Pregnancy/birth experience following PPH

[ShabbyChic8]

Hi, I had a Post Partum Haemorrhage following the birth of my DC a year ago, lost 2.3L of blood and had a transfusion. I wonder if anyone else experienced the same or similar and how their subsequent pregnancies and births were? For example, were you deemed high risk next pregnancy? Did you H again? How did you feel about going through it all again?

I'm not pg yet but plan to start trying over the next few months and although I want another baby I am already feeling anxious. I would love to know how it has bee for others. Thanks.

[OhTheDrama]

In my last birth I suffered a PPH and lost 2.5l. I'm now 9 weeks pregnant and have been told I'm high risk and will be consultant led. I've not had my booking in yet but have been told that I will have a cannula sited in my hand as soon as I present in labour but will be able to labour normally.

I'm being very positive and am quite happy that they know there is a potential problem and can prepare for it and minimise the the effect if it happens again. I would also be very upfront throughout your pregnancy and labour and make sure they know you are anxious about this happening again. Would it be worth seeing if you can have a debrief with a consultant to discuss what happened last time and why and to come up with a plan of action for next time?

[FengMa]

I had a PPH of 1.5 litres with DD. I was deemed high risk with DS. This meant being under consultant, not midwife, led care. I was able to labour normally, with a cannulla sited at end of first stage. They hung bags of synto at the end of second stage and recommended an active third stage. They also did a manual contraction massage after my placenta had passed. No uterine PPH the second time.

The main thing during pg is to pester pester pester to ensure your iron levels are good and do your v best from the word go to keep them as high as poss.

[DontWorryBaby]

Reading with interest, I had a PPH with DS2 and it's my only source of anxiety over having a third. Didn't realise it'd make me high risk after two low risk pregnancies.

[CaramellaDeVille]

I had a 2L PPH with 1st birth. Was put on shared care with 2nd pregnancy (not consultant-led but they are involved). They were fully prepared for another one (cannulas, blood bags ready etc) and I had a tiny haemmhorrhage in the end (500 ml). I won't lie, I was scared when they said I was bleeding again, but they looked after me very well and it was all fine.

[CaramellaDeVille]

Oh yes I forgot that, they spent around 40 minutes holding my uterus firmly (from the outside - not anything painful or intrusive!!) afterwards. It's called guarding the uterus apparently. And I also had the synto drip for a couple of hours afterwards as a precaution.

[bakingtins]

Hi, I'm 33 weeks with my 3rd and lost 2 litres, emergency surgery, transfusion last time. I've been consultant led this time and had bloods taken regularly to check iron levels. So far I've been told I will have a cannula sited and active management of third stage. My main concern is getting to hospital in time since I had a 2 hr labour last time and made it with 10 min to spare. I have an appointment next week and am going to ask more about what will actually happen. RCOG guidelines say it should be taken into account when deciding on place of birth etc but not that it makes you automatically high risk. Your chances are 3 times higher than someone who has not had PPH of it happening again. I am assuming they will still only have a MW in attendance in which case I will ask about going to MW led unit to avoid the bright lights, bed, CTG monitoring scenario. It's right next to the delivery suite if there is a problem again.
I didn't at the time, and still haven't, had any debrief on why what happened last time. It all happened very quickly, there were suddenly ten people in the room and I felt massively out of control and traumatised by the whole experience. Once I was moved from HDU to the post natal wards the care was fairly appalling, so one thing I will be trying to do is book a private room so DH can stay and advocate for me if necessary. I think my birth plan is going to be pretty detailed run to several pages this time.

[bakingtins]

Can anyone who had had a subsequent birth comment on who actually looked after you, did you have any additional staff present? How long did you have to stay in afterwards? Were you able to use delayed cord clamping as part of active 3rd stage?

[blushingmare]

I had a 2.5L PPH with my first and am now 39+2 weeks with DC2. I don't think I'm officially classified as high risk and have had midwife led care, but have seen a consultant to discuss birth options. Similar to most that have posted, I'm to have a cannula put in during labour and they will have a syntocin drip and bloods ready, should they be needed. I wasn't allowed to use the midwife-led unit, even though it's only next door to the delivery suite, but will be allowed to use the pool and hopefully just labour as normal. The consultant was very reassuring and said, yes I have a higher risk of it happening again, but that if it does hopefully with those precautions it will be less traumatic as they will all be ready for it.

