Anxious - previous precipitate birth and PPH - WWYD?

[bakingtins]

DS1 7 hour labour, normal vaginal waterbirth, 7lb 7oz at 40 weeks, no complications
MC with haemorrhage requiring hospital treatment.
DS2 2 hour labour, got to hospital with minutes to spare, normal VB, not given Syntocin as their checks not completed, massive PPH after delivering the placenta requiring emergency surgery and a blood transfusion. 6lb6oz at 40 weeks.
3 consecutive MC, several requiring hospital treatment for heavy bleeding. Diagnosed with an immune condition which affects implantation/development of placenta.
Now 31 weeks pregnant with DC3 after treatment with steroids in first trimester and actually starting to believe this one will go the distance.

I'm high risk and consultant care because of the previous issues. Growth scans suggest the baby is on the small side but growing ok. The consultant's plan is that I go to the consultant led unit (had the other 2 in MLU attached to the delivery suite - so same building) have an i/v catheter put in so they have access for fluids or blood and have managed third stage. My issue is that I'm worried about there not being time for any of that - we really didn't mess about last time! It can take 20 mins at dead of night to get to the hospital or easily more than an hour in traffic. I will have my mum staying from 39 weeks but if I go into labour before that will have to arrange for someone to come over to look after our boys before we can set off. Community MW has said to call an ambulance if I think baby is coming quickly, but they don't carry any syntocin.

I'm considering asking about being induced a bit early. The other factor is that I'm nearly 40 and aware that stillbirth risks are higher in my age group as the placenta ages, but the main thing would be knowing that I had childcare arranged and was in the hospital should it all kick off rapidly. I'm not a fan of medicalising things and friends who have been induced say it's not much fun, but I'm at a point where all that matters is that we are both safe.

Thank you if you read this far, I'd appreciate any insights.

[isitme1]

No advice but pph are horrible! With both my dc I had pph (previous 2.5l) and im pregnant (unplanned) and scared. Do I go elcs or try normal again?
Soo sorry not much help

[Addictedtomaltesers]

Hi OP
I understand exactly how you feel as I had a massive pph with ds2. I have since gone on to have 2 more dc and both times since ds2 I have had a managed 3rd stage the same as you describe.

I'm not sure what they've explained to you but it is only a case of switching a drip on as the baby is delivered (might be as the placenta is delivered, i can't remember). Anyway, although they prefer to site an iv catheter before you are at delivery stage, I'm sure it wouldn't take very long to put something in even if you arrived at the point of pushing! They should also be well aware of your need for a managed 3rd stage but definitely point them to it as soon as you arrive just to speed things up.

I actually still had a pph with ds4 as well but despite it being classed as massive again, it was sorted out very quickly and with much fewer levels of drugs and interventions so my iron levels fell nowhere near to transfusion level.

There's no doubt that its scary but trust in the staff and even if it does happen again, they will be ready for it and all the drugs outside on a trolley just in case.

Good luck

[bakingtins]

Thank you. Have looked up Bishop's Score so at least I've learned something! I also looked at the NICE guidelines and they say induction shouldn't be offered routinely for previous rapid labour, but doesn't say can't be offered in any circumstances.
Everyone thinks the PPH was a consequence of the rapid labour, I was shocked and just didn't have a chance to adjust. It was very frightening, my DH was left holding the baby and literally didn't know if I was dead or alive for several hours. The worst bit was I had seriously considered a home birth since my first birth went so well and if that had happened at home I might well not have survived. I seem to have gone from my first birth being majorly woo with hypnotherapy and water birth to wanting the full on medical bells and whistles for no 3!