tale. This one is about a girl named Catherine Morland. She's a small town girl and she goes to the Big City with some of her parent's friends.

Now, Austen goes at lengths to explain to us that Cathy Morland is an Ordinary ™ teenager girl.

She has no tragic backstory, she's not particularly "accomplished" (which is on olde timey way of saying "talented"), she's not particularly intellectual because even though she loves to read she mostly just reads for fun, and she's a bit naive (or as Austen puts it: as "ignorant and uninformed as the female mind at seventeen usually is").

She loves her family, and her friends, she's sociable and she loves to read about romance and adventure.

She expects people to be like the friends and family she's grown up with, and she expects the adventures in her life to be like the ones in the books she reads.

I have to put a bit of a disclaimer here:

If I had read the book first, I don't know that I would have found Catherine to be such an endearing character as I do. But I watched the 2007 BBC adaptation of the book first, and the actorss for Catherine Morland and Henry Tilney just nailed it for me. If I hadn't watched that first, I probably would have assumed she was a bit dim, but Felicity Jones' performance is so eager, and sincere, and pure...it's not hard to see why someone like Henry Tilney might have fallen in love with her.




These actors really communicate the subtleties in Austen's narrative. So especially if you're not familiar with old timey-wimey writing, I recommend watching it first.


Here's a excerpt of the chapter where Catherine Morland is schooled in the rules of courtship by her date:

"We have entered into a contract of mutual agreeableness for the space of an evening, and all our agreeableness belongs solely to each other for that time. Nobody can fasten themselves on the notice of one, without injuring the rights of the other. I consider a country-dance as an emblem of marriage. Fidelity and complaisance are the principal duties of both; and those men who do not choose to dance or marry themselves, have no business with the partners or wives of their neighbors."


Catherine calls bull; obviously shocked by how seriously her date takes courtship: 

"But they are such very different things! [...] People that marry can never part, but must go and keep house together. People that dance only stand opposite each other in a long room for half an hour."

^^I'm right with Catherine on this one, but then her partner starts making this analysis of why he thinks that way, and you realize he kind of has a point:

"You will allow, that in both, man has the advantage of choice, woman only the power of refusal; that in both, it is an engagement between man and woman, formed for the advantage of each; and that when once entered into, they belong exclusively to each other till the moment of its dissolution; that it is their duty, each to endeavour to give the other no cause for wishing that he or she had bestowed themselves elsewhere [...] In one respect, there certainly is a difference. In marriage, the man is supposed to provide for the support of the woman, the woman to make the home agreeable to the man; he is to purvey, and she is to smile.  But in dancing, their duties are exactly changed; the agreeableness, the compliance are expected from him."

Catherine's partner is a bit of a smartalek, but it also seems like he's a big jaded with the pretense involved in courtship: You're just trying to get to know each other, but you kind of have to put up a facade of "niceness" as well. His whole banter with Catherine, here, is pretty much his own weird way of asking: 


"Are you hanging around with me because you like me, or are you just being 'nice' ?"


When you look at it in that light, it seems like his extravagant way of talking is really just him screening people. I don't think he's consciously putting up walls or anything, but he is testing people to see if they're willing to put up with his personality...or if he has to be "nice" around them. 

As it turns out, Catherine isn't deterred by his weirdness, in fact she really seems to enjoy it. And as the story goes on, he comes to value Catherine's sincerity and regard more and more.


One of the most fascinating, albiet not conventionally romantic, aspects of this book is when Austen as Narrator steps in to explain how their relationship developed:

"Though Henry was now sincerely attached to her, though he felt and delighted in all the excellencies of her character and truely loved her society, I must confess that  his affection originated in nothing better than gratitude, or in other words, that a persuasion of her partiality for him had been the only cause of giving her a serious thought.


Then she adds (somewhat sarcastically):

"It is a new circumstance in romance, I acknowledge, and  dreadfully derogatory  of an heroine's dignity; but if it be a new as in common life, the credit of a wild imagination will at least be all my own."



So ladies, you heard it straight from Austen:

It's OK to tell a guy you like him!


Henry Tilney wasn't thinking of marriage when he went to that dance party in Bath, he was just a guy trying to get a hotel room for an awkward family reunion. But he hit it off with this girl, and because she wasn't playing by the courtship "rules", they now get to experience "perfect happiness" together.





