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Anyone had a PPH? How did subsequent labours go?

(29 Posts)
marzipananimal Wed 27-Feb-13 10:58:45

I'm interested in how the medical staff treated your second labour if you had a PPH first time round.

I had a minor PPH with DC1 (600ml estimated) and this time they want me to give birth in hospital and have a cannula in my hand from the start 'just in case'.
I would really like to have a home birth if possible (and definitely not have a cannula in) and have been reading up as much as possible about the risks, and the hospital's proposed course of action seems very over cautious to me, especially as I only live about 1 mile from the hospital.

Any useful thoughts/knowledge/experience? TIA

Lolly12 Wed 27-Feb-13 11:09:46

I had pph of 2000ml after first labour due to retained placenta and have also been advised to have cannula in hand in hospital for this birth (currently 38 weeks). It is not what I want in an ideal world but I know the risk for another retained placenta is higher if you've already had one, so I'm happy to go along with it. After you've delivered it's harder to get a cannula in apparently so I'd rather it be in place just in case. I am being cautious because if I do have another retained placenta I definitely want to be in hospital so they can act quickly.

Your pph was less so guess the risk is less too. Can you chat it over with your midwife and weigh up risks and benefits of home birth? You don't have to agree with anything you don't want.

DamsonJam Wed 27-Feb-13 11:11:00

Having one PPH means you are higher risk of having a subsequent PPH. You are obviously still much more likely to have no PPH, but the risks are higher (can't remember the details off hand, if I were you I'd definitely want to be armed with the facts).

My personal experience was that I had a 1 litre PPH with DD1 and then went on to have a 2.5 litre PPH with DD2 so was obviously pretty glad I was in hospital. With DD3 I had a actively managed birth to ensure no PPH (think it was syntoconin - can't remember details now - plus manual removal of placenta) and blood loss was pretty normal (300ml).

Given that PPH can be a major issue, personally I can understand why the hospital are being so cautiuos (1 mile is a long way when you're bleeding profusely). Sorry I know this isn't what you wanted to hear and you obviously need to make and be happy with your own decisions, but personally in your position I would opt for the hospital birth.

Catsdontcare Wed 27-Feb-13 11:16:07

I had a big pph the first time around 1500ml and a bigger one the second time around 2000ml and I had another bleed the following day of around 500 ml. Given history of bleeding and big babies a hospital birth was really my only option.

PseudoBadger Wed 27-Feb-13 11:17:55

Sorry to hijack a bit - I lost approx 1000ml during my c section and needed a transfusion, but it's never been called a pph - is that because it wasn't, it was just surgery related?

strawberrie Wed 27-Feb-13 11:19:39

I had 1600 ml pph after first birth ( 4.1kg baby. Back to back, forceps delivery). I was advised to have a cannula sited As a precaution which was a bit of a pita but nothing major. Thanks to fabulous midwife care I was able to labour and deliver in the hospital pool and 4.4 kg baby was born with only 100ml blood loss.

perceptionreality Wed 27-Feb-13 11:20:24

I had a PPH with first baby - the hospital felt it was caused by the injection I had which expels the placenta. My next two deliveries were fine with very little blood loss either at the time of afterwards - I tried to avoid medical intervention and had physiological 3rd stages.

marzipananimal Wed 27-Feb-13 11:37:12

Thanks everyone. strawberrie it's good to know they'd let you deliver in the pool - I meant to ask about that too.
I feel my PPH first time may have been due to having an augmented labour (synto drip), and 'unnatural' pushing (epidural, on my back, being told when to push cos I couldn't feel it). Induction/augmentation does increase the risk of PPH. Also I don't think they way they dealt with with it at the time was anything that couldn't be done at home.
I appreciate though that big PPHs can happen very quickly and be very dangerous though. Food for thought.

Catsdontcare Wed 27-Feb-13 11:50:42

I have to say I was induced the first time and had an epidural, forcepts etc and although the blood loss was less than my second birth it was a harder, longer labour and a harder recovery. With ds2 I had no induction or epidural and it was a much quicker labour (4 hours) and although the blood loss was high I felt much more with it afterwards (with ds 1 it was about six hours before I even looked at him or held him)

SchroSawMargeryDaw Wed 27-Feb-13 11:58:12

I had a PPH of 1000ml, I think this was mostly due to having an induced labour, really big episiotomy and then forceps.

I'm having a homebirth this time, the consultant wasn't too keen but admitted the MWs will have drugs that would help if I did start bleeding heavily and am not too far from hospital.