I am scared, but have to keep telling myself it's going to be ok!

[blushingmare]

Oh bakingtins I have delayed cord clamping in my birth plan and it doesn't seem to be a problem. I don't think there will be anyone extra looking after me. The plan is for a normal labour, with the stuff on standby just in case.

[creamoftomato]

well these are a bit depressing to read :( i had a 1.1L pph four weeks ago (first baby). i was told there was no particular reason for it to happen ('just one of those things') and reassured afterwards that there was no reason id be any higher risk in a subsequent pregnancy, that i could definitely come back to have a second baby in the midwife led birthing centre etc. now sort of wondering if that's not actually true...

[WanderingTrolley1]

2L PPH after 1st child.

High risk CLC for 2nd pregnancy - had to be induced, but a straightforward "normal" delivery - less than 500ml blood loss.

Not high risk for 3rd pregnancy but ended in an emergency situation as haemorrhaged pre (APH) and post birth and lost very near 3L of blood.

Needless to say, I'll not be having any more children; too much drama!!

[CaramellaDeVille]

bakingtins hi! I've nanechanged but you supported me in the MC board last year - congratulations on your pregnancy :)

Anyway, just to say I didn't have any extra staff and I did have delayed cord clamping with 2nd birth.

[ShabbyChic8]

Thank you for your replies. I have a clearer idea of what to expect.

[Gen35]

1.5 l PPH with dc1, having mw led care for dc2, but seeing ob/gyn in a few weeks to discuss. Must admit I'm a bit terrified of it happening again, was due to fragmented placenta and went on and on.

[drivenbyyou]

PPH after DC6 with no warning (but very fast delivery) - just avoided transfusion but was pretty shell-shocked after. Only thing they did with DC7 was make sure I had a cannula in when I went in, in active labour. Bit more monitoring, but nothing intrusive - just a bit extra checking on BP and heart rate (both of us). No complications with delivery and home within 4 hours. Was told I was under consultant care (previous history as well as the PPH) but didn't actually see one in real life.

Oh and I asked for the emla cream for my hand cause I'm a big wuss - caused a bit of hilarity with the MW who had trouble finding some but we got there in the end.

[Geraldthegiraffe]

I lost over 3l and ended up in intensive care with several transfusions. I'm too scatted to try again but at my debrief they said if I did again vaginal birth would be less risky than c section and they'd have me on early and bloods ready etc.

I'm fairly traumatised still by waking up in intensive care. It's interesting to see others with a large pph.

[bakingtins]

I thought I'd update after a chat with community MW. One of the problems for me last time was that I had a precipitate birth and arrived at hospital ready to push so they hadn't done any of their checks. Apparently it's contraindicated to give syntometrine (combination of synthetic oxytocin and ergometrine) unless you have a baseline blood pressure reading, but I could have been given syntocin (oxytocin only) and still had a managed 3rd stage, so that recommendation is now in my notes. Also it helped to find out that background risk is 4-7% so a x 3 risk from a previous PPH still only means 15-20% recurrence, whereas I'd assumed it was almost inevitable. I'm seeing consultant (or at least an obstetrician underling) on Tuesday so will update again then.

[bakingtins]

Today I finally saw an obstetrician who actually listened to me. He went through my previous notes in some detail (turns out I had a 10x20cm piece of retained placenta - it's only taken me 4 years to discover what actually happened....) and discussed a birth plan. He advised against going to the MLU even though it's a shared site, as he said they wanted to have intravenous access, with iv syntocin infusion and blood on standby. However, he was very respectful of my wishes to have as natural/hands off a labour as possible and has put in my notes that there is no need to have continuous monitoring or to be confined to bed, and he actually agreed that delayed cord clamping as part of a managed third stage was a good idea. He's also documented that I can go into hospital in early/pre-labour if I want to, in order not to have the worry of a precipitous labour and unplanned homebirth. Pretty happy with the advice overall, and will make my peace with being on delivery suite (as long as the OBEM cameras have gone home!) He was also the first obstetrician to acknowledge my 4 previous miscarriages and the effect they may have on emotionally handling labour.
He was fab - so much better than the women I have seen so far who have been completely unsympathetic.