Bonus:

"Hey Girl" Meme (courtesy of theotherausten)





Monday, December 19, 2016

Thoughts on Rogue One and the Star Wars Fandom

Hey Friends, I'm at work so this post will be a short. I just wanted to post that I saw Rogue One yesterday and I thought it was outstanding.

My sister said something to the effect of "It makes The Force Awakens look like crap" and I'll have to say there is some truth to that.

Over the years, the Star Wars franchise and fandom have kind of trivialized tragedy and loss, and Rogue One kind of smacked us in the face with the gravity of it.

Watching it was a fantastic experience, and I was shocked at how integral it all felt to the Star Wars Saga: illuminating themes and plotholes and delivering  them in a whole new light. (I highly recommend watching it in a double feature along with my favorite episode: A New Hope.)

But it's also the type of thing I don't want to share with the fandom right now. I'm not ready to contend with their negativity about how the CGI looked dumb, or how they changed too much from the trailer. Or how the content is not canonical anyway; or that it's basically Episode III's opening crawl....or just exists to explain away a plot hole in Episode III.

I just don't care for that discussion at this point.

I'm sorry you (that's a proverbial you, not a personal you) can't appreciate something for what it is. Embrace it's flaws and imperfections, and find beauty and meaning and motivation in it. 

So I'm keeping Rogue One all to myself. Nope, I'm not sharing. Not fair? Okay, you can borrow it when you learn how to treat it nicely.

Be good and have a Happy Christmas ;)

Monday, November 7, 2016

Mormonhippie Answers: Why Don't Mormons Drink Coffe?

The last few weeks some of my coworkers who know I'm a Mormon asked me about the whole 'mormon's don't drink coffee' rule and  I don't think I did a very good job at explaining it, so I'm going to try again here.

The coffee restriction is part of a health code called

"The Word of Wisdom"



(If that title sounds intimidating, it's not...it's basically just 'common sense diet and health guidelines')

But a lot of people really misunderstand what its all about, and many of us (People of the mormon faith) get so caught up in the rules themselves, we forget what the rules are actually for.

So I'm gonna do a little overview and commentary of the Word of Wisdom here:


The Word of Wisdom is found in a document of Mormon Scripture called "Doctrine and Covenants", (Section 89 if you ever wanna look it up). A lot of the language is archaic 1800-ish words because that's who it was originally written for. In fact, it was originally aimed towards the leaders of the church at that time, but has since been received as a guideline by the general church.

The Words of wisdom were to be received:

 "not by commandment or constraint, but by revelation  showing forth the order and will of God in the temporal salvation of all saints in the last days—

(These rules are not meant to be something that holds you back, or keep you from experiencing all that life has to offer, they're meant to help you live the best life you can.)

Given for a principle with promise, adapted to the capacity of the weak and the weakest of all saints, who are or can be called saints.

(Many people can drink alcohol socially without becoming addicted to it, but some people can't. These guides are meant to protect both groups of people.)

 4 Behold, verily, thus saith the Lord unto you: In consequence of evils and designs which do and will exist in the hearts of conspiring men in the last days, I have warned you, and forewarn you, by giving unto you this word of wisdom"

(There are people in the world who will use food, drink or drugs to take advantage of you. This problem will get worse in the future.)



The rest of the 21 (short) verses go over some particulars for healthy nutrition, like:


  • 'Strong drinks' are bad for you.
  • Tobacco is bad for you, but it's good for sick animals.
  • 'Hot drinks' (Modernly interpreted as "Coffee and Caffeinated Teas") are not good for you.
  • Don't over-indulge in meat, even during times of thanksgiving (ie. holidays) 
  • Eat plenty of healthy grain



The Word of Wisdom itself refers to these rules as "principles" as opposed to "commandments".  and we are promised that when we observe these principles we will receive health, knowledge, energy, and we will be protected from destructive influences.


So coffee isn't some evil "Broth of Satan" substance, and in fact the Word of Wisdom makes it pretty clear that God created it (and a host of other plants and herbs) for medicinal use. The problem is when people use it (or any other substance) in ways that are destructive.

