“I have come to believe that changing a mind is rarely the point. Planting a seed is,” writes nurse-midwife Mara Evans.
In the dimmed light of a hospital room in Nevada, the placenta — blue and shining — has just delivered. I coaxed it gently, spinning the warm, bloody organ and twisting the trailing membranes into a compact coil, leaving nothing behind. Even a small fragment of placenta or membrane can prevent the uterus from contracting properly, failing to squeeze shut the great vessels that have spent 40 weeks surging with blood to feed a growing baby. If those vessels do not abruptly close, blood continues pumping into the empty uterus and a hemorrhage begins.
I am always vigilant for bleeding — but today I am also uneasy. My patient has made it clear that she does not consent to blood products, even in an emergency. She will not risk receiving blood from a donor who has been vaccinated against Covid-19. No hospital or blood bank tracks donor vaccine status, because it poses no known transfusion risk — but no fact will change her mind.