SchroSawMargeryDaw Wed 27-Feb-13 11:59:13

I also had an epidural and was on my back, I knew when to push though as my epidural hadn't worked.

VivaLeBeaver Wed 27-Feb-13 12:04:17

Most hospitals will want you to have a hospital birth and a cannula if you've had a previous pph. Many will also want you to have 40 units of syntocinon as a prophylactic measure following delivery.

Having a previous pph doubles your risk of having another pph. PPH rates are rising and are about 8-10% now so I guess that gives you a chance of 16-20% of having another.

I wouldn't let been 1 mile from the hospital necessarily be a comfort to you. It could still take 30 mins for an ambulance to reach you on a bad day depending where they are. In a massive pph you can lose 800-1000mls of blood per minute.

Saying that a 600ml pph is not a massive pph and Southampton Uni have just done some research showing that home birth lessens your chance of a pph.

I'd be considering stuff like why did you bleed last time - was it a tear, was it an atonic uterus? Did you have other risk factors such as a long labour, syntocinon drip in labour, instrumental delivery, pusshing for a long time, etc? Which hopefully you'd avoid at a home birth.

VivaLeBeaver Wed 27-Feb-13 12:09:28

PsudoBadger - no thats still a pph. You do lose more blood at a section than a vaginal birth but its still a pph. Some hospitals won't classify under 1000mls as a pph if a section for their stats but 1000mls and over then definetly. And to be honest whether its classified by the hospital as a pph or not it still is and still needs treating as one. The majority of sections will lose around to a bit over the 500mls mark.

PseudoBadger Wed 27-Feb-13 12:12:48

Thanks, reading the thread I had plenty of contributing factors (long labour, drip induction, pushed for over 2 hours). They didn't actually tell me how much blood was lost until they noticed I was about to keel over 36 hours later....

VivaLeBeaver Wed 27-Feb-13 12:16:19

Having a section when fully dilated massively increases your risk of a pph.

PseudoBadger Wed 27-Feb-13 12:20:37

Wow, something else I didn't know! Mind you, he had to get out somehow so I wasn't going to say no grin

littone Wed 27-Feb-13 12:24:33

I had a secondary pph of 3litres with my first. Was due to have 2 cannualas ans 24 hours on syntocin after delivery of baby no 2. In the end I had one cannula in and no syntocin. No excessive bleeding and could have gone home same day, but I asked to stay for 24 hours. A mile journey in an ambulance whilst haemorrhaging feels very long and scary.

SchroSawMargeryDaw Wed 27-Feb-13 12:29:43

Viva What is your experiences of women who have had a PPH with many contributing factors (drip up full for around 10 hours, episiotomy, forceps) and then went on to have a homebirth? (I also have EDS which apparently increases my risks but I think the biggest risk is that they don't know how to handle my condition in hospital and more likely to end up having intervention).

I didn't even know how much blood I had lost until 3 days PP when the MW came to visit me at home and told me and said I was probably quite anemic and took my blood to see if I needed a transfusion so I doubt being in hospital would make much difference. sad I was told that 1000ml was a small PPH though?

BigSpork Wed 27-Feb-13 12:31:31

I've had four births and had bleeding issues with 3 of them, 2 with placenta problems. I had two home births after the first one (my first was a hospital birth with bleeding and placenta issues with the injection).

The only one without was my second which was a homebirth where I was able to be upright and nurse from moments after her birth until the placenta with no injection.

My worst was also a home birth with unsupportive midwives who refused to allow me to nurse (or see) my child until I had the injection and then yanked on the cord while I was in such intense pain and a chuck came off leading to very heavy bleeding, ambulance, and placenta removal under general (and transfusions). Cannulas were inserted without any problems at the hospital.

With my 4th I did go to hospital and they did put in cannulas due to my history- the first was put in by a student and it inflated my hand, the second ended up falling out somewhere during labour so after my birth they had to put one into my elbow. So I recommend waiting on those (though having it in my elbow made moving and holding my baby a lot easier that when it was in my hand for my third though `it meant I stayed in a dressing gown until it was removed as couldn't get anything on). Also, even though it wasn't their preferred option, they waited until after the placenta was delivered to give the injection and was allowed to nurse almost straight away. I was still in PPH territory and required uterus massage but I lost a lot less and the placenta was delivered a lot faster/smoother (it was also the first of my four that I saw and the midwives kept commenting on how big it was and that that was likely a cause of my bleeds/slow expulsion of them previously though with 4 it only took about 30 minutes).

