So Serena Williams had a baby. A beautiful baby girl.

But let’s back up. This woman made pregnancy look like body goals. I swear to my Father in Heaven that I NEVER want to be pregnant again (#mythreekids), BUT IF I DID, I’d want to look like Serena. Strong, gorgeous, and courageous. The woman had it all together.

But then she almost died.

No, really. Serena had a c-section because her baby girl wasn’t tolerating labor, followed by a blood clot that traveled to her lungs and almost killed her. I appreciate her valor in telling the world her story. I am here to bring clarity to some of the details.

First of all, there are different types of blood clots.

There is the type of blood clot that a woman can see during a heavy period, and there are the types that can collect within our blood vessels and cause oxygen to not be able to travel to vital parts of our body. I also can’t help but bring up this small fact: The word is clot with a “T” not clog, with a “g”. Check out a post about other commonly misspoken medical words, just to get the proverbial spinach out of your teeth. Okay, I’ll get down off of my nerdy high horse.

The types of clots that form during a period and are visible are often caused by heavy menstrual bleeding, polyps or fibroids. Blood is lost so rapidly that it forms jelly-like blobs that can plop out, often at the worst times. These types of blood clots are often not normal and should flag a need for a woman to talk to her gynecologist about how much blood she is losing every month. I recently spoke with a patient about how much blood she was losing during her period. She had no idea that her loss was excessive and potentially harmful. It was normal for her. Clots are usually not normal.

After having a baby, women can sometimes see blood clots in their pad or in the toilet because the volume of blood loss after having a baby is larger than a typical period. The nurse or doctor can still be involved in the discussion of how much is too much, because postpartum hemorrhage or excessive blood loss is a “thing”.

But what did Serena have, Doc?

She had the kind that forms in the blood vessels, often of the leg or deep veins, but can travel to the lung and stop blood from flowing through the lungs to get oxygen. Those types of blood clots are not massive like the ones you see in your pad, but they can kill you. There are proteins in our blood that should keep in from clotting, but some have too few or too many of those proteins which can let their blood clot. People can have genetic predispositions to this too.

How likely are YOU to develop a blood clot? For the sake of perspective, I want to offer some clot risk numbers. The following is an excerpt from my book, It Smells Just Like Popcorn. The risk of developing a blood clot while not on birth control is about 4 in 10,000, or 0.04%. To say that another way, out of 10,000 women, 4 will develop a clot, just because. On an estrogen-containing birth control, the risk is about 10-14 in 10,000, or about 0.1%. In pregnancy the risk is about 5 times that of the no birth control group (the N.B.C.s as I just decided to call them), which is 0.2% (1 in 500). The risk is about 20 times higher in the postpartum period than the N.B.C.s, or about 1% (1 in 100). Long periods of immobility (not moving), major surgery, high age and ethnicity can also affect these numbers.

I recently watched a video on social media where a woman was talking about herbs for clot prevention.

People were asking about herbs for energy and health. One person asked about herbs to make her blood “less sticky” because she has a history of blood clots. I was shocked because I kept thinking, “if you have a history of blood clots, you better see your doctor and take the necessary steps to make SURE you don’t get them again.” I like holistic and complementary medicine, but when issues can be life-threatening, I need the treatments with evidence demonstrating that they are effective. I won’t stake my life on a medicine that “might work”, especially without scientific evidence.

Serena was a mild blood thinner and STILL got a clot. What’s up with that, doc? Well, medicine isn’t perfect. She was a high risk because of her ethnicity, and moreover because she was postpartum. They put her on stronger blood thinners and she is alive today to tell her story.

What I hope people take from her story are three things:

1. Medical complications can happen to anyone, even the most athletic woman in the world. (By my calculations, she is.)
2. Never underestimate the value of speaking up and being your own advocate. Serena knew her medical history and had had a clot before. She knew what it felt like and was at the highest risk possible after having her baby girl. She spoke up and asked the doctors to evaluate her when she didn’t feel well. I will never fault my patients for making a reasonable request. My expertise combined with my patients understanding and agreement is what’s known as Shared Decision Making. This is important for the best care and for trust in the doctor-patient relationship.
3. Having a baby is unpredictable. The risks are high. The stakes are higher. Getting regular prenatal care is important, and following through if complications arise is even more so.

I want Serena’s story to open the dialogue between doctors and patients, not drive a wedge of distrust between us. The latter worsens health outcomes. The former improves them.

LONG LIVE THE QUEEN!

Check out my post about that time I had Diastasis Recti after having my kids by clicking on my pregnant belly (or anywhere on this picture for that matter, lol.)

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