One thing I'd like to stress here is that while many Mormons shun coffee, very few of us actually observe the whole health code of the Word of Wisdom. I think that, to a large degree, the reason why we (Mormons) have made such a big deal about coffee is because it's the one part of the Word of Wisdom that we can honestly say we follow with impunity.


The Word of Wisdom is about a lot more than coffee. Like Sabbath Day Observance, it's meant for our temporal (earthly) salvation, and to protect us from unhealthy (physical and spiritual) influences.

In the Bible, when people caught Jesus breaking the Sabbath he reminded them that, "The Sabbath was made for man, not man for the Sabbath"

The commandment was a means to an end, not the end itself, and the 'rules' should never be used as an excuse to do what's right. When Jesus "broke" the Sabbath, he was healing people. He expressed that it would be absurd to hold the "Sabbath day observance" rule against someone who was helping a trapped animal getting out of a well (or helping other people who are sick to get better)

The Sabbath is for remembering what's really important in life: giving thanks for what we have, helping others, spending time with our families, and being mindful of our walk with God. The Word of Wisdom is for giving us the strength to achieve the righteous desires that God planted in our hearts: take care of our families, help others, avoid materialism etc. 

So, drinking the occasional coffee when you need to stay awake on your 3rd twelve hour shift after you've taken the kids to school and picked up your husband from his doctor's appointment is not going to be detrimental to your spiritual salvation. 

1) Because the Word of Wisdom is about so much more than just coffee consumption

and

2) Because the Word of Wisdom is aimed to assist you in your temporal salvation...To help you be all that you can be in this world.


But I know that when I eat right, I'm motivated when I get out of bed in the morning (or evening...as the case may be...), my body craves things that are actually good for it

(Like...Steamed Kale...mmmmm!)

And exercise actually feels good...

I want to be there again. I want my body and my mind to be on the same page, I want to be motivated to get stuff done...and not just "OK, When can I go get Del Taco?"

But I'm so not there yet!

And I can't honestly say that I'm observing the word of wisdom when I'm really just living out of habit by not drinking coffee. So no, the reason I don't drink coffee isn't because I'm keeping the Word of Wisdom, I rather think it's because I'm too lazy to keep it.

(Sorry for the long confessional...hope this made sense!)

Tuesday, October 4, 2016

The Return of the Jedi Doesn't (?) Stink

I've been putting this post off for a while. Partly because I've been focusing on work, but also because I want to work on the "Doesn't Suck" series in reverse-chronology and I realized how much I kinda don't like The Return of the Jedi. I mean, I've always known it was my least favorite of the original sequel trilogy, but now I'm thinking it might be my least favorite installment of the franchise to date.


What it does well: An incredibly heart-wrenching conclusion to Darth Vader's story-arc, particularly in relation to Luke. 


What it does bad: Literally everything else.


Really though, the whole plot is rehashed content to serve as placeholder until Luke can finally get to Vader again and offer him redemption. Every other character, relationship, and conflict in the story gets sidelined.

(Even the actual "Star War" between the Rebellion and the Empire.)


Luke shows up as our resident "Badass Jedi" ™ because the plot requires him to be one, with no explanation as to how he got that way.



Lando Calrissian? (You know, that guy who was the head of this whole colony/organization and had this awesome cyborg sidekick and henchmen galore?)
....He becomes just another face to do stuff the main characters can't do because they're off playing with teddy bears.



"This deal's getting worse all the time!"



Even the resolution to Han Solo's cliffhanger feels off...like it even belong in the same story: like it's just a plot point the story has to get over with so it can get on to more pertinent things.



(Which I suppose from a storytelling perspective it actually is.)

And let's not even get started on this guy....






Most disappointingly, the suggestion that there is 'Another New Hope' that is moot NEVER becomes a significant part of the story.


 (Even though, it totally could have.)

I'm sorry to be so negative, but it's all I can think of when I contemplate the end of the original trilogy. 

Leia was kinda cheated out of her own heroic arc. 

I've also realized that in some ways, the newest movie makes it worse. Because even if they don't show the resolution to all of these stories, you can kind of imagine how it went in your own mind. Leia might have gone on to become a powerful Jedi. She might have had her own journey/spiritual awakening and ended up helping her brother restart the Jedi order. Luke could have been a teacher to new Jedi initiates, and she an administrator and organizer: head of the new Jedi Council. And together they would have brought in a new golden age of enlightenment and spirituality for the galaxy. 