TL;DR: You can homebirth with a history of PPH/placenta problems, and it's very possible not have any issues. Nursing, being upright and relaxed are known helpers for this and the injection can be helpful though having it after placenta delivery may be helpful for those with history of placenta problems. Cannulas can easily be done afterwards and for those who tend to actively move during labour it may be best to wait until then and if needed it easier to care for a baby with them in your elbow than hand though it makes it trickier to get dressed. Hope for an easy birth and placenta delivery for you!

OutsideOverThere Wed 27-Feb-13 12:34:23

I had a normal delivry with ds1, in hospital, epidural and so on. No bleed.

Ds2 was born at home, I had a very intense 3.5 hour labour from the first ctx, and I bled after he was born - probably around 5-600ml.

Apparently the midwives panickedwhen this was happening as we're about half an hour from the nearest proper hospital. but syntometrin sorted it out quickly and I didn't have to transfer.

I was worried this last time and mentioned it, but they said they didn't classify such a small bleed as PPH so my risk was deemed normal.

I had another hospital birth (for other reasons) this time and didn't bleed - possibly loss of around 1-200ml, I think the notes said. but I had synto I think just before/as he was being born as I'd requested it. I can't remember now.

HTH a bit.

marzipananimal Wed 27-Feb-13 12:40:04

Thanks Schro. What helped you make your decision to have a homebirth? Is your midwife positive about it or did she seem worried? Is there anything in your care plan that's different due to your PPH (eg managed 3rd stage rather than physiological)?

Viva (am I right in thinking you're a midwife?), it was due to atonic uterus apparently, although I also had a 2nd degree tear. I was on syntocinon drip and it was quite a long labour. Hopefully with a 2nd baby, hypnobirth at home labour is likely to be quicker and obviously no drip at home.

They evidently don't consider PPH so dangerous that they want everyone to give birth in hospital, even though rates are fairly high. The stats I found for subsequent babies were 6.9% if no previous PPH and 18% if there was a previous PPH.

SchroSawMargeryDaw Wed 27-Feb-13 12:49:12

Hey, my MW is entirely supportive and thinks that it is the best option for me, there are other risks with me and these also need to be planned as best possible. My joints dislocate and due to the weight of being on my back the entire labour last time and a MW who kept lying me with the wedge on my hips, I spent most of the time with my hips subluxing (partially dislocating), the only way to stop this is the pool to take the weight off my joints.

I also have poor healing and skin, all of my stitches tore out and no one took notice that this was a possibility, the only way to minimise this is to not be at hospital where the chances of intervention are higher.

I was also convinced to take an epidural when I hadn't wanted one, it didn't work due to me being insensitive to anasthetic (was in my notes), only way to avoid this is being somewhere where they are not available!

My MW is very supportive of it and agrees it would be the best route, I am only 19 weeks so haven't written a plan yet but making sure the MWs will be aware of my past birth will be important and that they are armed drugs to help with bleeding, I have already decided I would like a physiological third stage this time anyway and do not want anyone bloody pulling on the cord randomly unless it really needs to be out. smile

I hope everything goes well for you. x

NAR4 Wed 27-Feb-13 16:51:49

I had a pph after my 4th baby and nothing was mentioned until I went into hospital in labour with my 5th, where they sais yjey wanted to put a cannula in just in case. I went from 2cm dilated to pushing, in about 15 minutes, so they were caught off guard and hadn't put the cannula in in time. No pph though, but placenta did take 30 minutes after injection and lots of pursusion, to come out.

VivaLeBeaver Wed 27-Feb-13 21:48:05

Viva What is your experiences of women who have had a PPH with many contributing factors (drip up full for around 10 hours, episiotomy, forceps) and then went on to have a homebirth? (I also have EDS which apparently increases my risks but I think the biggest risk is that they don't know how to handle my condition in hospital and more likely to end up having intervention).


I don't know to be honest. I don't have anything to do with home birth women unless they get transferred into labour ward. We don't have many home births but the ones we do have a very low pph rate. Whether thats becuase they're all low risk women I don't know. It may be that the women with previous pph, drip, forceps, etc don't go on to have home births...or maybe some do but have no problem so I don't see them as they don't come back into hospital.

CitizenOscar Wed 27-Feb-13 21:53:57

I had large PPH with DC1 and have been given similar advice to you now I'm pregnant with DC2.

I think it is good advice for me. I fainted after delivering the placenta last time (otherwise straightforward but long labour, G&A only) and ended up having procedure under general anaesthetic and a blood transfusion. Was also v scary for DH, who thought he was going to lose me & have to bring up DS alone.

We're fairly close to hospital too but I have to say I wouldn't want to be further than a few metres away, given my experience last time, for my sake and DH's!

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