[ilovemonstersInc]

Glad you got to see the consultant baking.
I spoke to the consultant who I saw when making birth plan with ds2 (who is 9months and im 5months pregnant) I lost 2.5l+ of blood, 2 transfusions, infections, passing big clots etc. She said the risk is the same for c section and vaginal for me as my problem was uterus not contracting. She recommended I had spinal during delivery (induced a week or so early if possible) and if they had to work on me again at least I would be pain free and worst case scenario if I needed to go theatre at least spinal is in place. This was just a chat in the corridor so once I actually see the consultant whom im under this time will make a proper plan that is something like what she recommends

[blushingmare]

Thought I'd do an update, by way of support/information on this thread as I gave birth to a beautiful baby boy on Wednesday . As I posted previously, I'd had a 2.5L PPH following the birth of DD, due to atonic uterus and a third degree tear.

I hesitated before writing this as don't want to scare anyone, but I did have another big PPH this time, but the experience was completely different this time and for me is a positive birth story, which I hope will bring some hope to you other lovely ladies.

I had a birth plan for a managed third stage, which meant that they put a cannula in before I started pushing and had the syntocin drip on stand by. This was all done quite rapidly when I arrived at hospital as I had a very fast labour and it was all in place in time for the second stage. We had managed to tell the midwife briefly what had happened last time and that it was quite traumatic. Apart from the cannula being in, I had a completely intervention free labour and delivery.

They realised pretty quickly that I had a retained placenta and I had to go to theatre for an epidural and manual removal. However all of this was done in a very quiet and measured way, with normal speaking voices, no emergency alarm and no appearance of panic. I became very unwell at one point in theatre, but again it was handled very calmly. I had an anaesthetic assistant holding my hand and explaining everything to me throughout.

Afterwards I was transferred to recovery, where DH & DS were allowed straight in and we did skin to skin and breastfed while I was given 4 units of blood. I had a day on HDU being monitored and then was transferred to the ward, although they wonderfully got me a side room so I could get more rest. I had a terrible experience of care (or lack of it) on the ward last time, but this time was completely different (admittedly different hospital).

I later found out I had lost 3L of blood and they were really quite concerned about me at one point. But at no point in the experience did I feel afraid or like I was going to die, unlike when it happened the first time.

It was my worst fear having another big PPH, but it happened and it was all ok. The medical team were prepared and calm and also aware that I'd found it traumatic the last time and seemed to take extra care to keep things calm. DH & I were also more prepared for the fact that it might happen so weren't as thrown by things not being "perfect". It wasn't scary in the same way as last time at all. The last few days have been a bit rough physically, but mentally I've been fine and that has just made everything so much easier to cope with.

I hope this hasn't upset anyone. I know it's not the perfect birth story you'd hope for, but I just wanted to say that having another PPH needn't be a huge trauma like the first time. DH & I will look back on DS's birth with mainly good memories. Good luck to you ladies!

[DontWorryBaby]

Congratulations blushing! Feeling emotional reading your birth story but I guess all we can hope for is that a plan is in place and is calmly and professionally put into place if necessary. Sounds like you've been very well looked after. Hope you are feeling better now. X

[oohdaddypig]

So glad it worked out ok OP. congratulations.

Just want to add my story in case it helps anyone. I had a large PPH complicated by third degree tear with DC1. Needed 4 units of blood. With DC2 I had a large bleed but under the definition of PPH. Basically my care was a lot better so the various risk factors reduced.

I also had a miscarriage (early) which resulted in a large bleed. I have no clotting issues with my blood.

However I did some research that suggested vitamin E supplements/fish oils can thin the blood and contribute to problems, especially in blood group O. So before I had DC2 I stopped my pregnacare at 32 weeks. I have no idea how much merit there is to this and my experience is anecdotal but it worked for me.

I'm now pregnant again and if it goes well, will stop all supplements again at 32 weeks

[elliejjtiny]

Not sure if my experience counts but I lost loads of blood when I miscarried (1st pregnancy). I lost about 2 litres but when I was pregnant again I was told that it didn't count as a previous pph because it wasn't a birth as such. I've had 4dc and never had a problem with blood loss with any of them.

[bakingtins]

Updating to say I had my baby on 23rd, another precipitate labour, 80 mins start to finish, as predicted no time to get a cannula in as though we arrived at hospital with 50 mins to spare they couldn't find anyone to site one, actively managed 3rd stage, placenta delivered complete and very minimal 150 ml blood loss. Felt a bit like I'd been hit by a truck immediately post delivery from the shock of it being so fast but within a few hours felt marvellous, totally different to last time

[blushingmare]

Congratulations bakingtins! So pleased things went well