But now that's ruined...in two planes of un-reality! 

One thing I do appreciate is that the costume department was able to finally give Leia an outfit that makes her look like a boss.








(You were thinking of the metal bikini weren't you? :P )

And now for another of Mormonhippie's Star Wars Theories:


I can't believe it took me so long to realize that Bail Organa (Leia's dad) wasn't just sending her on a random errand to recruit Obi-Wan Kenobi. He was sending her so that she could be trained as a Jedi, learn her about her heritage, and be reunited with her brother. (And, obviously, they would take down the empire together)

But Ben Kenobi had other plans:

From his perspective, Anakin should have never become a Jedi at all. Old Ben blames himself because he couldn't tame Anakin's personality.


And which of Anakin's children inherited his temperament?



There we have it! Leia was not "Chosen" to become "A New Hope" because Obi-Wan thought she was too much like her father.

Monday, September 19, 2016

Book vs Film: Wolf Hall & Bring Up the Bodies



 Last year I read a historical non-fiction book called "Six Wives: The Queens of King Henry VII" by David Starkey and since then I've become really interested in the minor historical figures of Tudor England, particularly...


 Thomas Cromwell







 and...

Thomas Cranmer:





These two were some of the most influential figures in the rise of the Church of England.

Cromwell was a big figure in secular transition, although he was learned in scripture of his day and disenchanted with a lot of the corruption he saw in the Catholic Church of the time, and Cranmer was a leader of the religious reformation.

As David Starkey tells it, it seemed like these men were kind of using the situation of their King being unhappily married, seeking an annulment/divorce/prosecution (or whatever would work to get the undesired wife out of his life...) to further their own social, political, and religious ends.

It's a fascinating story! And a lot more complex than I would have imagined.

However, it wasn't until I was getting a little bored of this years Children's Reading Challenge that I decided to delve back into Tudor-era history. This time in Historical Fiction.

I watched the miniseries, "Wolf Hall" (Which is a compilation of two novels: Wolf Hall and Bring Up the Bodies by Hilary Mantel) on amazon prime, and then listened to the book series on CD.

If you're into Tudor history, this is a pretty intense retelling. It's about the rise of Thomas Cromwell in King Henry Tudor VIII's court, and his role in the prosecution of two major historical figures:

Thomas More







And Anne Boleyn





















Surprisingly, most of the brutality does not come from people getting executed in horrible ways (Although that does happen). This is not "Game of Thrones", violent and illicit content is off-screen (and for the most part off page).What's really messed up is the psychological aspect: Henry and Co rationalizing every selfish maneuver, and Cromwell's systematic, "guilty even when proven innocent" approach to investigating trumped-up charges (particularly in book 2).


I can't speak for the historical accuracy of either the novels or the miniseries, but as stories I thought both versions of the story were pretty well told. I watched the mini-series (which covers both books) first and I felt like the narrative was a little disjointed at the start; where they just barely introduced characters to us, and then do a flashback with them meeting each other for the first time, that was a little confusing. But it turns out they were just trying to follow the format of the book. The book is able to get inside Cromwell's head really well and follows the flow of his thoughts so he becomes a really engaging, personable character. That doesn't work very well in film format, but fortunately they do have an excellent actor: Mark Rylance, who does a fantastic job with his chillingly understated portrayal of the character. In both adaptions, the result is the same: you become seduced by the persona of this man so completely, you start to forget about all the evil stuff he did until it's staring you in the face.









Notes:


More Alignment posers I made for this book:


William Tyndale-


























Henry Tudor-












Wednesday, August 10, 2016

Why Harry Potter and the Cursed Child Sucks

As much as I love the Harry Potter series, I was a bit skeptical about the feasibility of continuing the story at all. I consider the Harry Potter Series to be a monumental achievement in children's literature and I wasn't convinced anything should be added to the story.

So when I went to the Harry Potter and the Cursed Child midnight release, it was mostly on a whim...because I realized I didn't work that night and I had nothing else to do...

I didn't place expectations on it. (Unlike when I went to the Deathly Hallows midnight release...where I'd planned for days, dressed up, and made butterbeer and licorice wands for the occasion, stalked the Barnes and Nobel forums for weeks to read people's theories for what the last installment of Harry Potter had in store, and agonized about what would happen when/if my favorite characters would die.)  

At this point, there are thousands and thousands of fanfictions on what people who've read Harry Potter think should happen to the next generation of Hogwarts students. There is no way this story could've fulfilled all of those expectations. But the cool thing is, JK Rowling and her script-team don't try to. They're too busy giving nods to various fan-theories, explaining various purported "plot holes" in the series, and expounding on some of the themes that went over people's heads six years ago.

As such, this story feels less like an "Eighth Harry Potter" book than a review of the series.


-The Pros:

The strongest parts of the story are when JK Rowling and Co revisit the relationships between familiar characters:

It's enjoyable to see your favorite characters interact in ways they ever got to in the original books. Harry and Draco could never be friends as kids, but in adulthood they can put differences aside and find common ground.

In play format, we get to view the story outside of the confines of Harry Potter's POV, characters like Ron and Severus take on a new light outside of his limited perspective.

At the end of Deathly Hallows, Harry has opinions about parenthood and the type of father he'd like to be, in many ways this story continues his development so it's rewarding to see him struggle to be the best dad that he can be.


-The not-so-bad: 

The Epilogue of Harry Potter and the Dealthly Hallows introduced us to a whole new generation of Hogwarts attendees and a big, sprawling extended family for Harry. Unfortunately, except for Albus and Scorpius, they're largely absent for much of this story. 

Although she seemed to annoy a lot of fans, I really liked Delphi Diggory, not in the least because I wrote a fanfiction character somewhat like her. She's an interesting character, and its unfortunate they only used her as a plot device. 

Even the whole time-travel plot wasn't completely horrible (even though some parts of it felt like a bad Doctor Who episode). 

-The slightly sucky:

The fact that all of the younger characters have this minutely detailed knowledge of things that happened years and years before they were born, knowledge that the can recall and exploit at leisure. (Did they have Tri-Wizard Tournament Trivia night at Malfoy Manor?) Everybody in this story is a freaking 'Harry Potter' Nerd! Gah!

...But the worst part of the story? The part that really made this story suck


Is this little jerk right here:





Yes, the most promising character of the Harry Potter and the Deathly Hallows Epilogue and the ONLY Character I could have envisioned as a future protagonist of a second generation "Potter" series is the most annoying and unsympathetic character in the Cursed Child. 


And now, I will explain why:

....Remember [CAPS LOCK HARRY] from The Order of the Phoenix

This was Harry Potter at his most annoying. He's all insecure and super hormonal, angry, and confused. And he takes out his anger at all the people closet to him: at Ron and Hermione, Mrs Weasley, Sirius Black  and Albus Dumbledore.

Well, that's pretty much ALL Albus Potter does in this story. 

The problem is, Harry Potter had four books of character development to get him to that point. We knew about his relationships with all of those people: Ron and Hermione had stopped writing to him, Mrs Weasley and Sirius weren't being honest with him, and Dumbledore was avoiding him...

Even if you didn't particularly like Harry Potter during his hormonal-teenage years, you could understand how he felt when the people he loved shut him out.



(...Like his son does in this scene:


(Harry was angry because he felt isolated from the people he cared about, 
Albus is angry because he's not as popular as his dad is.))


Albus Potter never gets the chance to become a sympathetic hero because he gets one transitional scene to convey all of that complicated family dynamic and it just. doesn't. work.


(It just appears as if Harry is making effort after effort, and Albus is being a little shit.)

What bothers me even more is that throughout the story, different characters keep insisting that Albus' personality is sooo different from Harry's and that's why the two don't get along...

I could understand that, if they'd made Albus' neurotic or introverted, or even remotely Slytherin in aspect AT ALL. 

(But then he wouldn't be pushing his father away, but rather looking for ways to exploit his relationship with a famous person)

But they don't. Harry knows what his son is going through, OK? Harry knows what it's like to be lonely, and he's had to deal with people gossiping about him as a kid. What he's forgotten is what it feels like to be insecure. For Albus all those emotions are present. For Harry, they're all a part of his past. 

It's like when you're really worried about something: A date, or not getting a date...a big test at school, or not getting invited to someone who you thought was your friend's birthday party or some such first world problem.  Your parent's are dismissive of your concerns because they went through the same thing when they were your age (only they'll insist it was a million times worse) and they got through just fine. 

^^That would have been true to character. It would have made Albus a little more sympathetic, and it would have been HILARIOUS to watch. 

Unfortunately, the Cursed Child version of that argument just doesn't sting as it should. Partly because they failed to build up Albus and Harry's relationship to where we lament their falling out. Their reunion is less sweet because the relationship that should have been the cornerstone of this entire story was never big enough a deal for us to care about anyway.

Fortunately, there's more to this story than Harry Potter's Garbage Son. 

Like this sweet roll:


(Why didn't they make a scene where he comes over to Grandma Weasley's house for Christmas dinner, and everyone there loves him more than Albus? Now THAT would be realistic!)


Saturday, July 2, 2016

Postpartum Hemorrhage

Hemorrhage is the most common complication mothers face in the postpartum period. It usually occurs within the first 24 hours after giving birth, but it can occur later on during the postpartum period.

In pregnancy, the uterus had to grow to accommodate the fetus: the uterus' muscle fibers stretch and, in between the fibers, blood vessels enlarge to supply and accommodate the growth. The placenta, which is basically network of blood vessels and capillaries (albeit with a little barrier between the mom and the baby) that supplies nutrients to the growing fetus, it is attached to and fed from the uterus' blood supply.

After childbirth the uterus is basically a big bleeding wound, and it's up to hormones and mechanical changes to cut of circulation to the wound so it can stop bleeding.  

Postpartum Mom's bodies do have advantages that normal women don't, though. Even though their blood is expanded to almost double it's original volume, most of the extra blood volume exists as plasma. That the part of the blood that contains the clotting factors that are activated in injury, protect against excess bleeding, and promote healing. 

However, it also means Mom's blood is hemodiluted: there are fewer red blood cells circulating, mom is already anemic before birth even happens. So a large amount of blood loss at birth, or shortly thereafter can have a big impact on cardiovascular stability. 

That's why its important for the postpartum nurse to get a time of birth estimated blood loss (EBL), so total blood loss can continue to be monitored. 

There are several reasons Postpartum Hemorrhage can occur:

Sometimes the uterus muscle becomes atonic doesn't clamp up like it's supposed to, and blood continues to flow as if it's still supplying a baby there. 

Other times there's a mechanical obstruction, such as a full urinary bladder, or clots that prevents the uterus from contracting and getting smaller like it's supposed to.

There can be a retained placental fragment still in the uterus after the rest of the products of conception have been delivered. 

multiparous mom (a mom who's had a lot of kids), or a multigestational mom (a mom who has been carrying more than one fetus), is also at increased risk for postpartum hemorrhage just because her uterus has had to stretch more.

A mom who experienced a traumatic birth; laceration or epistotomy along the birth canal is also a source of bleeding. 

There are also medications that can increase the mom's risk for developing hemorrhage, such as magnesium sulfate (given to moms who have preeclampsia or eclampsia, and are at risk for having seizures).

Sometimes clotting factors can activate when they're not supposed to and deplete: forming tiny little clots in some areas of mom's capillary bed and extremely thin blood that bleeds very easily everywhere else. This is a very ominous condition called dissiminated intravascular coagulation (DIC)

It's important to monitor the patient's uterus and lochia flow. Palpate the patient's abdomen, while supporting the neck of the uterus at the pubic bone, and locate the fundus (the thick, top part of the uterus) of the uterus in relation to the patient's umbilicus (belly button). Note if the fundus feels firm or boggy. If the fundus is boggy, perform a fundal massage until it is firm.

If the fundus is deviated to the left or right of the umbilicus, it may mean the patient's bladder is full, and the uterus is being displaced. Assist the patient to the restroom to void and then re-assess.

If clots or excess lochia are expelled on fundal massage, weigh the soiled linens. It is also important to assess the patient's pad and peritoneal area. If patient is on bedrest, have the patient lift or turn to assess bed pad, if patient is ambulatory make sure the patient is not saturating 1 peri-pad per hour or more, if this occurs it is important to weigh the pad

(To weigh soiled linens: First place clean linens of the same type on scale and zero the scale, then remove and place the soiled linens. (If you weigh in grams, you can convert easily to ml because 1gram=1ml))

and calculate the patient's total blood loss.

IF

The cumulative (added together) blood loss is greater than 500 ml (for a vaginal birth)

The cumulative blood loss is greater than 1000 ml (for Cesarean birth)

OR

Vital signs are unstable:

 a 15 percent change in vital signs is noted


  • HR 110 tachycardia
  • BP less than 85/45 Hypotension
  • O2 saturations less than 95 percent Hypoxia




OR

There is even more bleeding in the recovery or postpartum period, which when weighed increases the patient's total blood loss above 500/1000ml respectively. 


  • The patient is in Stage 1 of Postpartum Hemorrhage.


It's important that a nurse (usually the primary nurse) stay with the patient and call for the assistance of the charge nurse, or another nurse. Continue fundal massage, and (if patient's IV has been removed) start another one, preferably 18 gauge or larger because those are the ones suitable for fluid resuscitation.

Call the doctor and notify of EBL at birth, current loss in MLs, presence of clots, lochia color (bright, dark, pale red) vital signs, and most recent hemoglobin and hematocrit level.

Receive orders, which may include:


  • Oxytocin 10-40 units IV (Oxytocin is a hormone is released in a pregnant woman's body when the placenta disconnects from the uterus, and when the infant starts to breastfeed. It can also be given as an IV infusion.)


  • Hemabate 250mg IM (NOT IV) Q15-90 minutes. Not to exceed 8 doses/24 hours. May cause nausea, vomiting, hypertension.


  • Methergine 0.2 mg IM (NOT IV) Q 2-4 hours. Do not give to patients who have high blood pressure, primary hypertenstion or pre-ecclampsia/ecclampsia because it can make their blood pressure go even higher and they can have a stroke or seizure.


  • Misoprostol 800-1000 mcg PR once. Causes diarrhea (sorry mom D: ) Nausea, vomiting, transient fever and headache.


  • Type and screen for 2 units of blood


  • Oxygen administration, frequent V/S, LOC checks, keep patient warm, insert foley catheter for strict I/O and to depress bladder, continue vigorus fundal massage.

These medications are available on the hemorrhage crash cart located in L&D.

It's also important to review the patient's history and consider the potential cause of the bleeding (For instance: atony, trauma/laceration, retained placenta amniotic fluid emboli, uterine inversion, coagulopathy etc.)



If Vital sign instability continues, or bleeding continues to greater than 1500ml

  • The patient is now in Stage 2 of Postpartum Hemorrhage.


This is where a team effort really comes into play, as everyone prepares to take the patient to Labor and Delivery, OR, or recovery room.

You'll need another nurse to help perform a bimanual uterine massage (which is basically a uterine massage with two sets of hands).

The charge nurse will call a code OB

Labs are drawn for STAT CBC with platelets, CMP, Coagulation panel, ABGs.

Additional doses of medications listed above will be given,

Blood products are administered

A second large bore IV site will need to be inserted, the primary nurse will need to communicate the total blood loss and vital signs to team members.

Prepare for massive transfusion protocol.

Some of the procedures the doctor may perform include:

  • Repair of laceration or episiotomy
  • D&C to remove retained placenta fragments
  • Intrauterine balloon
  • selective embolization
  • B-Lynch suture
  • Bilateral uterine relaxation drugs
  • Hysterectomy
  • Aggressive respiratory, vasopressor, and blood products support (if DIC)


If blood loss continues beyond 1500ml, 2 PRBCs have been given but V/S are still unstable or disseminated intravascular coagulation (DIC) is suspected:


  • Initiate massive transfusion protocol
  • Move patient to OR (prepare for artery ligation or hysterectomy)
  • Call ICU for bed



Other considerations:

The patient will probably be really cold through all of this, do your best to keep patient warm and if possible warm blood products before infusion using designated device.

Re assign staffing for infant

Support for other family members.

Resources:

http://www.ncbi.nlm.nih.gov/pubmed/4075604


https://www.hon.ch/Dossier/MotherChild/preg_changes/circulation.html

http://www.open.edu/openlearnworks/mod/oucontent/view.php?id=279&printable=1

My hospital's policy and procedure


Notes:

I had this all printed up and the text flowed all pretty, but I forgot to save BOOOOOOOOOOO!!!!!

Serves me right for typing up on blogger.